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State running short on primary care docs

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The Hudson Valley region was one of only two areas in New York that gained more physicians than it lost in 2011, though hospitals here reported a collective shortage of more than 140 primary care doctors in 2012.

Those were among the recent findings of the 2012 physician advocacy survey of the Healthcare Association of New York State (HANYS), a Rensselaer-based health care advocacy group and data provider representing more than 250 hospitals and health systems statewide. The report, “Doctor Shortage: Condition Critical,” drew on survey responses from 110 hospitals, which represent 73 percent of hospitals in the state outside New York City.

Participating in the survey were members of the Northern Metropolitan Hospital Association (Normet), which includes 29 hospitals in Westchester, Rockland, Putnam, Dutchess, Orange, Ulster and Sullivan counties.

HANYS found that more than 1,200 physicians were needed by hospitals across the state last year, a 64 percent increase from 2011. Primary care doctors accounted for a greater percentage of the shortage, as demand for primary services increases in a reformed system of health care delivery and payment driven by the federal Affordable Care Act and in New York by a redesign of the Medicaid system.

A total of 374 primary care physicians were needed by hospitals in 2012, representing 31 percent of the total physician need statewide. In 2011, primary care physicians accounted for 18 percent of that unmet need.

Normet hospitals reported a shortage of 143 primary care doctors, far exceeding unmet physician numbers in all other regions of the state. Long Island hospitals, which had the second highest unmet need, looked to recruit 62 primary care doctors last year.

Yet only Normet and its partner in suburban hospital advocacy, Long Island’s Nassau-Suffolk Hospital Council, recruited more physicians in 2011 than they lost to retirement or doctors’ relocations from the metropolitan area. Hudson Valley hospitals reported a net recruitment gain of 98 physicians, while Long Island medical staffs gained 25 doctors.

Statewide, hospitals reported adding 2,399 physicians to their medical staffs in 2011. But those additions were offset by the departures of 2,283 doctors for employment elsewhere and the retirement of 246 physicians, leaving the state with a net loss of 130 physicians in 2011.

The survey found an additional 281 doctors would retire by the end of 2012.

Among Hudson Valley hospitals surveyed, 88 percent cited a shortage of primary care doctors in the region, while 69 percent said physicians here are aging out of their practices.

HANYS officials pointed to a report last summer by the state Center for Health Workforce Studies in Albany that only 28 percent of doctors in the state provide primary care to their patients, compared with 32 percent nationally. The state’s primary-care shortage could worsen, as at least 15 percent of primary care physicians in New York are over 65. More than 3,000 primary care physicians likely will retire in the next few years, according to the report.

Reflecting a national trend in the changing health care landscape, 57 percent of the doctors that joined hospital medical staffs in 2011 were directly employed by the hospitals. That is a 20 percent jump from physician hiring by New York hospitals the previous year.

Hospital-employed doctors represented 24 percent of total physician employment in New York in 2011, up from 22 percent in 2010.

“With the need for integrated delivery systems, the uncertainty of the payment environment and the need to manage (patient) populations, hospitals are recognizing the necessity to directly employ more physicians,” the HANYS survey noted. “Direct employment also helps with physician retention.”

Yet the migration of doctors from solo or group practices to hospital employment has moved at a slower pace in Westchester and the Hudson Valley.

At Normet hospitals, 43 percent of doctors joining medical staffs in 2011 were directly employed by those hospitals, compared with 30 percent in 2010. Hospital-hired doctors accounted for 14 percent of physicians practicing in the region in 2011, up 2 percent from the previous year.

In contrast, Long Island hospitals directly hired 79 percent of the physicians added to their medical staffs in 2011. Hospital-employed doctors represented 23 percent of physicians practicing in Nassau and Suffolk counties in 2011, a 4 percent increase from 2010.

As thousands of New Yorkers are expected to gain health insurance coverage in 2014, “Our hospitals and health care systems already indicate a dramatic need for primary care physicians throughout the state,” HANYS President Daniel Sisto said in a statement accompanying the survey. “New York state must have a comprehensive strategy to address this shortage and ensure all New Yorkers have access to care.”

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