A hiccup in the foretold medical pro shortage

With even health care jobs not immune to the scalpel in the Great Recession, there was perhaps one unforeseen benefit ”“ with their retirement savings ailing, many experienced doctors and nurses chose to stay on the job, helping Connecticut defer for a few more years the prospect of finding their replacements.

Connecticut has one of three oldest physician populations in the nation, according to Matt Katz, executive director of the Connecticut State Medical Society, who addressed the outlook for shortages of physicians last month for organizers of the SustiNet universal health insurance system being readied for Connecticut.

“We have many physicians, thanks to the market, who are still practicing and who wouldn”™t be practicing if the markets hadn”™t dramatically changed the way they did a year and a half ago,” Katz said.

Due primarily to high premiums for medical malpractice insurance, neurologists are proving the toughest group to recruit, with a CSMS survey showing they were not likely to recommend Connecticut has a good place to practice for peers looking for work.
General surgeons and obstetrics and gynecology doctors reported similar sentiments.

“This is important, because when physicians look to go somewhere to practice, they often ask their peers; (or) they ask those they went to medical school with or did residency training with,” Katz said. “These same specialties were most likely to reduce their exposure to high-risk patients, as well as the most likely to performing high-risk services.”

The problem is even more pronounced in that Katz said there has been a “dramatic” increase in doctors moving out of state the past few years, without specifying figures, some very far afield to states like Kansas.

The economy is having a similar impact on nurses”™ decisions to keep working past their planned retirement dates, according to Marcia Proto, executive director of the Connecticut League for Nursing.

One unforeseen consequence, Proto added, has been reduced opportunities that would otherwise be available for graduates from the state”™s nursing schools.

Not that there has been a bevy of young nurses to begin with. Connecticut ranks next to last nationally in producing nurses, at a rate of 19 per 100,000 residents versus a national average of 31. For the most recent entrance year on record, the state denied 1,200 qualified applicants for lack of educational resources, and nearly one in every four nurse faculty members is planning to retire within the next five years.

“We are very fortunate for nursing that the economy did tank, because many of the nurses that were planning to retire did not,” Proto said. “There were some federal studies done in (2005 and 2006) that forecast by 2020 Connecticut was going to have a 20,000-nurse shortage. I think due to this delay and some creative staffing ”¦ we”™ve been able to mitigate the initial impact; but once these nurses start to retire, we have no pipeline to replenish the bedside nurses as well as the other nurses.”

Proto and others agree that the main problem is that with such an acute shortage, nurses can command far higher salaries in practicing nursing than they can teaching it, discouraging some that otherwise might take academic jobs. Fewer professors equals fewer students.

“The compensation is one-third to one-half less what they could make in the job market today, so you have to look and say, ”˜Why would someone want to be a faculty (instructor)?”™” Proto said.

The state has attempted to address the shortage by increasing funding for nurse faculty.

Both CSMS and the Community Health Care Association of Connecticut are also trying to improve mentor programs for graduates taking residency here, in hopes of improving the odds they will stay in Connecticut for the long term.

With funding from the American Recovery and Reinvestment Act, CHCAC has begun offering six-week internships at several community health centers, including in Bridgeport, Stamford and Danbury. According to Executive Director Scott Selig, the association is getting calls from students in other parts of the U.S. interested in coming here for an internship.

“We are very lucky that the federal government identifies community health centers as a great resource for health care disparities, and so we”™ve gotten great funds to build that infrastructure,” Selig said. “But the real issue is how do we staff those medical and dental suites as we are building those facilities ”¦ There are currently students and residents that are working in community health care settings, but we want to make sure that that experience is a great experience, and is going to encourage them to work in this setting after school.”

Both Selig and Katz emphasized the focus must be on creating incentives among local medical profession graduates to stay put.

“We have not done a good job with our academic institutions here, keeping those academic students in residence in Connecticut,” Katz said. “Though UConn has a greater percentage of their graduates ”¦ staying in Connecticut, Yale has very few, and we don”™t get many young physicians to come to Connecticut anymore.”

The X-factor going forward may be the medical school proposed by Quinnipiac University.

“We understand it is going to be looking primarily at primary care, which of course is needed throughout the country, but we would hope it would focus more on what are Connecticut-based care needs,” Katz said. “Many of Connecticut-based care needs are not just that we need primary care physicians or specialists, but we need them in certain locations for certain populations. If Quinnipiac is looking at answers to those questions about geography and demographics (not) simply someone who is going to simply be a pediatrician or an internist, we are excited.”