New Jersey’s medical schools might consider giving away bridge fare with their diplomas, since increasing numbers of new doctors are leaving the state after finishing their residencies, according to a survey by the New Jersey Council of Teaching Hospitals.
The reason? Other states are offering incentives too good to resist, council President Dr. J. Richard Goldstein said.
“The primary driving force responsible for the dramatic decline in New Jersey is that other states are now stepping up their recruitment efforts to address their own shortages,” he said. “To put it simply, they offer richer loan-repayment programs, better Medicaid rates, caps on pain and suffering (insurance payments) and lower tax burdens.”
The survey found that 62 percent of doctors completing their residencies planned to find work outside the state.
Local hospitals are aware of the problem, which is expected to get worse as more doctors retire with nobody to fill their lab coats.
“Next year is the first year that baby boomers turn 65,” said Dr. Peter Jungblut, director of medical affairs at Shore Memorial Hospital in Somers Point.
Jungblut said many new doctors are leaving the state to practice specialty care, where New Jersey now has ample resources and stiff competition.
“Four out of five graduates are seeking specialties,” he said.
Primary-care physicians, however, are lacking in parts of New Jersey.
“One of the biggest deficits in Atlantic and Cape May counties is primary care,” said Kim Simers, Shore Memorial’s vice president of strategic planning and business development. “One of our biggest concerns is the ability for medical practices to do succession planning to recruit new physicians to their practices,” she said. “All health care is local, but we’re competing on a national level in terms of recruiting physicians.”
Brigantine resident Dr. Brendan Kelly is bucking the trend. Kelly, 33, plans to stay in Atlantic County to practice medicine after he completes his residency at the University of Medicine and Dentistry of New Jersey.
“I have deep roots here. I’ve known people 30 years. There’s a comfort level here that I like,” he said.
But lately, Kelly is the exception.
“Considering some of the factors that impact physician practice and how those issues are accentuated in New Jersey, it wasn’t a particular surprise to me that many are leaving,” said Dr. Thomas A. Cavalieri, dean of the School of Osteopathic Medicine at UMDNJ.
Cavalieri said malpractice insurance and property taxes are higher, while salaries for doctors are comparatively lower in New Jersey.
“It is more difficult for them to run a small business and be able to make an appropriate living,” Cavalieri said. “Today, medical school graduates have $175,000 in debt. When you consider the debt they have and the (business) climate in New Jersey, those factors are often influencing graduates to practice elsewhere.”
Goldstein predicts patients soon will notice this doctor drain with longer waits for appointments — unless the state takes steps to retain graduates.
“Failure to reverse the tide will result in a decline in the quality of life for New Jerseyans by reducing access to physicians and specialists,” he said.
A council report in January predicted a shortage of 1,000 primary-care physicians and 1,800 specialists in New Jersey by 2020, unless more incentives were offered to keep doctors from leaving the state. And the latest survey suggests those numbers are too conservative.
The brunt of this shortage will be felt locally in counties such as Cape May, Cumberland and Atlantic, Cavalieri said.
“This is for many reasons. It’s an aging population. As the population ages, their utilization of health care resources increases,” he said.
And too few recent graduates are filling the void of retiring physicians, he said.
“It is not as easy as it was to find a primary-care physician. I hear reports especially in Cape May County, which has a geriatric population over 65 well over 20 percent. The national average is 13 percent,” he said.
Terry Brown, director of graduate medical education at UMDNJ, said financial incentives are behind the exodus.
“Move there and make better money,” Brown said. “Reimbursement is better in the middle of the country than on the East Coast.”
Brigantine’s Kelly has seen the financial incentives offered to his colleagues.
“Could I make more money elsewhere? I’m certain of it,” he said. “Salaries far exceed what the average or median is around here, especially in Atlantic County. There’s no doubt you can make more elsewhere. That’s one of the reasons people are leaving. But salary is just part of the decision-making process.”
Kelly graduated from Holy Spirit High School. His wife, Liza, is also from Brigantine, where he still has family and now is raising his children, 7-year-old Kayla and 10-month-old Cameron. Kayla is in a Girl Scout troop. Kelly still follows sports at his high school alma mater.
“I’m in a unique situation. I have a desire to practice in the community where I live. I’ll withstand some of the burdens of practicing in New Jersey,” he said. “It might be more difficult, but it’s just another hurdle.”
But for too many graduates, these hurdles are steering doctors to places such as the Midwest.
Reverse the slide
The council suggested forgiving student loans and offering doctors tax exemptions to keep them in New Jersey.
Deborah Briggs, vice president at the New Jersey Council of Teaching Hospitals, said no one is tracking the rate of incoming doctors from out of state. Federal regulators plan to do that as part of the recently passed health care reform package, she said.
In the meantime, she is hoping Gov. Chris Christie will help make the state more appealing to doctors.
She points to Texas, a state that was losing doctors five years ago. The Lone Star State cut malpractice insurance and forced insurers to pay doctors promptly.
“In five years, they turned it around and now it’s one of the leading areas to practice,” Briggs said. “So state government can make a difference.”
Meanwhile, the state’s medical schools are trying to recruit more would-be doctors from high schools and colleges in southern New Jersey, where they will be more likely to return to practice.
Shore Memorial has a Medical Explorers program to give teenagers an idea about the career options they have.
“Any time you can spark early interest in a profession and give these kids hands-on experiences, it’s a good thing,” Simers said.
Rowan University and Cooper University Hospital are establishing a new medical school in Camden.
Meanwhile, the School of Osteopathic Medicine at UMDNJ is accepting more applicants than ever before — from 108 in 2008 to 135 last year and as many as 150 this coming year, Cavalieri said. New Jersey applicants get preferential consideration. As a result, 82 percent of the current class is homegrown.
And the university focuses its recruitment south of Trenton, Cavalieri said. The university recently formed a partnership with South Jersey Healthcare.
“It’s not all doom and gloom,” Cavalieri said. “We are trying to respond to the problem by creating an environment where our graduates are more likely to stay,” he said. “We are the medical school of South Jersey. We are committed to training physicians from southern New Jersey.”
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