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Study concludes that physicians in state face many challenges

STARKVILLE – The Physician Labor Force Study conducted by the Health Policy Research Center at Mississippi State University (MSU) Social Science Research Center concludes that both political and population-level forces are negatively impacting the physician workforce in Mississippi, producing an unfavorable climate for physician recruitment and retention.

“Consequently, many of Mississippi`s doctors are leaving or choosing to retire early,” said the report`s author, Dr. Lynne Cossman, a research fellow at the Social Science Research Center and an assistant professor of sociology at MSU. “Without action, Mississippi`s already overburdened physician labor force may experience further shortages in number, diversity and level of expertise. Consequently, Mississippi residents may suffer from a lack of access to quality health care.”

The labor study concludes that access to care for some Mississippians is currently at a crisis level with an estimated 51 of 82 Mississippi counties underserved by physicians.

Cossman said the current Mississippi medical environment poses many challenges for physicians:

• Mississippi has high rates of Medicaid enrollees and declining reimbursement rates for Medicaid and private insurance.

• Many state residents don`t have health insurance.

• Medical malpractice lawsuits have increased insurance premiums for physicians in the state.

• The Mississippi resident population is largely rural, with fewer doctors choosing to locate in rural areas because of less-developed economies, a sense of isolation and a lack of medical infrastructure.

• The Mississippi resident population is chronically ill – ranking high in rates of obesity, cardiovascular disease and infant mortality.

Cossman`s study reaches different conclusions than a General Accounting Office (GAO) report released this past November that reported the number of doctors has increased in Mississippi over the past 10 years. That study reported a 16.5% increase in physicians in Jackson between 1991 to 2001 and a 30% increase of physicians in rural areas of the state – even though the number of doctors serving rural areas was still less than the national average.

The issue of the impact of the state`s legal climate on recruitment and retention of physicians has been hotly debated with physician groups such as the Mississippi State Medical Association (MSMA) alleging that doctors are fleeing the state because of the state`s malpractice climate, while the Mississippi Trial Lawyers Association has pointed at the GAO report as evidence that doctors aren`t leaving the state because of “lawsuit abuse.”

Cossman said her study was more in depth and accurate than the GAO report, and shows that the legal climate is a factor regarding the physician manpower available in the state.

The GAO report used American Medical Association (AMA) master files on the numbers of physicians in the state. Cossman said she started with that, but also looked at databases provided by the MSMA, Mississippi State Board of Medical Licensure and the Mississippi Academy of Family Physicians. Follow up interviews were conducted with 616 physicians.

“I removed a lot of people from the files who no longer practice in Mississippi but were included in the AMA files,” Cossman said. “So I think my estimate is far more accurate. We did ask doctors if the malpractice climate made them think about retiring early or going out of state. We did get a lot of doctors agreeing with that statement.”

Bill Roberts, executive director of the MSMA, said the ratio of physicians available per 100,000 patients in Mississippi is still much less than the national average. Nationally, there are on average three doctors to every 1,000 residents compared to two doctors for every 1,000 residents in Mississippi.

“That is really bad,” Roberts said. “The legal climate is only one of many things cited as problems in the report. It says we need to recruit and train more minority physicians, which we absolutely agree with. It is an excellent study. It proves what we have said, that we have a finite supply of physicians available in years to come unless we do something. One of the things identified is the need to change the current legal environment that is causing a lot of physicians to retire early or leave the state.”

Roberts said Cossman`s report reinforces something the medical community has known for a long time, that there is a dire shortage of physicians in the Mississippi Delta. The rural nature and severity of illnesses in parts of the Delta are disincentives for physicians to decide to practice there. Because of the physician shortages, doctors who do practice there can be overworked.

“A lot of factors go into the decision process when a physician decides to locate, including social amenities, the educational system and the availability of other physicians to cover for them when they are gone so they can have vacation occasionally,” Roberts said. “The shortage we have now in the Delta compounds some of those problems. But the Delta is not the only area of the state with the problem. The entire state has a similar, if not as severe, problem – with the possible exception of Hinds County.”

Cossman said 56% of all Mississippi physicians are located in four urban areas. Only 12% of the state`s doctors are located in the Mississippi Delta.

Another problem is the gender and racial makeup of physicians doesn`t match the state`s population. Mississippi has a much higher percentage of caucasian doctors than the nation as a whole – 90% compared to the national average of 75% to 80% – while the state has the highest percentage of African-American residents in the country, 36.3%.

“Therefore, the racial composition of the Mississippi physician population is not reflective of the racial composition of the patient population,” Cossman said. “This is a concern because patients report that they are most comfortable with a physician of their own race.”

There are some programs to encourage African Americans to attend medical school in Mississippi. But Cossman believes that minorities from Mississippi who are going to medical schools are leaving the state to practice because there are many opportunities elsewhere.

“Since they are under-represented nationwide, they have better career choices,” she said. “A lack of diversity is also seen in the Mississippi physician workforce in respect to gender. While 25% of the nation`s physicians are female, one-half of that percentage – 12 to 13% – is female in Mississippi. I think part of what is going on here is that many female physicians are married to male physicians. To recruit female physicians, you have to recruit them as a couple much like what happens in academia. So unless there are going to be positions for two of them, that is going to limit their options.”

Cossman predicts Mississippi will continue to face physician shortages if current trends continue.

“With the aging and subsequent retirement of the existing physician population, in conjunction with no legislative action to encourage the recruitment and retention of new and younger physicians to practice in the state, the current physician shortages will be exacerbated,” Cossman said. “Continued efforts to improve the medical malpractice climate and the resulting medical malpractice premiums need to be examined. Improving the medical malpractice climate may have the additional benefit of improving the effectiveness of recruitment and retention efforts.

“Given the racial make-up of the state`s population, recruitment efforts should be targeted toward minorities for medical school entrance as well as for physicians moving to the state. The ultimate goal of these efforts is to increase the presence of African-Americans in the Mississippi physician workforce.”

Retention could cause a bad situation to become worse. Of the physicians surveyed, 70% of doctors aged 35-44 said they have considered relocating, and 32% of the physicians under age 35 intend to relocate. Of doctors aged 55-64, about 70% have considered retiring early.

“G
iv
en low levels of intended recruitment as well as high levels of intended relocation and possible early retirement, Mississippi`s current physician shortages may be headed for worsening, and perhaps devastating, impacts,” Cossman said. “The physician labor force in Mississippi is experiencing some difficulties. However, with the implementation of the proposed policy changes, it is possible that Mississippi can thwart a physician workforce shortage. Without the changes, as more physicians relocate, retire early or otherwise opt out of practicing in the state, the extant physician shortage will become more severe.”

Contact MBJ contributing writer Becky Gillette at bgillette@bellsouth.net.

About Becky Gillette

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