There aren’t enough doctors to go around. It has been that way for at least the past 50 years. And there are concerns the problem could get worse in the future.
“We have the lowest per capita supply of physicians in the country,” said Dr. Eric Lindstrom, an ophthalmologist from Laurel who is president of Mississippi State Medical Association (MSMA). “We have two physicians per thousand people compared to three per thousand in most other areas of the country. We have a big problem with where the physicians are located, too. That has been a real concern. About half of the state’s physicians are located in the four urban areas. Only about 12% live and practice in Delta. That is where the shortage is the most acute.”
The Delta and other rural areas of the state have the lowest penetration of doctors. And they have some of the greatest needs. Those needs are especially acute for primary care specialists.
“Family medicine, OB-GYN, pediatric and internal medicine are the most needed,” Lindstrom said. “Those are the specialties that are in the shortest supply. We just don’t have enough of those people to deal with the problems.”
Along with the rest of the country, Mississippi has an aging workforce. That is true in medical fields, as well as all others. Mississippi isn’t attracting as many young doctors to replace those who are retiring. Lindstrom said while the average in the rest of the country is that 18% of physicians are under age 35, in Mississippi only 5% are under age 35.
“The majority of people who practice in rural areas of Mississippi are over 45 years of age, and are more likely to retire in the next few years,” Lindstrom said. “And we are not replacing them with young people.”
One thing that is being done to address the problem is increasing the class size at the School of Medicine at the University of Mississippi Medical Center. The school increased its incoming class size from 100 to 105 in 2005, and to 110 in 2006. Of course, physicians trained here can go anywhere they want after graduating. But Lindstrom said there is hope that more of them will choose to stay in the state.
“We are retaining about 60% of physicians who finish medical school here,” he said. “If they do a residency in the state, it is more like a 75% to 80% chance they will stay in Mississippi.”
Another issue that is expected to have a big impact is tort reform, which was passed by the Mississippi Legislature two years ago. Lindstrom said that tort reform has had a dramatic impact on recruiting new physicians.
“We have a lot better outcomes now,” Lindstrom said. “We don’t have the huge threat of jackpot justice we were dealing with for a while. Doctors from other states are now looking at coming to practice in Mississippi. For awhile, nearly every graduate was leaving the state because of the fear of being sued. We need to have a better practice environment so people are more likely to stay in the state. It is improving.We are doing better. And over the next few years, we will be a lot better.”
However, proposed cuts in Medicare in a state where such a large percent of the population is on Medicare could also have a sobering impact on physician recruitment.
Lindstrom said the 5% cut in Medicare funding proposed this year would reduce the amount of Medicare coming into the state by $29 million. If the cuts proposed for the decade ahead continue as planned, that would result in a 40% decrease in Medicare funding for Mississippi, costing the state about $2 billion in revenue.
“That is money that would be used in the medical care system that will not be there,” Lindstrom said. “We are a population with a larger percent of Medicare patients. Doctors who get a big cut like this will be in a position that they can’t take more Medicare patients. Doctors can’t afford to buy watermelons for a dollar and sell them for 50¢. And that is what we are looking at.”
Lindstrom said when it costs physicians more to provide service than what they are paid, it is as downhill spiral: If Medicare is cut, Medicaid also changes. If Medicare and Medicaid are cut, commercial insurance pays less.
“It is all tied together,” Lindstrom said. “When you get in that situation, there is a real problem. Doctors get caught in a squeeze. The only reason the system is still working is doctors are reasonably altruistic. They have been willing to suck it up at this point. But at some point, I don’t know that we will.”
Gov. Haley Barbour did a statewide tour recently to discuss the benefits of tort reform enacted two years ago. He stopped at several medical facilities where he heard about how tort reform had impacted recruitment of physicians to the state.
Pete Smith, spokesman for Gov. Barbour, said what they heard was that because of tort reform, it is not only easier to recruit doctors to Mississippi. But it is also making it easier to attract some of the best doctors in the country.
During the period of greatest medical liability crisis in Mississippi, younger physicians left the state to relocate to areas where the legal climate was more conducive to practice, especially in OB/GYN, neurosurgery and other surgical specialties, said Dr. Helen R. Turner, associate vice chancellor for academic affairs, senior associate dean in the School of Medicine, and a professor of medicine at the University of Mississippi Medical Center.
“Other physicians just out of training chose to begin their practice outside of Mississippi,” she said. “With the passage of tort reform in Mississippi in 2002 and 2004, there has been a stabilization of liability insurance premiums and a decrease in premiums for physicians insured by the Medical Assurance Co. of Mississippi.”
Turner said with all great challenges come great opportunities.
“Physicians working together can make a difference,” she said. “Physicians working together through organized medicine can tackle medical liability problems, can tackle reimbursement problems, and can tackle problems of the uninsured and the outmoded healthcare system. Dr. Tom Price, physician and congressman from Georgia described it as follows: ‘The only thing holding our healthcare system together is the altruism of our physicians.’ I strongly believe that altruism is alive and well among our physicians, but we need to translate this altruism into action, because too much is at stake to let others decide the fate of our patients and our profession.”
Contact MBJ contributing writer Becky Gillette at firstname.lastname@example.org.