It’s a grim diagnosis: As many as 200,000 more physicians will be needed in the next decade than medical schools will turn out, leading to a nationwide physician shortage just when millions of baby boomers are entering their later years.
The anticipated shortfall is already creating stiff competition among health care providers across the country to recruit doctors.
“What this means is — physicians will probably have 200 bona fide job offers anywhere they want to go. And the specialists, because there are so few doctors, they’ve got their choice of anywhere in the country,” said Allan Fain, director of medical staff development for Wellmont Health System.
Fain is responsible for physician recruitment and physician retention in Wellmont’s 14-hospital system. He said Wellmont recruited 54 doctors last year — it’s best year for recruitment to date.
This year, it’s looking for all kinds of physicians, particularly specialists.
“As the population ages, we’re going to need a lot more specialists — cardiologists, gastroenterologists, oncologists,” Fain said. “And the competition is heating up.”
Growing health care
Dr. Jerry Miller is always on the lookout for new doctors. The founder and president of Holston Medical Group has grown the practice from a handful of family physicians in 1977 to a multi-specialty group of more than 100 physicians, specialists and other mid-level providers today.
HMG operates 27 locations and it’s nearing completion on a massive five-story medical complex on Stone Drive. The group is accepting nearly 1,500 new patients every month, and it’s added 12 doctors this year to help treat its growing patient base.
But HMG is still 32 physicians short, Miller said.
“And that doesn’t count nurse practitioners that we’re looking for,” Miller said.
He attributed the growth in part to the number of people moving into this area from other parts of the country. Many of those folks are retiring here and need health care services. Plus, Miller said, the region statistically is home to some of the sickest people, and many residents suffer chronic illnesses, which adds to the need for medical professionals.
“That compels us to continually seek physicians, providers, nurse practitioners — you name it,” Miller said.
“My goal is — why send anybody to Vanderbilt? Let’s have all those services here in Kingsport,” he said.
Why so few doctors?
Tim Attebery, chief executive officer of Cardiovascular Associates in Kingsport, said the impending physician shortage can be traced to the mid-1990s. Back then the federal government, which partially subsidizes graduate medical education, encouraged new medical students to enter the primary care field, believing that too many specialists would inflate the cost of health care.
“So the government funding was dialed down for sub-specialties and dialed up for primary care,” Attebery said. “As a result, we have a pretty good number of primary care physicians throughout the United States, but there’s a growing shortage of sub-specialty physicians.”
The numbers are telling. For instance, nearly 1,200 cardiologists completed their training and were ready to begin practicing in 1994. By 2008, that number had fallen to fewer than 800, Attebery said.
Meanwhile, one-third of the cardiologists in this country are over age 55 and are expected to retire in the next 10 years — at the same time when baby boomers are entering their 60s and 70s, Attebery said.
“So at a time when we need more cardiology capacity, we have less,” he said. “There is an absolute shortage. Cardiology is in a shortage status right now, and that shortage is going to get worse.
“So we have to show that Cardiovascular Associates in Kingsport is better than the 15 other places they may be looking at. Otherwise, we will lose those new recruits to other communities. So it’s critical. The future of cardiovascular services for this region depends on our ability to recruit and retain high-quality physicians,” Attebery said.
Cardiovascular Associates currently has four heart surgeons and 26 cardiologists who practice in Kingsport, Bristol, Abingdon and Norton. Attebery said he expects Cardiovascular Associates to recruit another 12 to 15 heart physicians in the next five years.
“Some of that will be replacement for physicians who are slowing down or retiring. Some will be new physicians coming to town to expand our services and develop new market areas,” said Attebery.
The physician shortage is creating a new trend in health care in which “physician extenders” — such as physician assistants and nurse practitioners, will soon be handling more primary care duties than in the past, Fain said.
“You’re going to see them at the forefront of primary care. You’ll see one physician who is probably going to be supervising two or three nurse practitioners or physician assistants. That’s something we have paid a lot of attention to in the last two months,” Fain said.
Dr. Stephen Combs, Wellmont senior vice president for medical affairs and president and CEO of Wellmont Physician Services, said some nurses are returning to school to become nurse practitioners to help handle the load. He said there’s also a doctor nurse practitioner program, which will train people to treat patients in the primary care setting.
“I think it really comes down to the need — there really are not enough physicians,” Combs said.
Physicians aren’t the only medical professionals in short supply. Nurses too are being recruited to help handle patient loads.
The Department of Health and Human Services estimates that by 2020, the nation will need to add 2.8 million new nurses — 1 million more than the projected supply.
Health care providers are already competing for nurses, offering various incentives to recruit and retain them. Hiring bonuses are common, and some providers also work with area colleges and universities to educate the next generation of nurses.
For instance, Wellmont began a partnership with King College several years ago to establish nursing courses on-site at Holston Valley. Since then, Wellmont has partnered with Northeast State Technical Community College on a two-year nursing program. Today, Wellmont offers full scholarships to Northeast State’s nursing program, paying 100 percent of tuition, books and fees, as well as $1,000 for expenses each semester.
In addition, Wellmont works to recruit nurses through national electronic job boards, in nursing journals and in newspapers, said Hamlin Wilson, senior vice president of human resources for the health system.
Wellmont nurse recruiter Karen Kane said the health system also offers referral bonuses in which any employee who refers a registered nurse who has more than a year’s experience to Wellmont will get a four-day cruise for two on the Carnival Cruise Line, plus $500 in spending money.
As for retention, Wellmont features a clinical achievement program to help keep nurses. The program financially rewards nurses for achieving additional education, additional responsibilities and leadership within the hospital, and for becoming involved in the community.
And Wellmont ensures its nurses have a voice in patient care through a shared governance model, which helps show appreciation for nurses and encourages them to stay.
“It’s all about retention — holding onto the high-quality nurses. And we work very hard to do that,” Wilson said.
Back at Holston Medical Group, Miller said it all boils down to one thing: “I have no trouble selling the region. It’s a beautiful place to live. But there’s just a shortage of medical personnel. And it’s a constant burden to recruit.”