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Healthcare 2008

A simple equation is creating complex problems for Florida’s healthcare industry: A shortage in medical residency programs is translating into declining access to care.

The state’s physician population is aging. According to a Florida State University study released in November, 41% of Florida physicians are over 55.

Replacing them as they retire is problematic. Statistics indicate that new physicians tend to practice within 150 miles of where they get their residency training — the second phase of medical training after graduation from medical school. Florida, however, ranks 44th nationally in the number of graduate medical residency slots, meaning too few medical school grads finish their training in Florida and begin practicing here.

New medical schools in Orlando and Miami won’t generate enough graduates to meet the demand. Worse, those grads are likely to end up practicing out of state because of the shortage of residency programs in Florida, says Rich Rasmussen, vice president for strategic communication for the Florida Hospital Association. “We have a system now that will put them through medical school here and see their residency delivered in another state. As taxpayers, we have exported our investment to other states.”

Dr. Karl M. Altenburger
“It’s a huge problem. We don’t have adequate graduate medical education
(residency) programs in Florida.”
— Dr. Karl M. Altenburger, president, Florida Medical Association

[Photo: Kelly LaDuke]

Meanwhile, access to care is becoming a bigger problem throughout Florida, says Dr. Karl M. Altenburger, president of the Florida Medical Association. “The access to care problem has been present for a while in selected areas of the state in selected specialties. That access over the last several years has expanded to include most of the state and most specialties.”

Rasmussen says U.S. Sen. Bill Nelson has introduced legislation to redistribute federal funds for residency programs in states below the average, but the bill has stalled because other states believe it will hurt their medical programs. “Even if the bill passes tomorrow,” Altenburger says, “we’re talking about a five- to 10-year pipeline. The longer you delay, the worse the problem.”

The Trends
Continuing problem with uninsured patients (estimated at one in four patients under 65 in Florida)
Rising emergency room visits — up to 7.3 million in 2005
Increased interest among many hospitals in telemedicine. Creating communication links with physicians through teleconferences would
allow patients to consult a physician while holding down costs
Effort to get state legislators to allow automatic enrollment in an employer’s health plan
Continuing shortage of nurses
Attracting established doctors to Florida is also problematic — due to low Medicaid reimbursements in Florida, a large uninsured population and strong competition from other states. In Florida, the average Medicaid reimbursement rate is 56%, compared to 95% in North Carolina, 92% in South Carolina and 90% in Mississippi.

“There’s competition around the country for doctors,” Altenburger says. “In Florida, doctors are losing money to see these patients, so the question becomes ‘why come to Florida?’ ”

Another issue is Florida’s three strikes malpractice law, the only such law in the country. Altenburger says although the law has never been applied, other states use it when recruiting physicians. “On average, neurosurgeons are sued every other year. Why take a chance? Two strikes, and I’m gone. You can’t afford to lose your license.”

Lynne Takacs, director of communications and press relations for the FMA, says there’s a bill currently in the works to give sovereign immunity to physicians working in emergency rooms.

“We have to make Florida a friendly environment for physicians,” Takacs says.

10 Most Common Reasons
for Hospital Admission
Reason
Cases
Giving birth
221,490
Psychoses
90,649
Gastrointestinal & digestive disorders
73,559
Heart failure
69,161
Chest pain
61,359
Cardiac catheterization
52,733
Pneumonia
52,323
Hip & knee replacement
50,210
Chronic obstructive pulmonary disease
49,340
Total
758,323
Top 10 as a percent of total discharges
33.2%
Source: Florida Hospital Association, 2006

Going Green
Hospitals are increasing their efforts at conserving resources, says Rich Rasmussen, vice president for strategic communication for the Florida Hospital Association.

“We’ve had in-depth discussions, and we’re looking at recycling programs that are much more aggressive in dealing with biohazardous waste,” Rasmussen says. “We’re also looking at fuel cell technology for hospitals.” The FMA is also working with doctors in rural areas to implement electronic medical records. Some doctors in larger cities already use EMR, but physicians in smaller communities are more likely to use paper records. “We think it will save considerable resources,” says Lynne Takacs, director of communications and press relations for the FMA.