Maryland Faces Growing Physician Shortage

Maryland is confronting a growing, statewide shortage of practicing primary care and subspecialty physicians, a trend that could lead to much longer waiting times in physician offices while increasing emergency room visits for minor afflictions and ailments, according to the executive summary of a recent study (10-page PDF; About PDFs) released by the Maryland Hospital Association and MedChi, The Maryland State Medical Society.

Maryland has about 25,000 licensed physicians, the second highest rate per capita of any state. But approximately 40 percent of those physicians do not provide direct patient care, working instead as teachers, researchers or administrators. As a result, the state has 178 clinical full-time physicians delivering care for every 100,000 residents, 16 percent below the national average of 212, says the study.

The study found physician shortages in primary care and several subspecialties, including emergency medicine, anesthesiology, hematology/oncology, thoracic and vascular surgery, psychiatry, and dermatology. Shortages are most acute in rural areas and are expected to become more pronounced statewide by 2015, as more physicians retire and the state's population ages, according to the study.

"Unless medical and political leaders find ways to reduce physician shortages, patient care will suffer," warns the report, which was presented to the Governor's Task Force on Physician Access and Reimbursement. "Some emergency departments may have to close or divert patients who could otherwise be treated locally."

Medical residency program directors, meanwhile, "indicate that the 52 percent of residents who now go on to practice in Maryland could fall to as low as 25 percent by 2015," the report says. "Not nearly enough clinical practitioners will be moving into Maryland to offset these factors."

Maryland has 3,274 primary care physicians in clinical practice, or about 57 primary care physicians per 100,000 residents, which translates into a shortage of primary care physicians on both the state and regional levels, according to the report. The southern region of the state has the fewest primary care clinicians -- about 44 physicians per 100,000 residents -- while the central region has the highest number, with about 61 clinicians per 100,000 residents.

"Because we have an aging patient and physician population, there will be an increased demand for services and a decreased number of practitioners to provide the services," said FP Joseph Zebley, M.D., of Baltimore, president of the Maryland AFP and a member of the 10-member task force that researched and wrote the report, in an interview with AAFP News Now.

In addition, Baltimore is a federally designated health resources shortage area where the shortage of primary care physicians has reached a "crisis" level, said Zebley. "In terms of patient care in Maryland, patients have sufficient difficulty finding a primary care doctor just about anywhere in the state."

The state's physician shortage is a result of several factors, including low payment rates and the state's medical malpractice laws. In the report, the task force members urge the state to "raise physician fees so Maryland is competitive nationally" and to "change the state's medical liability laws so Maryland is competitive with (other) states currently attracting physicians."

The state also should "develop programs that encourage more residents who are training in Maryland to remain in state as clinical practitioners," the report says. Other recommendations call for increasing the number of residency slots and starting a loan forgiveness program that draws physicians to regions in need.

The data presented in the report are not new -- Maryland has long suffered from a shortage of practicing physicians. But many policy-makers and state representatives mistakenly believe that the number of physicians in the state reflects the number of practicing physicians in the state, a perception that should now change, Zebley said.

"We are hoping this report will open the eyes of legislators," he added.

As a family physician, Zebley was the lone voice for primary care on the physician task force. "My interest as a family physician was to mention the role of the patient-centered medical home and family physicians as a way to alleviate the shortage crisis," he said.

He also pointed out to other members of the task force that strengthening the state's primary care infrastructure could reduce the need for more expensive subspecialist services.