Addressing Arizona's doctor shortage

Diagnosis confirmed! I'm sure that's what Arizona physicians felt when they read about the Arizona State/University of Arizona physician workforce study recently released. Finally, research provides proof that our state has a shortage of physicians--something those of us in the medical field have painfully known for some time.

While this study verifies that there aren't enough doctors to care for our citizens, compared to the rest of the country, it does not reveal what this shortage means or why it exists.

Increasingly, people are having more difficulty finding primary care doctors, and primary care doctors have more difficulty finding specialists to refer them to--with patients waiting months to see a doctor, especially neurologists, neurosurgeons, hand surgeons, endocrinologists and other specialists--often the doctors who care for our sickest citizens.

Emergency physicians often face the greatest challenge finding specialists and frequently have to transport patients to other hospitals, or even out of the state, for critical specialist care.

In rural areas, the shortage is even worse. Certain types of medical services and some specialists simply aren't there. This is a problem not only for our rural communities but our urban communities as well, as they become the referral centers for patients when care isn't available in their own hometowns. This influx of patients further stretches the resources of urban health care providers.

Because of this shortage, these types of access to care problems will continue, and worsen. As the study points out, even with the planned opening of new medical schools, we will not be able to train physicians soon enough to fill the need for medical specialists.

Right now, 90 percent of our physicians have come here from other states. This recruitment needs to accelerate in order for us to meet the health care needs of our growing population. But, obviously, since we have a shortage, this is not happening.

Why, in a state with many good qualities, do we find ourselves in this dangerous situation? The reasons are complex but they add up to an unfriendly environment for physicians.

In recent years, all physicians, regardless of whether or not they've ever been sued, have seen their medical liability insurance premiums rise at an alarming rate. At the same time, physicians' incomes have dropped. Federal mandates such as the Emergency Medical Treatment and Labor Act, and the Health Insurance Portability and Accountability Act, along with other expenses associated with running a medical practice, have dramatically increased the cost of providing care.

This staggering weight of rising expenses and falling income is discouraging physicians from staying in, or moving to, Arizona and is compelling many physicians to retire early, curtail services to cut costs and risk and, for some, seek more practice-friendly environments in other states.

What can we do to encourage physicians to come here and stay? According to a study published in the Journal of the American Medical Association, states that have passed medical liability reform have seen a 3.3 percent increase in their physician population in a short period of time, with a large number of the high-risk specialists returning to practice medicine.

So is this the answer? It may be part of the solution, but Arizona faces many other challenges that seem to be driving doctors out of medicine, or discouraging them from coming here at all.

Will care be there when you or your family needs it? This physician workforce study suggests it may not.

(Dr. Ditmanson, a Tucson internist, is president of the Arizona Medical Association.)


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