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New Jersey among states suffering from PCP shortage

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According to the U.S. Department of Health and Human Services, by 2025 demand for physicians in New Jersey will jump to 75,000 while supply is projected at about 65,000.
According to the U.S. Department of Health and Human Services, by 2025 demand for physicians in New Jersey will jump to 75,000 while supply is projected at about 65,000. - ()

In less than a decade, New Jersey could face a critical shortage of primary care physicians, according to a federal report. Experts say the culprit is the high cost of medical schools coupled with lower pay for PCPs, but some institutions in the Garden State are trying to come up with solutions.

In 2013, there was enough demand for almost 66,000 PCPs in New Jersey, although only about 60,000 were practicing, according to the report by the U.S. Department of Health and Human Services. The gap gets wider by 2025, when New Jersey demand jumps to nearly 75,000 physicians while supply is projected to nudge up to only about 65,000.

“There are local and national shortages of primary care physicians and it’s very important to address this,” according to Dr. Thomas A. Cavalieri, dean of the Rowan University School of Osteopathic Medicine in Stratford. “More physicians are specializing and fewer are going into primary care, or family medicine. But the demand for PCPs is rising as the nation’s population ages.”

“New Jersey ranks third-highest in the nation for the percent of physicians over the age of 60, at 32.7 percent. Meanwhile, we rank 45th nationally in the percent of physicians under the age of 40, at just 13.3 percent.”

- Mary Ditri, New Jersey Hospital Association

It’s sort of a double whammy, Cavalieri added, since the state has a higher percentage of elderly individuals. The 65-plus crowd made up about 15.8 percent of New Jersey’s population, a shade more than the 14.5 percent national average, according to U.S. Census Bureau numbers.

“But the elderly account for around 20 percent of the population in Cape May, Ocean and other coastal New Jersey areas,” cautioned Cavalieri. Taking on more elderly patients can also stress out physicians, who often have to spend a lot more time with older patients.

“In geriatrics, my field, you may have an 80-year-old with multiple issues who may be on multiple medications,” he said. “Add to that possible memory issues and the fact that they may not be as mobile, so simply getting him or her across the room and onto the examination unit can take a lot more time. The extra time you give them is critical to their proper care, but you’re not reimbursed accordingly.”

Rx for the physician shortage

In 2015, the New Jersey Hospital Association set up a committee — which included representatives from medical schools and teaching hospitals — to study the state’s physician shortage. Some of the recommendations from the committee’s report:

Retool the state’s Primary Care Practitioner Loan Redemption Program, which currently offers student loan repayment assistance of up to $120,000 to physicians who work at an NJLRP-approved site for a minimum of two years to a maximum of four years.

“NJHA has supported legislative initiatives to expand the program to additional underserved areas,” according to a report issued by the association. “In addition, NJHA has supported legislation to ensure at least a portion of the current loan redemption program funding is directed toward needed primary care physician practitioners.”

Reform the state’s Conrad 30 program, which allows foreign medical graduates with J-1 visas in residency training programs in the U.S. to remain here for two years after completing their residency.

“The burdensome application process steeped in legalese is a frequent deterrent for hospitals interested in supporting program applicants,” according to the NJHA. Additionally, the Conrad 30 program “places additional restrictions – above and beyond the federal statutory requirements – on program participants. Finally, the state underutilizes federal designations available to broaden the service areas interested applicants can serve.”

Give new physicians a tax break.

“Practicing medicine in New Jersey can be more expensive than other states,” notes the NJHA. Many who leave the state cite “economic factors as a reason for establishing their practice in another state. NJHA supports legislative efforts to encourage more physicians to remain in state to practice, and a tax deduction/credit for these physician practices would help achieve this goal.”

In fact, pediatric physicians are near the bottom of the pay scale, at about $212,000 a year, while family medicine physicians don’t do much better, according to a recent Beckers Hospital Review report. At the upper end are specialists like plastic surgeons ($501,000) and those in orthopedics ($407,000).

Even the low-end pay isn’t exactly chump change, but the physical and financial costs of training are high: typically four years of undergraduate college, followed by another four years of medical school, and then up to seven years of residency. “Plus you typically come out with at least $200,000 of student debt,” Cavalieri added. “It’s like a mortgage except you don’t have a house.”

It could be a long-term problem, he added, since the pipeline of physicians is too shallow. “We’re not training enough. New Jersey has four state-sponsored medical schools — two at Rowan and two at Rutgers [New Jersey Medical School and Robert Wood Johnson Medical School]."

Hackensack Meridian Health and Seton Hall University recently partnered to open a school of medicine at the former Hoffman LaRoche campus in Nutley and Clifton, which has been described as "New Jersey's first private medical school in decades." As of July 1, Hackensack Meridian Health took on the full financial responsibility of operating the medical school.

The Rowan School of Osteopathic Medicine just admitted about 200 students, about double the size of a decade ago, he said. Separately, Cooper Medical School at Rowan University currently has 336 students. “The school will gradually increase total enrollment to a maximum of 416 students,” according to a Cooper spokesperson.

It’s not just the numbers, Cavalieri added. “We also have to recruit more African-Americans and Latinos who can reach underserved communities in the state. And we have to get more New Jersey residents interested in the medical field; we’re meeting with high school students in an attempt to do that. 

“Also, many people from New Jersey go to other states for their education or for a job after they graduate, and they represent lost opportunities for the state. A solution will involve better coordination and assistance from higher educational institutions, hospitals and the state government. It won’t be easy, but it can be done.”

In fact, policy solutions can include both state and federal action, according to Mary Ditri, director of professional practice at the New Jersey Hospital Association. “On the federal side, one of the bills we support is H.R. 2267, which would expand the number of residency slots by 3,000 slots nationally from 2019 through 2023. With added residency slots, we hope to train more medical residents in New Jersey hospitals and show them that the Garden State is a great place to live and work.”

The NJHA also supports education loan forgiveness programs for medical residents. “The state of New Jersey, for example, enacted a law under Gov. Christie that created a tuition reimbursement program specifically for psychiatrists looking to remain in the state to practice,” she added. “There are a number of additional loan forgiveness programs introduced in Trenton that we support.”

The shortage, though, is compounded by an aging physician population that’s getting closer to retirement.

“National and state data shows that a significant number of New Jersey physicians are reaching retirement age, but there’s not a sufficient number of young doctors in the state rising up through the system to replace them,” according to Ditri. “New Jersey ranks third-highest in the nation for the percent of physicians over the age of 60, at 32.7 percent. Meanwhile, we rank 45th nationally in the percent of physicians under the age of 40, at just 13.3 percent.”

This shortage of health care professionals isn’t limited to physicians, she cautioned. “Our population is aging and the demand for health care services is increasing. There is also a well-documented shortage of nurses and certified nursing assistants. We need a thoughtful policy discussion on creating a system to attract and educate health care professionals and staff our facilities in the most effective way for high-value patient care.”

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