| Naples Daily News
A shortage of primary care physicians in Florida and nationwide is expected to worsen while the impact of the COVID-19 pandemic is not looking favorable.
The Kaiser Family Foundation recently ranked states based on the number of communities that face health professional shortages. Florida comes in fifth.
At the top of the list is California, followed by Texas, Missouri and Alaska.
Below Florida in sixth place is Michigan, followed by Illinois, Georgia, Arizona and Washington.
Data compiled quarterly by the U.S. Health Resources and Services Administration shows 279 communities in Florida with shortages of medical professionals in primary medicine, dental care and mental health.
The primary measurement is a population-to-provider ratio. A shortage exists at a threshold of 3,500 people to one provider.
In Lee County, low-incomes areas of Lehigh Acres, North Fort Myers, Bonita Springs, Cape Coral and Fort Myers do not have enough doctors, according to the federal data.
Collier is similar with shortages in Immokalee/Everglades City, East Naples and Golden Gate.
The federal agency estimates Florida’s shortage of primary care physicians is 1,636 and will increase to 3,060 by 2025.
In the retirement mecca of Florida, multiple issues are coming together to exacerbate the shortage of medical providers. They include a growing aging population, an aging physician population and not enough residency training positions, according to data.
The state has 21 million residents. Figures from the Florida Department of Health says there are 54,677 physicians actively involved in patient care in Florida this year. Others are licensed but not practicing.
The COVID-19 pandemic is expected to fuel the need for more medical professionals across all fields, especially for those working in hospitals.
“COVID-19 is making it more challenging for physicians and other healthcare workers to gain experience and training, like during clinical rotations,” Dr. Rebekah Bernard, president of the Collier County Medical Society, said.
The pandemic may hasten physician burnout that already was an issue before the virus, she said.
The shortage of doctors nationwide is an important issue to address, Bernard said.
Studies show having the same doctor over time, especially the same primary care physician, lowers mortality, she said.
Healthcare Network, a private nonprofit organization in Collier that serves underserved areas of Immokalee, Golden Gate and East Naples, has experienced challenges hiring primary-care clinicians, according to Julie Blauman, vice president of human resources.
“Limited housing, location and cost of living are the most common reason candidates decline a job offer,” she said in an email.
Similar health centers across the country like Healthcare Network that receive federal support for serving rural and low-income communities face the same struggle to attract doctors, she said.
It’s a concern that was recognized by the National Association of Community Health Centers during a recent virtual meeting, she said.
The association said health centers need to emphasize to new medical school graduates about a loan repayment program in exchange for working in areas identified by the federal government as facing shortages of health professionals, she said.
“The program has been an excellent recruiting tool for us,” she said. “We currently employ approximately 30 clinicians through the program including behavioral health, (nurse practitioners) and dentists.”
Changes in supply
The Florida Department of Health produces a physician workforce report annually that shows a 27% increase over the past 10 years in the number of physicians engaged in patient care while the population has grown 15%.
The most recent report released this month also highlights some troubling trends.
It found nearly 9% of surveyed physicians, roughly 4,757, plan to retire in the next five years. Almost 60% of practicing physicians are 50 and older.
The data for Southwest Florida shows Collier has 1,069 physicians and Lee has 1,571.
Collier has a rate of 25 to 50 practicing physicians per 10,000 population and Lee has 10 to 25 physicians per 10,000 population.
For primary-care physicians alone, where the shortfall is greatest, Collier has 7.5 to 10 primary-care physicians per 10,000 population. Lee has 5 to 7.5 primary-care doctors per 10,000 population, the state report shows.
There is not a breakdown between urban and rural areas where the need is greatest throughout the state.
More than one-third, or 34%, of the 67 counties have fewer than 10 physicians per 10,000 population.
Overall, Collier and Lee have boosted their supply of doctors since 2013.
Collier has seen a 30% increase and Lee has increased the supply by 25%, according to the data. What’s not included is how that compares to population growth in each community.
Training new doctors
Lee Health and the NCH Healthcare System, the two dominant hospitals in Lee and Collier counties, respectively, have residency training programs to help address the need for primary-care physicians.
NCH started its graduate residency program in 2017.
“Five out of 12 graduates thus far from the (program) have remained in Collier County,” hospital spokesman Shawn McConnell said in an email.
NCH is keeping up the demand for family practitioners, he said.
“NCH has been able to consistently provide quality family medicine to the residents of Collier and south Lee Counties while keeping pace with the demand in our community for primary care,” McConnell said.
Lee Health launched its family medicine residency program in 2014. Out of 32 graduates to date, 18 have stayed in Southwest Florida, according to the hospital system.
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From a national perspective, the Association of American Medical Colleges in June revised its projected shortfall of physicians to be 139,000 nationwide by 2033. That’s up from an estimated deficit of 121,900 by 2032.
“The increasing physician shortage over the last two decades, and now the COVID-19 pandemic, has demonstrated that we need to increase the number of physicians to ensure we can care for patients in the near term and in the future,” Dr. David Skorton, president & CEO of the association, said in a news release.
The pandemic has brought to light that hospitals need a lot of specialists, according to the association.
Bernard, of Collier, said the U.S. is not keeping up with producing new doctors to address need.
Enrollment in U.S. medical schools has increased by 28% in recent years but is still behind what other countries have done, Bernard said.
There are hundreds of medical school graduates who remain unmatched to a residency spot and waiting, she said.
“We need more residency training programs,” she said. “There is very little that anyone can do to increase physician volume until Congress increases funding for residencies.”
Recognizing the role of residency programs, the Florida Legislature in 2013 appropriated $80 million in recurring state and matching federal funds to help residency programs at hospitals that serve Medicaid patients.
According to the Safety Net Hospital Alliance of Florida, about 9,400 residency slots were funded for the first two years.
In 2015, the Legislature allocated $100 million for a graduate medical education “bonus program” to train physicians in specialties that were in a deficit in Florida.
The 2020 Legislature appropriated a total of $280.3 million to these programs, according to the state.