Virginia struggling to counter decline in physicians

Dr. Brandon Cox is one Lynchburg native who couldn’t wait to get home after college.

“I love the area, and I have lots of family here,” said Cox, who chose to do his residency in Lynchburg after graduating from the Medical College of Virginia at Virginia Commonwealth University. “It’s actually a really nice place to live.”

Cox, 28, isn’t the norm, though. He said it is difficult to convince young doctors to come to Lynchburg.

Attracting more physicians to the area, and keeping them, is a challenge that has become more urgent. So much so that Centra is in the midst of creating a formal Physician Recruiting Office, where staff will work to convince physicians to consider coming to Lynchburg for their residency or to practice.

The need is expected to grow locally and nationwide. Studies released last month predict a significant shortage of doctors across the country over the next 15 years.

At the same time, Virginia has a more difficult time retaining new doctors than many other states, with only about a third of graduates from the state’s medical schools choosing to stay in the commonwealth, according to a study from the state’s Healthcare Workforce Data Center. That ranks Virginia 30th out of 45 states in the percentage of physicians remaining in state after medical school.

“The primary care area is stretched very thin in our area,” said Dr. Daniel Carey, President of the Medical Society of Virginia and director of the Cardio Cath Lab at Lynchburg General Hospital.

“Many of our patients are already having difficulty accessing primary care,” Carey said. “That’s a problem now that I only think is going to get worse.”

The Association of American Medical Colleges predicts a doctor shortage of up to 159,000 physicians by 2025 nationwide. And that, Carey said, could lead more people to delay care and turn to the emergency room for treatment, resulting in escalating health care costs.

Carey said it’s much cheaper to treat bronchitis early, for example, instead of pneumonia later.

Compounding the problem, Carey and other medical experts said, is the growth trend in the aging population. Clients age 65 to 75 need twice as many medical services as the general population, while those older than 75 needs three times as many services.

Aging also is a factor in the projected decline in the number of practicing physicians. Doctors tend to begin retiring at age 55, and, according to the Medical Colleges Association, more than one in three physicians nationwide are age 55 and older and likely to retire in the next two decades.

“One of the biggest fears I have is 50- to 60-year-olds leaving the practice,” said Carey, who graduated from the University of Virginia Medical School and did his residency in California. He said the profession has got to do more to “make sure that this career path is stimulating, supported and sustainable” so physicians will stay in the field full time.

“It’s not a mystery; we’re going to have to make scarce physician resources go further.”

Relying more on nurse practitioners and physician assistants is one way to fill in the gaps, something that already is occurring in this area, Carey said.

“That’s part of the local solution,” he said. “I think that’s an excellent way of making the limited number of physicians go further.”

Centra also works to bring more doctors to the area through the Family Residency Program, said Skip Leavitt, vice president of the Centra Medical Group

Leavitt said Centra brings six potential new doctors to the Lynchburg area through the program each year. This year the residency added a geriatric fellowship, which is expected to provide one graduate annually as well.

Since the residency began in 1975, about 70 percent of the graduates have decided to practice in the area, Leavitt said.

Cox, in his last year of residency in the program, will be another.

“It’s the biggest draw to this area,” he said.

Cox, who went to Brookville High School, came back to Lynchburg and wants to practice in the area because his family is here and he wants to raise his kids here.

But, he said, getting other med students to consider Lynchburg isn’t easy.

“The hardest thing is getting people to come here in the first place,” he said.

Once they join the residents, though, they tend to want to stay, he said.

The tight-knit medical community and agencies such as the Lynchburg Academy of Medicine are tools Leavitt uses to recruit new med school grads unsure of where they want to do their residency.

“We try to offer them various components,” Leavitt said. He touted the city’s “tradition of high-quality medicine” and quality of life.

“It’s a good place to be if you want to settle and raise a family,” he said.

Carey said in the end, physicians want to work in cities where medical malpractice and medical litigation practices are forward thinking, the environment is welcoming and stimulating, and the financial models keep doctors offices open and patients coming in.

A key challenge is the Medicare and Medicaid payment system, the doctors said.

Medicare payments, for example, are based on what’s been done in the past, so if you don’t use a service a lot, doctors get paid less for it. But over time, the problem compounds itself and the payment rates continue to decline.

“You have to increase the incentive to go into primary practice,” said Cox, who wants to be a family practice doctor because he likes to do a bit of everything.

“You’re kind of like the quarterback of medicine, sending people where they need to go,” Cox said. If he went into a specialty, he said he would make significantly more money — which would allow him to pay off his med school loans more quickly — because the current medical payment system is based on procedures.

Leavitt and Carey said the payment system also should figure in quality of care so physicians are paid for keeping patients healthy, too.

“We’ve got to shift the revenue stream to prevention, which, in time, will make us healthier,” Leavitt said.