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NJ Checkup: Finding Solutions Before Doctor Shortage is Critical

Senate’s health committee approves bill to alleviate lack of primary care physicians.

New Jersey’s chronic doctor shortage is expected to worsen as patients get older and sicker, and federal healthcare reform brings broader coverage for the uninsured. Over the next decade, the state will have 3,000 fewer doctors than needed, according to projections cited as the state legislature begins to tackle the problem.

The Senate’s health committee has approved a bill, S-173, requiring the state Commissioner of Health and Senior Services to convene a planning summit to address the doctor shortage and provide a “blueprint of what we need to do in New Jersey,” said Sen. Robert W. Singer (R-Monmouth, Ocean), the measure’s sponsor.

The legislation was drafted in response to the Physician Workforce Policy Task Force which predicted a shortfall of nearly 1,000 primary care physicians and 1,800 specialists.

"Unless we get to work now to prevent that shortage, many New Jerseyans may soon find themselves without doctors or unable to obtain appointments or treatments when they need them,” Singer said.

The bill directs the health commissioner to convene a strategic planning summit consisting of state agencies and boards, and representatives of medical schools and teaching hospitals. The summit would analyze the physician workforce supply, consider the redistribution or expansion of residency slots, and look at including more community hospitals in resident rotations in family medicine, internal medicine and pediatrics.

“There are things we can start doing now because we know we have a shortage of primary care physicians,” said Deborah Briggs, senior vice president of health policy at the New Jersey Council of Teaching Hospitals, which supports the measure.

The reasons for the impending doctor shortage are varied, including an aging population, healthcare reform, and that New Jersey trains more doctors than it keeps. “We are a net exporter of family medicine residents,” said Ray Saputelli, chief executive of the New Jersey Academy of Family Physicians.

A survey of primary care doctors who completed their residencies in June 2011 found 35 percent planned to remain in New Jersey, while the rest said they were leaving and setting up their practices elsewhere. “We are competing with, at a minimum, 27 other states that try to recruit our physicians away once they graduate,” Briggs said.

The relatively low level of compensation in primary care is one reason new doctors leave. The Council of Teaching Hospitals is hopeful the planning summit, if approved, will consider recruitment and incentive packages that will start keeping graduates in New Jersey.

“How can we make it more attractive for them to stay?” Briggs asked. Primary care physicians generally earn about $150,000 when starting out and the Council of Teaching Hospitals has proposed a seven-year exemption from taxes on incomes up to $200,000 a year, which would provide a tax credit of about $10,000 annually to help the doctors repay student loans or invest in setting up practices.

Other strategies include expanding the number of training slots for graduate medical education, said Lawrence Downs, chief executive of the Medical Society of New Jersey. The legislature might also want to consider “some modest reforms to the medical liability system to attract new physicians here, similar to the reforms that have been achieved in Texas.”

Passage of health reform has heightened concerns that the newly insured will find it harder to access primary care services, Downs said. “There is certainly by most accounts going to be a shortage of physician services when many uninsured New Jerseyans come on to the rolls of the insured under federal healthcare reform.”

Without planning, the state’s healthcare system risks becoming one of “the have and have nots,” Singer observed. “The rich are always going to be able to find healthcare. What about the poor?”

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