The time has come to decide whether New Jersey is training enough doctors — particularly primary-care doctors — and to determine if they are distributed adequately across the state, according to a bill advancing in the Legislature.
The measure, S-90/A-1930, would require state officials to convene a “strategic planning summit” to analyze the state’s supply of doctors; discuss redistributing or expanding the number of medical residencies; and investigate ways to have family, internal, and pediatric medicine residents in more community hospitals.
The bill stems from a 2010 report by the New Jersey Council of Teaching Hospitals that foresaw a 2,800-doctor shortfall by 2020, including 1,800 fewer primary-care doctors than would be needed.
Council President and CEO Deborah S. Briggs said the report recommended that the state increase its strategic planning as a first step to addressing the expected shortfall.
“(In 2010) there was absolutely no strategic planning occurring between the Department of Health, Department of Labor, the medical schools and the teaching hospitals,” Briggs said. “And ultimately, when you don’t have a strategic plan and you haven’t identified areas of reconciliation or areas to work on, you’ll never get there.”
The state has made progress in increasing the number of medical students since then, with the opening of Rowan University’s Cooper Medical School in Camden. But it remains limited in the number of post-medical-school residencies, which is an important consideration since many doctors choose to practice in the area where they had their residency.
The federal government pays for most medical residencies, but federal law largely limits each hospital to the same number that they had in 1997. In raw numbers, New Jersey doesn’t appear to lack medical residents — a study published by the journal Health Affairs last year found that
New Jersey ranked 15th in the number of medical residents per 100,000 population.
But this statistic obscured other problems — including that a disproportionate share of the state’s residents are training for medical specialties, which can skew the state toward providing more expensive specialty care. In addition, New Jersey is between two states — New York and Pennsylvania — that have higher densities of medical residents, potentially putting New Jersey at a competitive disadvantage.
Senate sponsor Robert W. Singer (R-Monmouth and Ocean) said the bill looks to a future in which the demand for doctors isn’t met by the projected supply, particularly in primary care.
“We have to find a way to attract them and help them survive,” Singer said.
He said one potential benefit of having a state strategic plan on medical residencies is that it could encourage the state’s congressional delegation to consider pushing for changes to federal limits. But beyond that, he said the state could consider providing more funding for residencies.
He also noted that the state would be experiencing savings from the projected drop in the number of uninsured people due to the Affordable Care Act. With a drop in the need for charity care, New Jersey could consider using some of that money to increase residencies, Singer said.
“I just don’t think that as a state we’re paying enough concerns as we ought to how to delivery healthcare to the masses in the long term,” said Singer, who represents a district with many retirement communities. He also is worried that fewer senior residents will choose to live in the state if the quality of healthcare declines.
Assembly sponsor Herb Conaway Jr. (D-Burlington), a primary-care doctor, said he has supported the concept of a strategic planning summit ever since he participated in the state task force that led to the council report.
“Where people train has a lot do with where they end of practicing,” Conaway said. Some factors that discourage medical residents from continuing their careers in the state — such as the state’s high cost of living — are difficult to affect, but increasing the number of medical residents “should be on the table,” he said. He added that New Jersey should consider the experiences of other states that have funded additional medical residencies.
He said there is another potential benefit to bringing state officials together with stakeholders. Currently, residency slots can be transferred from a hospital that hasn’t been able to fill all of its slots to a hospital that is “oversubscribed” with too many residents. But this is done on a case-by-case basis and a state strategic plan could help bring more order to this process, he said.
Conaway said expanding the number of medical students by opening Cooper Medical School was a good first step.
“What needs to follow on that expansion is a place to go for graduate medical education — the residency program — and to make sure that there are places for advancing that training here in New Jersey,” said Conaway, adding that he doesn’t foresee the measure being controversial. The Senate passed it unanimously and it’s been referred to the Assembly Higher Education Committee, which must release it before a vote by the full Assembly and consideration by Gov. Chris Christie.