Cumberland Times-News

December 5, 2008

We’re facing a crisis in health care access

To the Editor:

How many of you have had a problem finding a primary care physician or timely specialty care in Western Maryland? How much have your health insurance premiums gone up in the past 10 years? Have you had problems finding obstetrical care?

How many of you are seeing mid-level providers such as nurse practitioners because there is no time for the doctor to see you? Are you getting any better service for the increased cost? How many doctors have left this area in the past five years, and why?

The loss of physicians is exacerbating an already strained health care delivery system in Western Maryland and having a significant impact on access to care.

Recently the Maryland state Medical Society and Maryland Hospital Association conducted a one of a kind study to investigate the causes of the current crisis in health care access and the growing physician shortage in our state.

The findings are very enlightening. Maryland has 16 percent fewer physicians per capita than the rest of the U.S., and the U.S. as a whole has many fewer physicians per capita than most industrialized countries.

Maryland’s physician population is aging, as is the general population, with the expected population over age 65 expected to double between 2000 and 2030. There are an increased number of doctor visits as age increases.

Why do we not train more doctors? We are currently suffering from poor projections from the 1980s that have limited training slots and contributed to the crisis nationwide. Maryland only retains 52 percent of graduates to stay and practice in the state. With current growth in medical schools, we may not be able to reverse this trend for 30 more years.

We as a nation have relied upon international medical graduates to fill 24 percent of training positions. This number is likely to increase over time.

In Western Maryland, we have seen shortages in neurology, obstetrics, cardiology, gastroenterology, orthopedics, infectious diseases, plastic surgery, emergency medicine, vascular surgery, urology and psychiatry and primary care.

Why can we not attract and retain physicians in our region? We cannot compete with other states because of the liability climate and poor reimbursements.

Maryland ranks 48th in physician reimbursement by health care insurers. We have a monopoly of two heath care carriers that dominate the market and cover 85 percent of those insured. Our legislature would not tolerate this domination in any other industry. In many cases reimbursements have dropped by 50 percent over the past 10 years.

Has anyone seen a drop in premiums? Instead we are seeing a growth of over 10 percent per year. Where is this money going? Certainly not to our health care. Administrative overhead and inefficiency are consuming health care dollars at a voracious pace. Insurance company CEOs are given bonuses and buyouts that often exceed $100 million. It is the same broken system that is bankrupting Wall Street.

What can we do? On a national level, the progress will be slow and painful to gear up training of new physicians. On a local level we can urge our local and statewide elected representatives to take serious measures to address the physician migration out of our state and to find ways to promote our local students in training with enticements to return home to practice.

We need to strive hard to maintain quality medical care in this community as we embark on a new era in the new Western Maryland Hospital System hospital. We have built it but will they come?

Thomas E. Chappell, MD