Pick up the phone, said Dr. Lawrence Bonchek, and you can figure out that there's a doctor shortage in Lancaster.
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Getting an appointment with a specialist can take months. Bonchek, a retired heart surgeon, knows a woman whose tests for breast cancer came back positive — and couldn't get an appointment with an oncologist for more than two weeks, and then because Bonchek called on her behalf.
So when Bonchek chaired a commission to determine whether Lancaster County had enough physicians to fill a growing need, he had an idea what the group might find. Last fall that organization, the Lancaster Medical Manpower & Education Study Commission, issued its report, asserting that the Lancaster County "service area" was already short 72 physicians, and that the shortage could grow to 160 doctors by 2012.
The relative dearth of doctors nationwide has drawn the attention of Obama administration officials, who say they are particularly concerned about a shortage of primary care providers, the main source of health care for most Americans.
Earlier this decade, talk of a doctor shortage was dismissed by trial lawyers and others as a ploy intended to boost malpractice reform. And state officials say there is no across-the-board shortage of doctors in Pennsylvania, though there is a growing need for more primary care physicians. In rural areas in particular, they say, both primary care doctors and specialists are in very short supply.
What to do?The question is what to do about it. Nationwide, medical schools have begun to increase enrollments, and some advocates want the federal government to begin paying for more doctor training.
Here in Lancaster, other steps are being considered. Bonchek, editor-in-chief of The Journal of Lancaster General Hospital, said there has been talk — but only talk — of eventually opening a medical college here.
In the meantime, the focus is on recruiting more doctors, and convincing them to stay in Lancaster County. "And the whole community has to be part of that effort," Bonchek said.
The Lancaster Medical Manpower & Education Study Commission convened in September 2007 and counted among its members former state Sen. Gibson E. Armstrong; Tom Baldrige, of the Lancaster County Chamber of Commerce & Industry; the Rev. Louis A. Butcher Jr., of Bright Side Baptist Church; Franklin & Marshall College President John A. Fry; and Lancaster Mayor Rick Gray.
It also included 11 officials from Lancaster General, by far the biggest hospital/health care system in the county (as well as the county's biggest employer). Lancaster General Hospital ended its last fiscal year with a surplus of $113 million.
The group hired consultants and visited regional medical schools, including Pennsylvania's newest, The Commonwealth Medical College in Scranton, the first new medical school to open in the state in 46 years.
Officials with the college have been touring the state — including a November 2008 stop in Lancaster County — hoping to raise awareness of what they call a looming shortage of physicians. Some studies show that by 2025, the nation could have a shortfall of 200,000 physicians.
The supply of doctors in Pennsylvania has been a contentious political issue. A predicted physician shortage was cited as an argument for medical malpractice reform earlier this decade, when malpractice rates soared by as much as 150 percent.
The Pennsylvania Bar Association, which opposed reforms, asserted in a 2006 report that statistics from the American Medical Association and the Federation of State and Medical Boards showed that "there is no doctor shortage in Pennsylvania."
Jeff Gingerich, a spokesman for the Pennsylvania Bar, said the organization "has not commissioned additional reports since 2006 so doesn't have the data to comment on [the] issue."
A Pennsylvania Department of Health survey showed that between 2004 and 2006 the number of physicians engaged in direct patient care in Pennsylvania fell slightly. But Amy Kelchner, a spokeswoman for the Governor's Office of Health Care Reform, said those numbers — which are based on license renewals — aren't necessarily accurate, as many who pay to keep a license current aren't necessarily still practicing in Pennsylvania.
A more accurate figure, she said, would be reflected in the number of doctors who buy Mcare, malpractice insurance which must be purchased from the state. It's expensive, she said. "No one's going to buy that unless they are going to use it."
Those figures show that between 2000 and 2009, the number of physicians in Pennsylvania has increased, from approximately 31,000 to just under 38,000 now. "It hasn't been a huge jump," she said, "but there hasn't been a decline in any way."
The catch is that some doctors are in short supply — primary care physicians.
"By all accounts, the number of primary care health providers is dropping and is a concern, particularly with our older population in Pennsylvania," Kelchner said.
Kelchner, who grew up in Tioga County, said there is also an across-the-board shortage of all kinds of doctors in rural Pennsylvania. "There are plenty of specialists in Philadelphia and Pittsburgh, but is there a neurosurgeon in Tioga County, or an OB-GYN who does high-risk pregnancies?"
Locally, Bonchek said, primary care — a category in which he places pediatrics, OB-GYN and internal medicine as well as family practice — has the greatest need. Others in the local medical community say there are other needs as well.
"I think we're very well-served in some areas but under-served in others," said Dr. Anthony Mastropietro, chief medical officer at Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center in Lititz.
"Take neurology — it can take months to get an appointment. The [doctors] we do have here are excellent. There just aren't enough of them."
On the other hand, "We probably have around 35 orthopedic surgeons; we're pretty well-served," Mastropietro said.
Ephrata Community Hospital has had a harder time recruiting doctors in recent years, said Dr. Vincent Glielmi, vice president of medical affairs. "It's a supply-and-demand issue," he said, with fewer physicians going into primary care and existing primary care doctors retiring.
Kelchner said a big reason more physicians aren't going into primary care is because of money. "The median salary of a primary care doctor, as opposed to a surgeon or another type of specialist, is low, and that's a consideration for young physicians going into practice who have family obligations" and loans to pay off, she said.
In April, The New York Times reported that family doctors and internists are pressing Congress to increase Medicare payments to primary care physicians. Specialists, who would see their reimbursements cut, are lobbying against the change.
There's also a concern that increasing the supply of doctors could drive up health costs. That was the rationale for the Balanced Budget Act of 1997, which placed a cap on the number of resident physicians each teaching hospital can claim for reimbursement under Medicare. Now some, including Bonchek, think the cap needs to be lifted.
However, that would mean more spending by the federal government, a hard sell in a time of economic crisis.
Still, simple demographics suggest that Lancaster County will need more physicians.
The county's population continues to increase and the percentage of the population aged 65 and older has grown from 13.8 percent in 1996 to 14.4 percent in 2007, according to census statistics.
Pennsylvania has the third-oldest population in the United States, and the graying of the state means more demand for doctors, Bonchek said.
So, too, might health care reform.
"When you have [an estimated] 50 million people who are uninsured and you give them health insurance, demand for medical care is going to go up exponentially," Bonchek said.
Medical college?When the commission discussed ways to meet this need, one proposed solution was opening a medical college here, perhaps on the old Armstrong World Industries site now being cleared for redevelopment.
But Susan Wynne, an executive vice president at LGH and a member of the commission, said "that is not a goal of this effort, and we have no plans for a medical school."
The Lancaster General College of Nursing & Health Sciences will build a new facility on the Armstrong site. Pending approval by the state Department of Education, the school hopes to begin offering a four-year Bachelor of Science in nursing program this fall.
For now, the solution to the medical manpower shortage doesn't involve building. Instead, it involves convincing doctors who do a residency at Lancaster General to stay in Lancaster County. Bonchek said about half of them stay.
"To keep someone here, you have to have a welcoming community," said Bonchek, who moved to Lancaster from Milwaukee in 1983 to head the hospital's new open-heart surgery team.
"The attitude towards newcomers — 'Are you from around here?' — That is not the way to welcome people."
Mastropietro, on the other hand, said his experience was that physicians who move to Lancaster like it here — it's getting them here in the first place. "The reason Lancaster County is a tough place is because it's in Pennsylvania," he said. "People think 'malpractice,' and they don't want to be here."
More recruitingSince the commission completed its work last fall, LGH has stepped up recruiting efforts; the hospital has professional recruiters on staff but also works to put the spouses of new doctors in touch with the spouses of doctors already established here.
At Ephrata Community, Glielmi said the hospital used to attract plenty of candidates by simply advertising; now it uses recruitment firms to help fill vacancies.
Bonchek said that if the recession persists, doctors who planned to retire might stay on longer — and mitigate the shortage.
The number of doctors in a community is directly tied to the quality of life in that community, said Baldrige, executive director of the Lancaster County Chamber. "Successful recruitment of a doctor can have a million-dollar impact on a community," he said, "but it also has other impacts.
"If we ever become a community without adequate health care, that, too, will have an economic impact."
Gil Smart is associate editor of the Sunday News. E-mail him at gsmart@lnpnews.com, or phone 291-8817.
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