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Health Care Changes Spur Need For More Medical Specialists

If you've tried to get an appointment with your dermatologist or neurologist lately, you may have experienced a four- to six-week wait. That's because these are two of the most in-demand specialists, and there aren't enough of them. The specialist shortage could be affected if Medicaid expansion in Ohio moves forward. It's no secret there aren't enough doctors. Central Ohio's health system executives said last year they expect to hire more general practitioners and nurses to handle additional patients who will get health insurance under the Affordable Care Act. Medicaid expansion would extend care to about 250,000 additional Ohioans. Many of those people likely will need a specialist. And in some areas - general surgery, urology, dermatology, oncology, gastroenterology, neurology, to name a few - there's already a deficit. The Association of American Medical Colleges expects a shortage of 46,000 specialists within the next 10 years. Atul Grover is AAMC's chief public policy officer. Grover expects it will take longer to see a specialist as the federal healthcare law continues to roll out. He uses Massachusetts' insurance expansion as an example.

"Your immediate demand for primary care goes up right away because people are now trying to access entrance into medical care," Grover said.

"But what they found in Massachusetts was that there was actually a big increase in referrals for things like elective surgery: heart valve replacements, knee replacements, where people have been putting off care for years because they couldn't afford it." In Columbus, Ohio Health Physician Group president Hugh Thornhill said the health system has ramped up its group of doctors by 20 percent during the past few years. Thornhill said recruitment is focused on specialists who also can serve outlying communities. "What you see is a cluster of specialties in the larger urban areas and a lack of attractiveness of practicing in a specialty in a more non-urban community where you might only have one or two physicians in a specialty. And that's what I'm seeing in many of the smaller communities, is they may have one neurologist or two orthopedic surgeons," Thornhill said. Thornhill said he thinks a lack of access to care is, in large part, due to the maldistribution of physicians rather than a significant shortage of doctors. But Grover said the shortage will accelerate as more people get insurance. "It's really that there's just not enough physicians now to go around. That problem's going to get worse. And the places that are already underserved, like people living in rural areas, are the ones that are going to be the most hurt by it," Grover said. Dr. Chris Ellison is CEO of Ohio State University's faculty group practice. Ellison agreed the concentration of doctors in urban areas creates a barrier to health services. But he said the dearth of doctors, including specialists, is at "near crisis" levels. And Ellison attributes the issue to stagnant federal funding for residency positions following medical school where new MDs get the necessary training to practice medicine.

"The amount of money that has been infused in post-graduate medical education was capped in 1997. It has not increased in 16 years. The population has increased by 50 million," Ellison said.

There are more medical schools and graduates than ever before, but hundreds of new MDs are left without a residency placement. That happened to 528 U.S. grads last year, according to the Association of American Medical Colleges. "With the cap in the post medical school education that is taking place, we have not kept up by increasing the number of specialists or the number of primary care physicians that complete post-graduate education," Ellison said. The Ohio State Medical Association is in conversation with state and national leaders about increasing funding for residency programs. Its spokesman Reginald Fields said the association also worked with the legislature to expedite licensure for out-of-state doctors who want to practice in Ohio in an effort to increase the number of doctors. "A lot of times these are physicians who maybe did their medical school studies here in the state, moved outside the state to begin their careers and they want to come back," Fields said. With shortages looming in general practice medicine, the industry has worked to change its care model to incorporate more nurse practitioners and physician's assistants. But Ohio State's Dr. Ellison said that would be difficult in specialty care. "It takes years of training to be able to learn the depth of knowledge that's required to take care of those diseases. And, you know, we have not gone down that road. It's not saying we can't do it in the future," Ellison said. It's uncertain whether Medicaid expansion will take place in Ohio. Governor John Kasich favors it, but Ohio House leaders have yet to take up possible expansion.