Who’ll Fix the Physician Workforce?

Hospitals and health systems can’t bear all the burden of assuring that New Jersey trains and retains the doctors it needs. What is being done to fix the state's doctor shortage?

Beginning in 2011, the second year of her family-medicine residency at CentraState Healthcare System in Freehold, Dr. Sara Leonard began receiving job solicitations from all over the country. The outreach intensified at the start of her third and final year, at which point she was getting “five to six calls a day, 15 to 20 e-mails and glossy brochures from everywhere.” But apart from her own hospital and the occasional flyer listing available positions, usually in the southern counties, almost no solicitations came from New Jersey.

The seeming indifference puzzled Leonard, a New Jersey native committed to remaining in her home state, who knew about its acute doctor shortages. In the end, she was happy to accept a position at a practice affiliated with CentraState, where she had been a chief resident. “If not for the hospital system I’m in, I don’t think I’d be in the state right now,” says Leonard. “New Jersey almost lost me, and I’m one of its own.”

Juan Soto, who handles the New Jersey and New York market for the national physician recruitment firm Merritt Hawkins, hears this sentiment a lot. “Among those on the hiring end,” he says, “the assumption seems to be, if doctors have trained here, we don’t need to go after them—they will come to us.”

But hospitals and health systems can’t bear all the burden of assuring that New Jersey trains and retains the doctors it needs.

Medical schools and residency programs also need to step up their game, experts say, especially in the area of primary care. “There are people out there with an aptitude for medical school who have a strong sense of community and are likely to go into primary care,” says Dr. David S. Kountz, vice president of academic affairs at Jersey Shore. “We need a new approach to identifying and admitting such students.” Residency programs, Kountz says, also need to do more “to expose students to strong primary care role models. Get those students out into those [community] settings where we want them to practice.”

The state government can also play a bigger role in addressing the doctor shortage, experts say, both in primary care and the specialties. Unlike other states facing similar challenges, New Jersey is largely missing in action on the issue, says Deb Briggs of the New Jersey Council of Teaching Hospitals.

Confronting the shortage could fall to Mary E. O’Dowd, the commissioner of the Department of Health, but, says Briggs, O’Dowd has followed the lead of her predecessors and neither assumed a leadership role nor developed a comprehensive state health plan, one that would, among other things, correlate population needs with health workforce supply. O’Dowd declined a request to be interviewed for this article.

O’Dowd’s office directed New Jersey Monthly to a Rutgers-based project called the NJ Health Care Talent Network, funded through a grant from the New Jersey Department of Labor and Workforce Development. But though this project collects some market data and talks to groups to discern trends in physician hiring, its major focus is on nursing and the allied health professions. Even the network’s director, Dr. Padma Arvind, is puzzled “that the DOH isn’t focusing on a lot of these workforce development issues, especially if there’s going to be a huge demand for physicians down the road.”

Some other states are doing a better job. In Massachusetts, for example, the Health Care Workforce Center, an agency within the Department of Public Health, looks at how well the existing physician and related workforce is meeting residents’ needs, especially in primary care. It does this by collecting data on supply and demand, monitoring the impact of laws and policies on recruitment and retention, and initiating programs that address imbalances, among other actions. In 2008, Mississippi established the Rural Physicians Scholarship Program, which pays the education expenses of medical students who agree to practice in their rural home towns after graduation. And through its Pathways to Health Careers initiative, New Mexico has created a variety of strategies to identify, encourage and prepare young students for the health professions, including medicine.

New Jersey could learn from other states’ efforts. At the same time, say experts, state officials who are interested in addressing the current and predicted physician shortages need to work more collaboratively with hospitals, medical schools and groups like the New Jersey Council of Teaching Hospitals

Says Briggs, “The state needs to be at the table.”

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