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Physician Workforce: Greener Grass Depends on Priorities


By Gus Geraci, MD

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UBM Medica recently released its list of “The Best States to Practice In.” Using the default setting on the relative value of factors like Cost of Living (25 percent),and 15 percent each for Disciplinary Actions, State Tax Climate, Medicare Geographic Cost Indices (GPCI), Physicians Density, and Malpractice Paid Loss, Pennsylvania ranked 43rd out of 50th.

We all need to move to Idaho, which ranked No. 1. You can adjust what is most important to you on their page and then separately add whatever factors you’d like to weigh by creating your own list.

Value malpractice 100 percent? Pennsylvania moves to 47th. Want to go where you’re needed the most (states with the lowest density of physicians)? Pennsylvania ranks 42nd. OK, how about where you might get paid the best – at least according to the GPCI? Pennsylvania breaks out of the bottom 25th, and rises to 14th.

Other folks have done similar measures. Medscape did its by region, with Pennsylvania lumped in with the “Northeast.” Virginia wins, and D.C. loses, with a non-mention for Pennsylvania in that region. But another Medscape study based mostly on lifestyle found different results for each region, still no mention of Pennsylvania.

With all the training sites exposing young physicians and physicians-in-training to Pennsylvania (fourth highest percentage of medical students in the country), we rank 37th in retaining in state trained physicians. Wallethub talks about its ranking of the best and worst states for physicians, and Pennsylvania is 31st in ranking compared to the other states.

We have some of the finest medical care in this country in some of the best medical centers in the world. People come here from across the world to get care. So why is Pennsylvania not ranked higher? Why can’t we keep physicians?

Loan Repayment? According to the American Association of Medical Colleges, the average amount of medical school debt for 2014 was $176,000. But if you’re willing to work in a Health Professional Shortage Area (HPSA) in Pennsylvania, you can get up to $100,000 a year as a physician. Pennsylvania Gov. Tom Wolf maintained this level of state funding when he released a portion of the state budget in late December.

Average annual compensation? The mid-Atlantic region is the worst, except for the northeast, which is lower by one thousand dollars, at $253,000. Moving to the Southeast gets you, on average, an extra $14,000. Searching by specialty makes the discrepancies even bigger for some. Doximity offers a salary survey by specialty.

The shortages of physicians is national, and some crises are about to occur in Pennsylvania with some regions having very few physicians under 50. From 2002 to 2012, the number of practicing physicians in Pennsylvania under age 50 dropped from 53 to 45 percent. We’re getting older, and those physicians will retire.

What can we do? It’s not all about the money. Malpractice is better in Pennsylvania than it was, but there is still a lot of room for progress. There are plenty of places in Pennsylvania where certain specialties are needed, but getting the word out is important.

Small and medium hospitals don’t have the resources and cash to recruit, and large hospitals face national competition for the physicians out there. But there are still lots of docs looking to be close to home and family, which is ranked very highly by physicians. But a good listing of opportunities is not out there, organized by region.

Better loan repayment programs will help, but the state budget is still up in the air. Pennsylvania is slowly hemorrhaging. Are there other solutions out there?

This post originally appeared in winter edition of the Pennsylvania Physician Magazine, which examines solutions to increasing the physician population in Pennsylvania. It was reposted with permission.​

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