Article Details

« Back

Florida losing new doctors as hospital residency posts lag

 On Friday, a small army of young adults gathered at Florida Atlantic University’s Boca Raton campus to make an ethics pledge and ceremoniously don white coats during orientation week.
 
The students, 64 in all, are the first class on the path to becoming medical doctors at the new Charles E. Schmidt College of Medicine.
 
Dr. Michael L. Friedland, dean of the school, sounded like a proud parent when describing the qualifications of the students, who start classes Monday.
 
“Their MCATs — medical college admission test [scores]— and their grade-point averages are as good or better than you could expect in an established school,” Friedland said.
 
The new medical students’ personal triumph — being selected for admission from a pool of 1,500 well-qualified applicants — is also a win for Palm Beach County. The Schmidt College of Medicine is the first medical school to open in Palm Beach County.
 
Its opening — made possible by a $15 million donation from the Schmidt family and matching funds from the state — is part of a concerted effort by Florida’s universities and major medical institutions to boost the number of doctors practicing in the Sunshine State.
 
In July, four general surgery residents began training at JFK Medical Center. The new five-year residency program they are participating in represents an expansion of the Atlantis hospital’s collaboration with the University of Miami.
 
In 2008, UM initiated a three-year internal medicine residency program that has 66 medical school graduates doing rotations and attending seminars at JFK. The programs at JFK are the first allopathic or conventional (as opposed to osteopathic) residency programs in the county.
 
And last month, the Accreditation Council of Graduate Medical Education approved Broward County’s first general surgical residency program — at Cleveland Clinic Florida in Weston.
 
Despite efforts, doctor shortage to widen
While these new programs will graduate and train more physicians in Florida — the numbers fall short of what is needed.
 
The state is not positioned to train enough doctors to replace a generation that could retire within a decade, according to Dr. Laurence Gardner, dean for education and policy at the University of Miami Miller School of Medicine.
 
One third of America’s physicians will reach age 60 within a decade, according to the Association of American Medical Colleges. The AAMC’s Center for Workforce Studies estimates that, by 2020, the country will have 91,500 fewer doctors than it will need to care for a rapidly graying population.
 
Florida is working to address the problem, but the small number of residency positions available in the state — along with the litigious environment — is hurting physician recruitment, Gardner and Friedland say.
 
The Council of Florida Medical School Deans reported about 500 medical students graduated in Florida in 2000, Gardner said. The same year, the state had about 790 first-year resident positions available. “Which means we had plenty of room for our 500 medical school graduates and a bunch more for graduates of schools in other states and graduates of foreign medical schools,” Gardner said.
 
While the number of students to graduate from medical schools in Florida jumped to 850 in 2010, the number of first-year residency positions increased only slightly, to 800, according to Gardner.
 
“We just became an exporter of graduates of medical schools. Those residency slots virtually didn’t increase at all,” he said.
 
That gap will widen in the coming years, even as the University of Miami and other schools expand residency programs.
 
“Based on what the medical schools have reported, we are going to graduate 1,350 medical students in the year 2020,” Gardner said. By comparison, the state will have about 820 positions available for first-year residents, he said. “That’s a shortfall of more than 500 residency positions to accommodate Florida’s graduates of allopathic medical schools.”
 
Friedland explains the problem.
“Physicians tend to practice where they’ve done their residency, and Florida has a shortage of residencies,” he said. More residency programs would help address the physician shortage, he said.
 
“Just graduating more medical students without having a place to train at in your community is not going to solve the problem,” Friedland said.
 
Dr. Robert Kozol, director of the general surgery residency program at JFK, said colleagues tell him Florida medical students want to stay instate for residency training.
 
“In any given year there may be 10-14 (University of) Miami medical school graduates who want to train in a general surgery (residency) program in the state of Florida,” Kozol said. “A lot of those students have had to leave the state for training even though they don’t want to leave the state.”
 
Graduate clinicians and research scientists
FAU will be sponsoring residency programs at Bethesda Memorial in Boynton Beach, Boca Raton Regional Hospital and other medical centers during the next three to four years, according to Friedland.
 
The specialties will include internal medicine, surgery, ob-gyn, pediatrics and family medicine, Friedland said. Those areas, along with geriatric medicine, are specialties of particular need in Florida, he said.
 
It is likely in four years a number of the FAU medical school’s first class will be interested in applying for residencies in state as 80 percent of them are Floridians (while many of the rest come from California), according to the FAU dean.
 
FAU also will offer an MD/Ph.D program in conjunction with Scripps Florida, according to Friedland. To participate in that program, would-be students apply to both institutions. Those students will meet with Scripps scientists during their first and second years in medical school and do independent study programs while sorting out what research path they’d like to take when they enter the Ph.D phase, Friedland said.
 
“There is a need not just for practicing MDs. There is a need for research-oriented physicians,” he said.
 
Scripps Research Institute is ranked seventh on U.S. News & World Reports’ list of top graduate schools in the biological sciences category. Scripps opened its satellite campus in Jupiter in 2004, with its 350,000-square-foot biomedical research complex unveiled in 2009.
 
“There’s also a real shortage of medical school faculty, so we hope these people will also become the full-time medical educators of the future,” Friedland said.
 
Programs may help supply doctors for Palm Beach County
Even with the challenges ahead, medical leaders consider recent developments and plans for more growth in medical education here reason to cheer.
 
“To have doctors trained here in Palm Beach is going to give us a better opportunity to have physicians practice in Palm Beach,” said Dr. Jose Arrascue, a nephrologist at JFK Medical Center and a Palm Beach County Medical Society board member. “They are going to have local ties and they’ll get used to what makes Palm Beach a great place to live: the weather, the multicultural opportunities and things like that.”
 
The opportunity to continue his residency, the weather and diversity are what attracted Dr. Alvaro Castillo to the fledgling general surgery residency at JFK. The 30-year-old native of Nicaragua completed medical school in Managua before moving to Miami to start residency training at Jackson Memorial Hospital through the University of Miami. Castillo, who moved to West Palm Beach in July, said he would love to practice in Florida if the opportunity arises.
 
“The diversity of the people here has always interested me,” Castillo said.
 
Castillo — and the 64 students starting medical school at FAU on Monday — could be part of a white coat brigade, as it were, that will have to grow dramatically if Florida’s healthcare needs are to be met.
 
“The problem in the state is profound,” said Gardner, of UM. “We are one of the states with the worst first-year residents deficiencies.”
 
Though Gardner said the state’s leadership has recognized the problem, tightening state and federal budgets are likely to harm the cause.
 
Residencies rely heavily on Medicare for funding, Gardner said. Potential cuts to Medicare represent an “enormous threat,” he said.
 
“The consequences would be that there would be even less residency training positions, and medical schools would be turning out physicians with no place to train,” the UM official said.
 
---

Search top vendors, suppliers, services providers & more