The number of doctors practicing in Florida has not kept up with the state’s surging population growth, and more money is needed to recruit and keep them here, hospital leaders said Wednesday.The shortage is particularly acute in four speciality areas: urology, thoracic surgery, nephrology and ophthalmology, according to a second annual report by the Safety Net Hospital Alliance of Florida and the Teaching Hospital Council of Florida. The alliance is made up of 14 hospitals, including Tampa General Hospital and Johns Hopkins All Children’s in St. Petersburg. So-called "safety nets" are hospitals that treat the uninsured, Medicaid cases and perform other charity care with the help of programs like Florida’s Low Income Pool. In addition to gaps in the specialty areas, the report also cited a "severe shortage" of primary care physicians in Southwest Florida, an area extending from Naples to Sarasota."The shortage of doctors presents a threat to the health security of the state," said Steve Sonenreich, president and CEO of Mount Sinai Medical Center in the Miami area and chair of the teaching hospital group. "There are not enough doctors, and the threat is growing." TO YOUR HEALTH: Keep track of trends and new developments that affect you. Visit the Times health page.Though the number of medical school programs has increased over the years at Florida universities, the number of residency spots at hospitals in the state has not kept pace, prompting many doctors to leave in order to continue their educations, said Lindy Kennedy, executive vice president of the safety net alliance.In 2013, Florida lawmakers made a point of investing in graduate medical education to address the shortages, Kennedy said. Since then, the report shows, the number of residency slots at the state’s teaching hospitals has increased by 29 percent. And Florida is among the national leaders in keeping newly trained doctors in the state to practice, with an 80 percent residency retention rate, according to the Association of American Medical College reports. But while the state has seen some progress since the inaugural 2015 report, which identified a shortage of nearly 7,000 physicians through 2025, hospital CEOs say there’s still plenty of work to be done. Based on the report, the hospital groups are hoping to secure more funding from state and federal sources to retain more doctors. They have laid out plans they think would help teaching and safety net hospitals in the future. Those plans are contingent on state and federal funding, which they intend to request in the state’s 2018-19 budget.They will ask for:• $2 million for areas of the state where the supply of primary care physicians falls short of the demand by more than 25 percent. This funding would give hospitals in Southwest Florida a $100,000 bonus for each medical resident in primary care. • $5 million to retain residency slots in the four speciality areas that the report says are in decline. • $50 million to help Florida’s 13 designated teaching hospitals offset financial losses associated with providing charity care. Last year, Florida’s Low Income Pool, which is designed to offset the expenses hospitals incur related to treating the poor and uninsured, covered $208.8 million of the $578.4 million in charity care provided by these teaching hospitals. Even as they move to increase residency positions, hospital officials say there are drawbacks to adding too many of them. "It’s a fine balance of delivering quality over quantity with the number of residency spots," Kennedy said.Tampa General Hospital already offers residency programs in the four underserved speciality areas mentioned in the report, said the hospital’s new CEO, John Couris. He is pushing for a new state designation that would give more funding to teaching hospitals that provide more than $10 million in charity care a year."As Florida continues to grow, academic hospitals are becoming more and more the primary care providers for the uninsured population," Couris said. "Our charity care volumes are increasing. We see some of the highest volumes in the state." Contact Justine Griffin at [email protected] or (727) 893-8467. Follow @SunBizGriffin.