Friday, September 21, 2018
Health

Florida moves to keep more medical residents in state, but thousands more are needed by 2025

TAMPA — She walks around the burn center at Tampa General Hospital with the confidence of a veteran physician, her long blonde hair tucked into a pink polka-dot surgical cap.

"How is everything?" she asks a patient recovering from burns to her right arm and shoulder. "Do you mind if I take a peek?"

But Dr. Alicia Billington isn't fully seasoned — not yet, anyway.

She's among the expanding ranks of resident trainees at Tampa General. The hospital grew its program by 5 percent this year, and plans to continue on that trajectory in the future.

It's happening across Florida. Hospitals statewide have added 422 residency slots this year, bringing the total number to about 4,400, according to the Teaching Hospital Council of Florida.

Steven Sonenreich, the council's chairman and CEO of Mount Sinai Medical Center in Miami, called the figure "a huge boost for our teaching hospitals."

But it isn't enough to resolve a looming doctor shortage.

A recent study found Florida will be short nearly 7,000 physician specialists over the next decade — and will need to create more than 13,500 new residency positions to address the deficit.

"This is a huge issue for Florida," said Marty Petty, of the University of South Florida Center for Advanced Medical Training and Simulation, during a health care seminar last week. "And we don't believe people really understand it."

Residency programs enable medical school graduates to train under physician educators. Most last between three and seven years, depending on which specialty the resident pursues. They are notorious for their long hours. Billington says she starts her day at 6:30 a.m. and often doesn't return home until after 10 p.m.

Florida had 19 medical residents per 100,000 citizens in 2011 — the ninth-lowest rate in the country, according to the Association of American Medical Colleges. The national average was 36.6. New York had 82.2.

That's a problem, Sonenreich said, because physicians tend to stay in the state where they finish their training.

"We now have 1,300 medical school graduates, but only 800 (open) in-state residency training slots," he said. "What that means is that approximately 500 individuals graduating from Florida medical schools have to leave the state in order to pursue residency and fellowship training."

Most won't return, he said.

The concern over graduate medical education in Florida has caught the attention of state lawmakers. In 2013, Gov. Rick Scott and the Legislature dedicated $80 million in recurring state and federal funds to growing residency programs. Earlier this year, they created a program that gives hospitals a $100,000 bonus for each new residency position in certain specialties.

The investment from the state enabled All Children's Hospital Johns Hopkins Medicine in St. Petersburg to add almost 10 residency positions this year. The hospital has about 70 residents between its two programs, hospital executives said.

Tampa General boosted its number of residency positions from 308 to 322, the hospital said.

Separately, the for-profit hospital chain HCA last week announced a partnership with the University of Central Florida that will create another 550 slots in hospitals across northern Florida.

In the Tampa Bay area, HCA trains newly graduated doctors at six hospitals: St. Petersburg General, Northside in St. Petersburg, Largo Medical Center, Regional Medical Center Bayonet Point in Hudson, Oak Hill in Brooksville and Brandon Regional. The chain hopes to grow the number of resident trainees in the region from 238 to at least 600 over the next five years, HCA West Florida chief medical officer Dr. Larry Feinman said.

"Selfishly speaking, we can open as many hospitals as we want, but if there are no doctors to take care of the patients, we're not going to fulfill our mission," he said.

But hospitals and their university partners still have a long way to go.

In particular, they'll need to boost the number of residency positions in psychiatry, general surgery, rheumatology and thoracic surgery — four of the specialities expected to have the largest deficits in 2025.

What's more, they'll have to focus on creating new slots in southwest Florida, north central Florida and the central Panhandle, where the shortage will be the most acute.

Whether the Legislature will further increase funding to address the problem is unclear. Senate Health Policy Chairman Aaron Bean, R-Fernandina Beach, said he believes the federal government should direct more federal dollars for residency programs to Florida.

"We put up state money because we were tired of waiting on Congress," Bean said. "But the truth is, the federal government created this problem. If the federal government would look at it, they could fix it."

Even with additional money, hospitals will need to expand their programs "in a smart way," said Dr. Sally Houston, the chief medical officer at Tampa General.

"There was a time when residency was really an indentured servant model," she said. "As we're becoming more enlightened, we're really trying to teach (the residents). You have to have the faculty, the patient population and the other resources that go into providing a good experience for them."

Houston said Tampa General will be working with the USF Morsani College of Medicine to determine how — and how much — to grow over the next few years.

Feinman, of HCA, said time is a critical factor.

"Depending on the specialty, it can take up to a decade to train a doctor when we count medical school, residency and fellowships," he said. "To address the shortage a decade from now, we need to start now."

Billington, the plastic and reconstructive surgery resident, hopes to see the number of positions grow. She's proof, she says, that resident training helps keeps doctors in Florida.

Before beginning her training, she had considered settling in New York. But the community she found at USF and Tampa General persuaded her to take another look at Florida.

"I'm going to stay," she said. "This is definitely my home."

Contact Kathleen McGrory at [email protected] or (727) 893-8330. Follow @kmcgrory.

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