California physicians upset with work force study

A new study indicates no physician shortage in California, but physicians and recruiters beg to differ.

By Jay Greene, amednews staff. May 7, 2001.

California physicians have a new target for their frustration: A study concluding that there is no physician shortage, that satisfaction is high and that compensation is comparable to national averages.

"Our report flies in the face of anecdotes that doctors are leaving the state in droves," said Edward O'Neil, PhD, director of the Center for Health Workforce Studies at the University of California, San Francisco.

In the UCSF study released last month, researchers found that California had increased its physician-to-population ratio 7% to 190 patient care physicians per 100,000 population in 2000 from 177 per 100,000 in 1994, a ratio slightly lower than national averages of between 195 and 200. UCSF used AMA Masterfile data but didn't count resident physicians or part-time physicians who work less than 20 hours a week. Critics of the study contend that the data are outdated, incomplete and flawed.

UCSF researchers also used a 1998 survey of 2,000 California physicians to conclude that income is not declining drastically because of managed care. Median yearly incomes in 1998 ranged from $120,000 to $140,000 for generalists and $200,000 to $250,000 for specialists, the study found.

While the report noted shortages of physicians in 25 of the state's 58 counties, Dr. O'Neil said most of those counties are rural and contain only a small fraction of the state's 65,000 patient care physicians and, in turn, a small fraction of the state's overall population The ratio of physicians to population varies from a high of 238 per 100,000 in the San Francisco area to 120 in the Sacramento region, which includes several rural counties. The Council on Graduate Medical Education, a federal work force advisory panel, recommends 145 to 185 physicians per 100,000 population.

"The UCSF study is off-base when it concludes that California has an oversupply of doctors and that we have no problems here," said Jack Lewin, MD, president of the California Medical Assn. "We have a serious problem recruiting doctors, and access to subspecialists is limited in many communities."

Dr. Lewin added that the real physician supply crisis is expected to hit the state soon. "From what we are hearing, it may be a horrendous problem in one year," he said.

Recruiters also say serious problems exist in attracting physicians to California, especially specialists such as cardiologists, anesthesiologists, radiologists, general surgeons, dermatologists and urologists.

"There are not many physicians who want to come to California because of the low compensation and the high costs of living in the cities," said Steven Thomas, vice president of the western region with Merritt Hawkins & Associates, a Dallas-based recruiting firm. "The ones who we recruit either are already here and want to relocate or have made their money elsewhere and want to relocate here from the east for the climate."

Surveys of physicians in Sacramento, Santa Clara County and Sonoma County showed that physicians are leaving those areas and retiring earlier than expected, Dr. Lewin said. The CMA is expected to release its own statewide survey of physicians in June.

At the Sierra Sacramento Valley Medical Society, a survey of members found a 12% decrease in practicing physicians between 1995 and 2000 while population increased nearly 10%, said William Sandberg, its executive director. Specialties that lost the most physicians included family practice, obstetrics-gynecology, internal medicine, diagnostic radiology, psychiatry, emergency medicine, ophthalmology, pediatrics and pathology.

"We understand that things can change rather rapidly, especially in a state like California with all its managed care," Dr. O'Neil said. "There probably are genuine shortfalls in some areas and in some communities. But I don't think overall we have a big problem."

In Santa Clara, 95% of physicians said they have problems recruiting other physicians, according to a survey by Santa Clara County Medical Assn. In addition, 44% said they plan to retire within three years.

"We are seeing physicians with medical problems in their 50s and 60s retire because they can't afford to cut back," said Eugene Ogrod, MD, who is the chief medical officer for development with Sutter Medical Foundation in Sacramento.

"A few years ago they could back off and still meet overhead. Now, even if you back off a little, all you do is pay your overhead," he said.

Although they still remain relatively low, according to the UCSF study, dissatisfaction rates also appear to be increasing. In 1991, 14% of physicians were "dissatisfied" with their practice situation. By 1999, that percentage had climbed to 18%.

"We are seeing physicians leaving the state for other parts of the country because they are fed up," said Dr. Ogrod, who also is on the AMA Council on Medical Services."

To successfully recruit, Dr. Ogrod seeks physicians with previous ties to California. "The larger systems have a greater ability to recruit because they can afford to offer additional financial support to doctors," he said. "Even so, I am very selective."

While the UCSF study showed that the number of patient care physicians in California is increasing, the rate of overall increase in the state is lower than national averages.

Total physicians per 100,000 population in California increased only 2% to 280 in 1999 from 275 in 1995 compared with an 8% increase in U.S. physician-population ratio to 285 from 264, the AMA said. In addition, California dropped to 14th in the nation in total physicians per 100,000 in 1999 from sixth in the nation in 1980, the AMA said.

"I am not a pessimist," Dr. Lewin said. "We are going to solve this problem, but we aren't going to solve it by pretending it doesn't exist."