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Help wanted: Docs

The Baltimore Sun

The U.S. is facing a shortage of physicians in the next dozen years, but the problem is even more acute in Maryland, where the situation could become severe by 2015, particularly in primary care, emergency medicine and at least a half-dozen specialties. A report released this week by the Maryland Hospital Association warns the situation will be particularly bad in the rural areas, where whole counties may be critically understaffed. Action needs to be taken soon to avert a crisis.

In Caroline County, for instance, it's difficult to find a pediatric specialist or to even get an appointment with a urologist or psychiatrist 20 miles or more away in Easton. It's even worse for those who don't have private insurance. "The ones who can make the drive have to go to Baltimore right now," says Dr. Leland D. Spencer, the Eastern Shore county's health officer.

Metropolitan Baltimore may be better off than the rest of the state with an above-average supply of doctors thanks to the presence of two major medical schools, but problems still exist in emergency care and some other specialties. (It should be noted that the study didn't look at the other roadblocks common to inner-city health care, including high unemployment and poverty rates, and lack of child care.)

The prescription for the shortage? Step one is for the nation's medical schools to train more doctors. Experts project they'll need to increase their numbers by at least a third, from 25,000 each year to perhaps 35,000, in order to meet the growing health needs of an aging population. Nursing faces a similar shortage, and nursing schools must also be prepared to add faculty and facilities to address the growing need.

But there is also much that can be done on the state and regional level. One potential help would be for the state to initiate a loan forgiveness program or other financial incentive to draw physicians to small towns on the Eastern Shore and in Western Maryland. Another would be to expand the use of foreign-born doctors brought to the U.S. through the H-1 visa program. That's happening now but could be expanded - if Congress allows it.

Providing facilities for telemedicine (where patients can get a medical consultation through the use of video-conferencing equipment) might also prove useful. So would raising third-party reimbursement rates to make practicing in Maryland more attractive.

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