States ramp up efforts to keep residents

Fearful of the impact physician shortages could have on their citizens' health, a number of states are looking to keep more of the medical residents they train.

Utah educators are hiring residents with ties to the state, and in October Pennsylvania's governor sent a letter asking residents to stay after graduation. And a new Michigan program may be one of the most ambitious efforts yet to keep medical residents in state.

The Michigan Health Council this fall began developing a marketing campaign to encourage more residents to stay after graduation. The council is trying to raise at least $30,000 to sponsor activities to give young physicians a better idea of what Michigan has to offer.

Retaining more residents, said the health council's president, Anne Rosewarne, is one cost-effective way to begin meeting the need for more doctors. Michigan expects to be short 6,000 physicians by 2020, according to a study the Michigan State Medical Society commissioned. Nationally, work-force experts predict a shortage of 85,000 to 200,000 physicians by 2020.

The looming physician shortage has prompted some states to become more active in retaining residents because one of the strongest predictors of where physicians will practice is where they did their residency, researchers have found.

According to the Center for Workforce Studies at the Assn. of American Medical Colleges, of the physicians who trained in Michigan, 46.1% are practicing in the state. On average, states keep 47.6% of residents they train, according to the AAMC.

More than a dozen states have done work-force studies to help determine how to increase the number of physicians practicing within their borders, according to Edward Salsberg, director of the AAMC's Center for Workforce Studies, and 28 of the 125 allopathic medical schools expanded their first-year classes between 5% and 9% this fall.

"They are very interested in how to get doctors in their states," Salsberg said. "It's a priority for state legislatures. They are looking at a variety of strategies to implement in order to direct physician supply."

Gar Elison, executive director of the Utah Medical Education Council, said physician retention is on everybody's radar. "Nationally, it's hit and miss what's going on in terms of what states are doing to retain residents or expand residencies. But there's no question states with the highest population growth are leading the way."

Utah is the fifth fastest growing state, according to the Census Bureau.

Courting residents

Populous states, such as California and New York, tend to more easily retain the physicians they train, according to researchers. Smaller states have to rely on other factors work-force experts have identified as key to keeping physicians after graduation, such as family ties.

That's the strategy some resident educators in Utah are using. They are giving preference to candidates who express a desire to practice in the state. Data from the AAMC show that Utah keeps 41.2% of the medical residents it trains.

"We're trying to nudge that up," Elison said. His goal is to keep 60% to 80% of residents.

"We don't want to set a goal of higher than 80%," he said. "We want to be able to pick and choose the best residents" through the National Resident Matching Program.

John Berneike, MD, director of family medicine residency at St. Mark's Family Medicine Center in Salt Lake City, has been particularly successful using that strategy with his program.

St. Mark's has a total of 12 family medicine residents, with four per class. In 2006 and 2005 all of its graduates stayed. In 2004, of the four graduates, one left to fulfill a National Health Service Corps obligation and one left with a spouse going to an out-of-state law school. In 2003, two stayed, one joined the military and one moved to the Midwest to be closer to family.

Dr. Berneike and his colleagues at St. Mark's began favoring qualified resident candidates with Utah ties in the late 1990s.

"During the recruiting season, we look for people who are likely to stay in Utah when they are done," Dr. Berneike said. "We make an effort on the front end."

Pennsylvania, with its high medical liability insurance premiums, is another state looking to improve resident retention. In 2004, 7.8% of Pennsylvania doctors-in-training stayed after completing residency, down from 50.5% in 1994, according to the Pennsylvania Medical Society.

In October, Gov. Edward G. Rendell sent a three-page letter to doctors in training programs that encouraged them "to stay right here in Pennsylvania" for the next step in their careers. The letter talked about the sharp reduction in the number of medical liability cases filed in the state, a program to help defray physicians' medical liability insurance premiums and an increase in the number of liability insurers willing to write policies in Pennsylvania.