by James C. Sherlock
Virginia’s political class ignores the severe shortage of doctors and nurses in Virginia — except when it actively works to make the problem worse. This essay will illuminate both the issue and the votes that rejected proven solutions in the 2020 General Assembly.
Virginia data – 2019 State Physician Workforce Report .
Physician Workforce Profile
• Virginia Population: 8,517,685
• Active physicians: 22,419
• Primary care physicians: 7,691
• Total MD or DO students: 3677
• Total Residents: 2457
• General surgeons: 623 / over age 60 – 30%
• Neurosurgeons: 132 / over age 60 – 29%
• Orthopedic surgeons: 461 / over age 60 – 43%
• Plastic surgeons: 189 / over age 60 – 41%
• Thoracic surgeons: 94 / over age 60 – 34%
• Vascular surgeons: 96 / over age 60 – 22%
• Pathologists: 258 / over age 60 – 57%
• Neurologists: 338 / over age 60 – 42%
• Preventive medicine: 229 / over age 60 – 52%
• Pulmonologists: 117 / over age 60 – 71%
Virginia rank among 49 states in active physician density per 100,000 population:
• 26th in physicians;
• 27th in patient care physicians;
• 33rd in patient care general surgeons ; and
• 29th in physicians age 60 or older
Undergraduate Medical Education – rank among states
• MD and DO student enrollment per 100,000 population, AY 2018-2019. Rank: 18.
• Percentage Change in student enrollment at MD and DO Schools, 2008-2018. Rank: 15.
• Percentage of MD students matriculating in-state, FY 2018-2019. Rank: 35.
Graduate Medical Education
• Total residents/fellows in ACGME Programs per 100,000 population as of December 31, 201. Rank: 33.
Retention
• Percentage of physicians retained in state from undergraduate medical education (UME), 2018 – 31.4%. Rank: 32.
• Percentage of physicians retained in state from graduate medical education (GME), 2018 – 38.5%. Rank: 40.
These data are exactly what you think — bad. Two trends jump off the page:
- Our physician workforce, notably our surgeon workforce, is small relative to the national average and it is aging quickly.
- We are not attracting enough Virginians to our medical schools and are not retaining enough Virginia medical school graduates and residents at Virginia hospitals.
Let’s address why we cannot retain or attract physicians in Virginia at a higher rate than we do.
Virginia’s Medical Schools. Virginia clearly needs an active program to recruit more Virginians to its medical schools and recruit more medical school graduates and residents to practice in Virginia.
A search of the Department of Health Professions and the Department of Health websites yields the impression that they do not have increasing Virginia’s number of physicians and nurses on their plates. Across the rest of the government, the search terms physician retention and physician recruitment returned no results on virginia.gov.
Based on a search of its website, the Medical Society of Virginia also seems to have no formal program for recruitment or retention of physicians here. I hope I am wrong.
My search of the websites of Virginia’s medical and nursing schools did not encounter any indication that they make an effort to retain their students in Virginia. They may do it and not publicize it or I missed it. I hope so.
Surgeons. The direct cause of our surgeon shortage is the Certificate of Public Need (COPN). Maryland has 2.5 million fewer people than Virginia and yet nearly as many surgeons as the Commonwealth: 1,595 in Virginia, 1,507 in Maryland. Maryland is second among 50 states in active physician density, Virginia 26th.
Maryland, which exempts physician-owned surgical centers from COPN regulation, has well over 500 physician-owned surgical centers (POSCs). Virginia has about 80 ambulatory surgical centers (ASCs), about half of which are owned by hospitals and reimbursed at hospital rates. Physician-owned ASCs compared to hospital outpatient departments are about half the cost to government, commercial and individual payers for the same procedure by the same surgeon, yet the surgeon himself makes more for that procedure in his ASC than he does in the hospital outpatient department. Such is the impact of hospital facility fees on the total bill. That is a self-making case for Virginia to model the Maryland exemption.
Del. Jason Miyares, R-Virginia Beach, introduced HB 1094, which exempts physician-owned ambulatory surgery centers from COPN review, which would emulate the Maryland exemption, and it was defeated. The hospitals, which have paid for the privilege, control the votes many members of the General Assembly. Surgeons, denied any possibility of owning their own surgical centers in Virginia, understandably seek greener pastures.
Primary Care Physicians
Miyares also introduced HB 608 establishing a Health Enterprise Zone Program and Fund to attract primary care physicians to underserved areas. It also failed. Perhaps the hospital lobby noticed that program has proven in Maryland to significantly reduce emergency room visits.
Nurses
On March 4, 2020, 7861 nursing positions were being actively recruited in the Commonwealth, about 3% of the 264,745 vacancies nationwide. I cross-checked the indeed.com numbers with Virginia healthcare systems’ individual recruiting websites and found them accurate.
Virginia currently has 107,540 active RN licenses in the state, 2.24% of the national total with 2.59% of the nation’s population , a shortage of 14% compared to the average density. That means that even if all of the open positions were filled, Virginia would be short about 6,000 nurses relative to our population.
Accountability
The Governor is a physician. By defeating Miyares’ bills, the General Assembly, primarily the Democrats, has actively discouraged both surgeons and primary care physicians from practicing in Virginia.
The House members who voted to kill Del. Miyares two bills are :
• HB 1094 – Delegates Sickles, Hope, Price, Levine, Aird, Hayes, Adams, D.M., Guzman, Delaney, Tran, Willet, Hodges, Head, and Avoli. The last three are Republicans.
• HB 608 – Delegates Sickles, Carr, Krizek, Hayes, Jones, Cox and Brewer. Cox and Brewer are Republicans.
James C. Sherlock, a Virginia Beach resident, is a retired Navy Captain and a certified enterprise architect. As a private citizen, he has researched and written about the business of healthcare in Virginia.
