Thursday, November 07, 2013
Meeting the demand for more doctors

By Dr. Anthony Policastro
The law of supply and demand governs many things. One of those things is the number of physicians available to the population. Many factors are involved in trying to figure out how many physicians need to be trained. Even if we have the right number of physicians nationally, that might not be what we need. There may be too many in one geographical area. There may not be enough in another. There may be enough physicians in an area but they may not be the right mix of specialties. As we move forward over the next 10 to 15 years, a number of factors will affect the number of physicians. Most of these factors suggest that there will not be enough physicians to meet the needs of patients. Right now there are about 680,000 physicians in this country. The best estimate for 2025 suggests that we will need about 860,000. Looking at the projections, we will likely have about 735,000 - a significant shortfall. As is often the case, a number of factors are involved. One has to do with the way we practice medicine. When I was a pediatric resident in the 1970s, the hours were long. Many weeks, we spent 110 of the 168 hours of the week in the hospital. We had to cover the Emergency Room. We had to spend the night at the hospital. The expectation was that when we finished out residency, our practice would be similar. We would work in the office. We would cover the needs of the ER. We would take care of hospitalized patients at night. Over the years, it became apparent that tired physicians were not the best decision makers. Therefore, a number of changes occurred. Resident hours were shortened. ER physicians specialized in handling ER patients. Hospitalists began to take care of hospitalized patients. The result was a better lifestyle for the practicing physician. However, it meant that many physicians were now doing full time things that other physicians used to do part time. For example about 10% of physicians practice as hospitalists. They do not work in an office. That 10% is available to treat patients only when they are hospitalized. A second important factor is the Baby Boom population. There will be many more patients. They will live longer and need medical care. Statistics suggest that this will double the number of patient visits for individuals over age 65. There will not be double the number of physicians treating that group of individuals. A third factor is related to physician retirement. In the past about half of physicians worked until they were 70 years of age. Now half of them retire by age 65 which results in less physicians. The Affordable Care Act is going to require more physicians to care for the individuals who will now have insurance. While many of those individuals without insurance are relatively healthy, that is not true for all of them. The estimate is that about 31,000 physicians will be needed to cover this group. Right now there is a significant federal subsidy to residency programs. With the need for budget cuts to balance the federal budget, it is likely that these programs will suffer. It is not clear what effect that will have on the number of residents. Another factor is related to practice ownership. In the past most physicians owned their own practices. The amount they made was dependent upon the number of patients they saw. More physicians are now working for hospitals. The result is that they receive a salary no matter how many patients they see. In the past physicians who owned their own practice saw more patients on the average than salaried physicians. This is liable to be true in the future. The bottom line is that we need to pay careful attention to what appears to be an upcoming physician shortage. It takes about eight years to train a physician (four years of medical school and four years of residency). Therefore, if we think the shortage is going to occur in 2025, now is the time to do something about it. We have about four years to put a fix into place. One viable approach is to use more nurse practitioners and physician assistants. However, those individuals also have an extended training period. In either case, the need for action is now.

Free glucose screenings offered Nanticoke Health Services will host a free glucose screening in honor of National Diabetes Awareness Month. The screening will be held from 7 to 9 a.m. on Friday, Nov. 15, at the Nanticoke E Z Lab located at 505 W Market St., Georgetown. This screening is free and registration is not required. An eight hour fasting is required. A registered dietician and certified diabetes educator will be available to answer questions and provide information about managing your diabetes. For more information about the screening, call 629-6611, ext. 8948.

First case of flu confirmed Delaware's Division of Public Health (DPH) reports the state's first laboratory confirmed case of influenza for the 2013-2014 flu season. The case is a woman between age 30 and 40 from Wilmington. She is not hospitalized and did not receive a prior flu vaccination. There are two main types of influenza (flu) virus - types A and B - that routinely spread in people and are responsible for seasonal flu outbreaks each year. Delaware's first case is an influenza A strain. DPH urges all Delawareans 6 months of age and older who have not yet been vaccinated against the flu to get a vaccine as soon as possible. The vaccine is readily available through medical providers, pharmacies, and some grocery stores. DPH will conduct public flu clinics including some with evening hours at various locations in the state. For DPH flu clinic schedules for this season, visit For more information on influenza prevention, diagnosis and treatment, call the Division of Public Health at 1-888-295-5156 or 302-744-1033, or visit

Drug Take-Back event a success Delaware collected 5,258 pounds of unwanted or expired medicine during the Oct. 26 Prescription Drug Take-Back Day, according to the U.S. Drug Enforcement Agency (DEA) and Division of Public Health. It was the third highest total ever collected at a Delaware Drug Take-Back event and the highest total for a fall collection date. Since the first statewide Drug Take Back event was held in May 2010, Delaware's eight Drug Take-Back Days have collected a total of 33,592 pounds of unwanted or expired medicines.

Hospice offers grief workshop Delaware Hospice's Family Support Center will present a workshop, "Coping with the Holidays," with Dr. Judy Pierson, clinical psychologist, from 10 a.m. to noon, on Saturday, Nov. 16, at the Delaware Hospice Center, Milford.

When you've lost someone close to you, the holidays can bring memories of previous years - some good, some bad. As people share seasons greetings, what's often a time of joy and excitement for many becomes an emotionally-charged festive roller coaster for those who are grieving. In this lively and engaging presentation, Dr. Judy offers useful advice and suggestions to help you and your family cope with your loss during and after the holidays. To reserve your space, contact Michelle August at 302-478-5707, ext. 1103, or 800-838-9800, or email

School of Nursing plans Open House Beebe Healthcare's Margaret H. Rollins School of Nursing invites anyone interested in entering the field of nursing to attend the school's semi-annual Open House on Thursday, Nov. 14, from 3:30 to 5:30 p.m. Ginny Rickards, MEd, RN, admissions chairperson, will conduct information sessions every 30 minutes (last session begins at 5 p.m.) to discuss educational opportunities at the school for those interested in the two-year, four-semester curriculum that begins each August. Representatives from the University of Delaware's associate in arts degree option will also be available to answer questions. The school is located behind Beebe Healthcare's Medical Center in Lewes. Pre-requisite college courses and a certified Nursing Assistant Course are required prior to enrollment in the Margaret H. Rollins School of Nursing program. For more information and to register for the Open House, call the School of Nursing at 645-3251.

Stroke and osteoporosis screenings Residents living in and around Bridgeville may be screened by Life Line Screening to reduce their risk of having a stroke or bone fracture at Union United Methodist Church in Bridgeville on Monday, Nov. 11. The event is sponsored by Bayhealth Medical Center. Screenings identify potential cardiovascular conditions such as blocked arteries and irregular heart rhythm, abdominal aortic aneurysms, and hardening of the arteries in the legs, which is a strong predictor of heart disease. A bone density screening to assess osteoporosis risk is also offered and is appropriate for both men and women. Packages start at $159. All five screenings take 60 to 90 minutes to complete. For more information or to schedule an appointment, call 877-237-1287 or visit Pre-registration is required.

Beebe announces name change Beebe Medical Center has changed its named to Beebe Healthcare, Jeffrey M. Fried, FACHE, president and CEO, announced Tuesday, Oct. 29, during the opening festivities of the new Beebe outpatient services in Georgetown. In focus groups that took place in 2012, participants made clear that the term "medical center" did not describe the scope of services and geographic locations that Beebe provides. The decision was made to update the name. The opening of Beebe Healthcare's new outpatient services in the College Park Medical Pavilion in Georgetown is an example of Beebe's effort to make healthcare more accessible to people in Georgetown and in the surrounding rural areas. The building is conveniently located in College Park, a new, mixed-use development at the intersection of Rt. 404 and Rt. 113 and across the street from Delaware Technical Community College. The development already houses La Red Health Services. For more information, visit

State to receive restitution payment The state will be paid $2 million by Johnson & Johnson as part of national settlement to resolve allegations that the New Jersey-based pharmaceutical manufacturer fraudulently marketed the antipsychotic drugs Risperdal and Invega. Of this payment, secured for Delaware by the Attorney General's Medicaid Fraud Control Unit (MFCU), the Delaware Medicaid and Medical Assistance program will directly recoup $943,821 in civil restitution and fines. Nationwide, Johnson & Johnson and its subsidiary, Janssen Pharmaceuticals, Inc., will pay state and federal governments $1.2 billion over charges that the companies promoted and marketed Risperdal and Invega for uses that were not approved by the Food and Drug Administration and for uses that were not medically indicated, made false and misleading statements about the safety of the two drugs, and paid illegal kickbacks to healthcare professionals and long-term care pharmacy providers to induce them to promote or prescribe Risperdal to children, adolescents and the elderly. Going forward, Delaware will receive an additional 10 percent bonus in its share of future settlements in cases like this under the new Delaware False Claims and Reporting Act. Earning a 10 percent bonus in shares of future false claims settlements is expected to generate hundreds of thousands of additional dollars in recoveries for Delaware and the Delaware Medicaid and Medical Assistance program.

Annual Run/Walk for MS The annual PNC Bank Thanksgiving Day Run/Walk for MS in Wilmington will take place on Thanksgiving Day, Thursday, Nov. 28. For more information and to register, visit All proceeds go to MS research and the programs and services needed by more than 1,550 Delawareans with MS and their families. Stroke and osteoporosis screenings Nov. 25 Residents living in and around the Seaford community can be screened to reduce their risk of having a stroke or bone fracture. Seaford VFW Post #4961 will host Life Line Screening on Monday, Nov. 25. This event is being sponsored by Bayhealth Medical Center. Screenings identify potential cardiovascular conditions such as blocked arteries and irregular heart rhythm, abdominal aortic aneurysms, and hardening of the arteries in the legs, which is a strong predictor of heart disease. A bone density screening to assess osteoporosis risk is also offered and is appropriate for both men and women. Packages start at $159. All five screenings take 60 to 90 minutes to complete. For more information or to schedule an appointment, call 1-877-237-1287 or visit Pre-registration is required.