The Pennsylvania Health Care Crisis: No Farm Team

By PA State Rep. Josh Shapiro

When the 2008 World Series Champions Philadelphia Phillies needed a player to strengthen their lineup, the coaches often turned to the minor leagues to scout for the next best thing. On the farm team, players train and practice before moving up the ranks to the major league.

Smart government should also look toward the future to anticipate problems before they become crises, training the farm team today to solve the challenges of tomorrow. 

Pennsylvanians of all ages will face sharply higher health care costs in a decade unless our state government acts now to bring new doctors, especially primary care and OB/GYNs, to our Commonwealth.

Currently, we aren’t recruiting or retaining enough new doctors to meet our future health care needs.  While it might not yet be a full-blown crisis, within the next 10 years, we will have far fewer doctors and far more health care consumers.  

There are at least three reasons why this problem exists.

First, Pennsylvania has one of the largest and fastest-growing populations of elderly in the country.  As this population increases, so will their health care needs.  Simultaneously, our doctors are getting older and planning to retire.  According to the Pennsylvania Department of Health (DOH), 41% of practicing doctors in Pennsylvania plan to retire in the next ten years, and half of those physicians plan to retire in the next five years. 

Second, according to recent DOH statistics, only 7.8% of doctors providing direct patient care in Pennsylvania are under the age of 35.  With nearly half our doctors retiring and very few young doctors practicing, it’s like having a veteran baseball team with no farm system. 

Third, and perhaps most importantly, we are not on track to increase the number of young doctors practicing in Pennsylvania.  Pennsylvania boasts one of the largest concentrations of medical school students in the nation but we have trouble retaining these medical residents after they complete their training.  While the number of medical residents training in Pennsylvania has increased in the past decade, the number of residents staying in Pennsylvania to practice medicine has decreased significantly.  In 1994, 50 percent of the medical residents who trained in Pennsylvania stayed here to practice; just 10 years later, less than 8 percent stayed after completing medical school. This shortage is especially acute with primary care doctors and OB/GYNs.

Government should look to the future to anticipate problems before they become crises.  If we as a community want to protect ourselves from even higher health care costs in a decade, now is the time to act to provide incentives for doctors to practice in Pennsylvania.  In an effort to do just that, I passed legislation in the House in 2007 to establish a loan forgiveness program for primary care doctors and OB/GYNs who agree to practice in Pennsylvania for a decade. 

Under my proposal, primary care physicians and OB/GYNs would receive 100 percent medical school loan forgiveness in exchange for agreeing to practice medicine in Pennsylvania for at least 10 years.  Participating doctors would receive a portion of their loan repayment for each year that they stay in Pennsylvania. If they leave the state before fulfilling their entire 10 year commitment, they would have to repay the state any money they received.   Statistics show that doctors who practice in Pennsylvania for at least 10 years are likely to stay and practice permanently, making the tax dollar investment worthwhile. 

The state has an important role to play in mitigating the overall health care crisis.  While there are many reasons for our current health care crisis that we must address over the long term, we cannot shy away from addressing a part of the problem that is fixable today.  The fact that in the next decade we will not have enough doctors to care for us requires government attention today.  We must act now to build up our farm team and sustain the availability of high quality health care in Pennsylvania. 

Rep. Josh Shapiro represents the 153^rd Legislative District in Montgomery County. For more information, visit www.pahouse.com/Shapiro.