As the health care delivery system continues to undergo significant changes in America, WalletHub recently released a comparison of the 50 states and the District of Columbia designed to identify 2015’s Best and Worst States for Doctors.
We have all witnessed changes locally, as with the Affordable Care Act, commonly referred to as Obamacare, and the rise of hospital networks. In addition, the rising costs of education have left the average medical school graduate with $176,000 of debt. The aging of baby boomers is causing an increase in enrollment of Medicare and the inevitable costs of caring for the aging population. Many older, seasoned physicians who are baby boomers themselves are choosing retirement in face of all these changes, not to mention the added costs of maintaining electronic medical records and the costs of malpractice insurance.
Today’s newly graduated physicians are certainly mobile as to where they choose to practice. Unfortunately, WalletHub’s Best and Worst States for Doctors ranked New York State number 50 for work environment. This is unfortunate for the citizens of New York State, especially since their tax dollars help educate medical students at both upstate and downstate medical universities. Many of the students from those institutions will end up practicing in other states.
In fact, a report by the Center for Health Workforce at the University at Albany in 2014 found that 55 percent of doctors who completed a residency in New York left to practice in another state. In 1999, that percentage was 45 percent. Nationally, 17 percent of all U.S. doctors completed their medical training in New York, making it the No. 1 state for training doctors.
In essence, New York State is a net exporter of doctors to other states. This is very troubling given the shortage of physicians, especially primary care, in New York, at a time when the Affordable Care Act is increasing the number of insured here.
One concern for physicians leaving New York State is malpractice costs. Given that the trial lawyers have a stranglehold over the New York State Legislature with their self-serving agenda, it is unlikely we will ever see any real tort reform legislation, unlike states that import New York doctors. With the scandals surrounding Albany leadership, it is clear that personal gain supersedes the public welfare.
Also, the lack of collective bargaining for physicians in New York State makes other states more attractive to doctors. There has been a bill of some form to correct this for over 20 years. Currently the bill is A0036 Gottfried/S3690 Hannon supported by the Medical Society of New York, the Central New York Area Labor Federation, the Physician Teamster Alliance 1149 and the Greater Syracuse Labor Council. It is designed to counter the McCarran-Ferguson Act of 1945, which essentially gives the health insurance industry a legal monopoly. Even in Central New York, Excellus and United Healthcare have a 73 percent monopoly.
While in Albany, I personally presented a case to a leading member of the State Senate in which a specialist lied in a patient’s record to get the proper testing for the diagnosis and treatment for a cancer patient. I asked the senator: “Is this how medicine must be practiced in New York State?” Apparently the answer is still yes, due to legislative inaction.
Unlike states with collective bargaining, there is no oversight of contracts in New York between insurance companies and doctors that would help protect the public’s interest. A collective bargaining law in New York State would help provide that much-needed oversight. Meanwhile, doctors must continue to sign one-sided contracts, which jeopardize their ability to be patient advocates. Doctors, in essence, have become beholden to insurance company executives instead of the patients they took an oath to care for.
Our citizens, and in particular our working families that pay the premiums, deserve better. Our state legislators should put an end to this now.
In the meantime, our state will remain No. 1 in producing doctors and exporting them, but number 50 in rank as the state to practice in.
Dennis J. Nave, M.D., is president of the Onondaga County Medical Society and president of the Greater Syracuse Labor Council.