Too few medical students stay in Virginia after graduation

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Study: Too few med students stay in Va. after graduation

By Amy Jeter, The Virginian-Pilot September 17, 2010

Fewer than 2 in 5 of Virginia's medical school graduates practice in the state,

a rate that puts the commonwealth behind much of the nation, according to

studies released Thursday by the Virginia Department of Health Professions.

Residents who trained in Virginia stayed at only slightly higher rates.

Such retention problems don't help the state, which paid more than $50 million

to support medical education in 2008 and faces an estimated shortage of 2,700

physicians by 2030, the reports said.

" This is a national problem, and we are competing to get these people to come in

and to be there when we need them, " Virginia Health and Human Resources

Secretary Dr. Hazel Jr. said Thursday.

But officials with Eastern Virginia Medical School in Norfolk said it matters

little whether Virginia's physicians received their education in-state. What

matters, they said, is that Virginia's medical education communities are able to

attract physicians.

" For every person who leaves Virginia, we get one that we would not have gotten

before, " said Dr. R. Pellegrino, associate dean for education at EVMS.

In 2008, 35 percent of the active physicians who had graduated from one of

Virginia's medical schools were practicing in-state, according to the

Association of American Medical Colleges. That put Virginia at 31 among 45

states with medical colleges.

The numbers for EVMS were higher than the state's percentage: Officials said

37.6 percent of nearly 3,000 graduates in the school's history live in Virginia.

About 39 percent of the active physicians who completed residencies or

fellowships in Virginia were practicing in the state, the study showed. That put

Virginia at 39 out of 50 states.

Local health professionals offered several explanations, including location and

pay.

With fewer big cities - where physicians are concentrated - and more rural

communities, Virginia is at a disadvantage, said Pellegrino.

The state also offers lower salaries, because of lower reimbursement rates from

government insurance programs such as Medicare, said Dr. Maizel, executive

medical director of Sentara Medical Group.

Most important, no significant loan repayment program exists to keep doctors in

the state after their residencies, said C. Combs, associate dean for

planning and health professions at EVMS.

" One of the things that clearly works is economic incentives, if they're big

enough, " Combs said.

In some ways, the residency system works against keeping future doctors in the

place where they attended medical school. The programs value geographic

diversity and seek the most talented students.

" Part of the bragging rights for a residency program is its attractiveness on a

national market, " Pellegrino said. " We would not want to be known as a school

that was packed with EVMS graduates. "

As job candidates, Virginia-educated physicians are slightly more desirable in

state because they're more likely to stay longer, Maizel said.

Some Virginia health officials worry that the state's trouble in keeping

home-grown doctors could foreshadow problems.

A shortage looms as doctors 55 and older start to reduce their hours or retire,

just as the state's aging baby boomers require more medical care.

The disparity of primary care providers and surgeons is likely to be the most

pronounced, according to researchers with the state Department of Health

Professions.

Virginia already has taken some actions to bolster the physician work force.

The state is investing $59 million in a building and renovation project that

will allow EVMS to increase each class size from 115 to 145 students, Combs

said.

Two other Virginia medical schools also have added to their class sizes, and two

new schools have opened: the Via Virginia College of Osteopathic Medicine

in Blacksburg in 2003 and the Virginia Tech Carilion School of Medicine in

Roanoke last month.

As a result, the number of Virginia medical school students graduating each year

is expected to increase to 786 by 2015, which is 21 percent more than the number

of medical students matriculating in 2009, said Virginia health secretary Hazel.

In a Thursday news conference, University of Virginia provost Arthur Garson Jr.

suggested other measures for ensuring Virginians' future health care needs are

met. The state should consider funding additional residency slots with the

stipulation that recipients must practice in Virginia for a number of years and

treat a certain number of Medicaid patients, he said.

He also recommended loan repayment programs. Garson and others spoke of

distributing doctors' responsibilities to physician assistants, nurse

practitioners, and even lay people, where appropriate.

" As you make life better for doctors in Virginia, they're going to stay here, "

Garson said.

Some second-year EVMS students said they hoped to settle in places that offer

the best opportunities in their specialties and that match their family needs.

Debt relief also wouldn't hurt.

Fourth-year medical student Mark Eakes counts plenty of ties to Virginia.

A Navy veteran, he's lived in Hampton Roads since 1998, and he and his wife

recently adopted three children from the Richmond area.

Eakes, 46, is researching opportunities on the Eastern Shore and the

southwestern part of the state to set up a practice after his residency.

However, he says he's " not ruled any place out. "

" Primary care will be in great demand, " Eakes said, " so I probably could go

anywhere in the country to practice. "

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