Demand for medical services grows in Virginia, but number of doctors doesn’t – The Virginian-Pilot

A Virginia Beach urgent care doctor noticed a trend that has gotten worse over the years and is putting patients in dangerous positions.

“It’s a daily occurrence,” said Dr. Glenn McDermott, of Minor Emergency and Family Care Center. “People come into the emergency room and (providers there) say ‘Follow up with your PCP’ and they can’t get in to see the PCP.”

One of McDermott’s recent patients, an octogenarian, had been hospitalized with pneumonia in August. She was given antibiotics and told to see her primary care provider soon. After she struggled to get an appointment sooner than a month away, she went to McDermott. After that, she still needed to see specialists, but over the following weeks, she was hospitalized twice more as her pneumonia got worse. She was ultimately diagnosed with lung cancer.

Situations like this woman’s show how important it is for some patients to be able to access care quickly and the potential repercussions of long waits to see overloaded providers.

“That’s the deadly part,” McDermott said.

He said not too long ago, it was easy to get follow-up care for patients to see a specialist within a couple days. That is no longer the case.

A recent study by Virginia Commonwealth University concluded that the number of primary care physicians and osteopaths, providers who focus on bone health, providing care in Virginia is roughly 25% lower than previous estimates.

The idea for the study originated in an effort to find out where exactly doctors are practicing and what kind of care they are providing, said Dr. Alison Huffstetler, the study’s leader and an assistant professor and clinician researcher at the VCU School of Medicine’s department of family medicine and population health. The study was completed by using health care claims data.

VCU found the number of medical doctors and osteopathic doctors remained somewhat stable — nearly 5,900 in 2019 — over each of the four years prior and 2019, but it still meant the workforce was spread thin. Huffstetler, a primary care provider, said she wasn’t surprised by the finding because many primary care physicians see their own high patient load and the long wait times for an appointment.

The VCU study results mean each of those doctors would have to care for about 1,500 patients each year for Virginia’s population of roughly 8.6 million.

At first, that doesn’t seem like too much, Huffstetler said. But it is believed an ideal level is 1,200 because of varying needs for patients who may need more specific and regular care, she said. Huffstetler said the study does not account for nurse practitioners or physician assistants, who are “very important,” but the data is less clear because of how the billing in medicine works.

The nationwide shortage of American physicians is predicted to worsen in the coming years to between 54,100 to 139,000 by 2033, according to a June 2020 study by the Association of American Medical Colleges. Of those estimates, the shortage of primary care physicians is estimated to land between 21,400 and 55,200 and a shortage of between 33,700 and 86,700 specialty physicians. The demand for medical services in the following years is expected to grow because of an increase in population while large numbers of physicians are expected to retire at traditional ages, according to the study.

Huffstetler and McDermott said there are ways to potentially address this shortage, such as reaching out earlier to children to find those interested in medicine and helping to build that interest. Huffstetler also said there is a need to focus on making sure more physicians are available in places where the need is even more dire.

“The policies that help move clinicians into areas that have higher needs are excellent and work well short-term, but they don’t always work out long term,” Huffstetler said.

Sentara awarded two Christopher Newport University professors a $95,000 grant to help pay for students in pre-health for materials, exams, preparation courses and application fees, as well as scholarships for nine students.

One of the professors, Gwynne Brown, director of pre-health programs at CNU, told the Virginian-Pilot the funding will help rural, minority and poorer students overcome barriers to medical schools. Studies have shown rural medical students are more likely to return to practice in rural areas, Brown said. There also are a disproportionately low number of doctors who identify as Black or Hispanic, according to the Association of American Medical Colleges.

Regional health systems also are doing their best to hire physicians. Specialties like neurology are some of the most difficult to hire for, according to Bon Secours and Sentara representatives.

“I think neurology is probably the one that jumps out at me that is challenging across the country to fill; rheumatology has been one that has been a challenge,” said Holli McConnell, manager of physician recruitment and retention of Sentara Medical Group. She added the system has placed two new rheumatologists across the system this year, but they are looking for more as retirements loom in 2023.

McConnell said most physicians leaving positions are required to give a six months notice, and similarly, hiring is not a rapid process.

“The industry line of thinking is that it’s three months to recruit and three months to credential,” McConnell said. These days, recruitment is now taking about twice that time, followed with efforts to expedite credentials.

Another factor is that more medical services are available than 20 years ago. That’s led to more complexity, hyper-specialization and exponential demand, according to Dr. David James, president of ambulatory services for Sentara Healthcare. He said these pressures have led to changes how staff is structured.

“In going forward, the emphasis now is much more on a team-based approach to health care delivery,” James said. “So there are many more team members that are part of the team that surround the physician to get a lot of things done, in particular advanced practice providers.”

He said the system is also trying to be as creative as possible to open more doors to access for different populations, such as televideo.

“The older crowd with multiple medical problems does prefer often to see a physician in person, but if you talk to people who are Millennial and Gen Z or below they don’t want to set foot in a medical office building and they really want to have the televideo visit, nurse triage,” James said. “Their site of service is their phone.”

Sentara’ telemedicine volumes have not reduced by much even as COVID eased and patients could access in-person care again, according Dale Gauding, a spokesperson for Sentara.

James said the idea of becoming a doctor can be daunting to a high-school students The many required years of education and training means finishing the process by their mid-30s.

“Our models forecast shortages in our primary service area by 2029 in surgical specialties, medical subspecialties and the most significant shortfall coming in primary care,” Jeff Kingery, chief physician relations office of, Chesapeake Regional Healthcare, said in an email. “We find that recruiting providers for the medically underserved areas of Northeast North Carolina is a challenge as well.”

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McDermott has spoken with legislators like state Sen. Bill DeSteph, R-Virginia Beach, about potential solutions.

DeSteph said he plans to reintroduce a bill in the next General Assembly session that would allow medical graduates who have passed all their board exams to serve under doctors for a couple years in lieu of completing a residency. Though the state has expanded its medical school classes, it has not expanded its residencies, ending up with a funnel-type situation that has led to thousands of medical school graduates who have passed their boards sidelined while they wait for a residency opportunity, DeSteph said.

“Frankly with our shortage of (providers) in rural areas, with our shortage of specialists, this (bill) gives us an opportunity to get more people who have passed all their boards into the pipeline to become doctors, then specialists,” he said.

The bill is based on similar measures taken by Missouri, according to DeSteph. Though his bill resulted in a study last session, the results have brought more support for the bill, he said.

For McDermott, the status quo isn’t acceptable. Situations where medical care is delayed to the point of further harm to a patient equates to medical care being denied, he said.

“As far as I’m concerned America has third world care because even if (patients) have the money and coverage, they can’t get in,” McDermott said.

Ian Munro, ian.munro@virginiamedia.com, 757-861-3369