Daleen Berry

Jul. 12, 2008 (McClatchy-Tribune Regional News delivered by Newstex) -- Rural areas face challenges unlike other areas, and many local physicians say health care here is being negatively impacted.

The shortage of doctors in Western Maryland alone -- it has 16 percent fewer physicians per population than elsewhere -- is one finding from a recent study that has local health care professionals concerned.

"The rural areas are getting hit hardest by these physician shortages," especially the poor and the elderly, said Dr. Robert Barish, chair of the Maryland Physician Workforce Study Steering Committee and vice dean for clinical affairs at the Maryland School of Medicine.

Appalachia has long faced challenges unique to its geographical location, cultural attitudes and depressed economic status. A panel of medical experts from Allegany, Garrett, Frederick and Washington counties spoke about these issues at a forum held recently by the Maryland State Medical Society (MedChi) at Rocky Gap Lodge and Golf Resort.

Dr. Maureen Conroy, president of the Allegany County Medical Society, acted as moderator for the program. Through a question and answer session, each member provided insight into the health care problem.

After noting that Dr. Ruth Dwyer, a Washington County pediatrician, has had trouble recruiting pediatricians, Conroy asked Dwyer what problems this has posed for her practice?

Dwyer said she opened 10 years ago with three pediatricians and one nurse practitioner, but has only been able to retain one pediatrician since then. She said she searched four times in 10 years trying to find another doctor. "Each time, we found people who look like really good, compatible matches ... but their financial expectations are beyond what we can afford," Dwyer said. This affects patients because it means a longer wait to get an appointment. But more than that, Dwyer said it produces "wear and tear on doctors" who are tired.

Conroy asked Dr. Tom Chappell, an internal medicine doctor in Allegany County, how the physician shortage affects indigent and other needy patients.

"We for years have had a great deal of difficulty recruiting into the area," said Chappell, who has practiced here 22 years. He cited not being able to "offer a substantial starting salary" to new doctors as a significant problem.

Allegany Health Right does provide primary and specialty care for the area, and is based on volunteer physicians, Chappell said. However, as the shortage grows, it's becoming "increasingly difficult to get primary and specialty doctors for this group.

"When you look at the physician supply, the people who are the most affected are those who are most in need," he said, adding that this group of patients has a "very, very high rate of uninsured," which is another problem Chappell has faced is in recruitment.

He also teaches medicine, and said he has brought medical residents here from Baltimore. "And although they love it up here, most of them do residencies out of the state and are not planning on coming back," Chappell said. "We've had a very, very poor success rate."

Saying that Allegany County is a quality place to live, and "Western Maryland is a wonderful place to raise a family and practice medicine," Chappell added, "It's very hard to sell that."

Conroy asked Dr. Vitarello, a cardiologist in Frederick County, to explain "the Tim Russert effect."

"Tim Russert comes in probably every 10 to 15 minutes," Vitarello said, adding that doctors are not allowed to do cardio tests on patients because of insurance companies. "They say 'we will tell you what to do and what not to do,'" he added.

And yet Vitarello said "half of all of our patients have normal stress tests," which is a problem since they have an underlying condition that can only be diagnosed with more conclusive testing.

"We can't fight back ... It's a tragedy," he said.

Conroy asked Dr. Kenneth Buczynski, a family medicine physician and obstetrician, to describe the barriers he faced in opening his Oakland practice three and a half years ago.

After moving across the country to set up practice in 2004, Buczynski said "the malpractice insurance cost more than the money we made delivering babies every year." Currently, only he and one other doctor in his practice do deliveries now, and both are on call every other night, he said.

Together, they deliver 300 babies a year while "working for a fraction of the average physician's salary." They charge $1,000 per delivery, but malpractice costs them each $120,000 per year, Buczynski added.

Conroy asked Dr. Robert Cirincione, an orthopedist in Washington County, how the physician shortage has affected his practice and why the Texas model will help the problems faced by local doctors?

Cirincione said "like anyone else here, we interview great physicians." However, "their opening salary demands are greater than any of the partners in our practice." Those demands are more than the salary he's ever "made in 30 years," he added.

In Texas, voters decided to set medical liability caps at $250,000 for non-economic damages, and $1.6 million for death caused by medical error, Cirincione said. "There are physician errors. Patients are harmed. They should be justly treated by the legal system. Physicians should be justly treated by the legal system," he said.

But, Cirincione added, that amount "shouldn't be so much that physicians can no longer practice medicine."

Texas voters decided on caps.

Conroy asked Karen Johnson, executive director of the Western Maryland Health System Foundation, to explain what the hospital system has to do to recruit a physician.

Johnson said the hospital was able to recruit 55 new doctors here within the last two years, but the problems go beyond that when doctors have so many choices, and Western Maryland can't compete.

"We might be competing for a physician who has 400 other opportunities," she added.

Finally, Conroy asked Charlie Ross, president and chief executive officer of Garrett County Chamber of Commerce and chair of the Rural Maryland Council, how business leaders there understand the current problem.

Ross said access to health care and doctors "in rural areas ... is different than it is in urban areas." Recognizing that the number of doctors has gone down, Ross said it seems like increasing the number of mid-level medical professionals would help solve the problem.

He also said the chamber is "ready to help as a business community to sell our area to doctors."

Contact Daleen Berry at dberry@times-news.com.

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