Marcus Rayner | The Star-Ledger
Later this week, the U.S. Supreme Court is expected to decide the constitutionality of the Affordable Care Act, more commonly known as “Obamacare.” The law’s constitutionality has sparked discussions and debate over the past three years as we vet the best way to keep ourselves healthy.
But irrespective of your position on the mandates and regulations that comprise it, New Jersey has a health care crisis all its own – one that has the potential to affect how its residents access specialized medical care in the very near future, and one that the court’s decision isn’t likely to affect.
New Jersey’s crisis is a shortage of doctors. And the hemorrhaging will affect us all.
Ask around and you’re likely to hear frustration about the amount of time it takes to schedule a visit with an OB-GYN. Unfortunately, that is becoming the norm. The New Jersey Council of Teaching Hospitals reports that there is already a 12 percent gap between physician supply and demand. New Jersey’s medical schools graduated 860 newly minted physicians in 2009; only 370 stayed in the state. By 2020, New Jersey is expected to be short an additional 3,000 physicians needed to care for its population.
And these shortages are most profound in obstetrics, cardiovascular specialties and family medicine. In short, women will bear the brunt.
There are many reasons New Jersey is less attractive to physicians. Our high cost of living doesn’t help. But the reality is that, while other states (particularly those in the South and West) have adapted to physicians’ market changes, New Jersey has not. New doctors, saddled with student loans, must take their trade to a market in which they can at least break even for their first few years in practice. In this way, doctors aren’t much different from other professionals.
The most significant expenditure they leave behind in New Jersey is the staggeringly high cost of medical liability premiums. And as New Jersey’s OB-GYN premiums approach the highest in the country, there is little question why obstetricians are particularly hard-hit by New Jersey’s health care crisis.
Physicians have repeatedly told us that defensive medicine and the risk of being named in a frivolous lawsuit affects the way they run their practice and tests their commitment to New Jersey, where lawsuits can be filed against them with little merit or consequence. It’s a key reason many New Jersey OB-GYNs have stopped delivering babies altogether and contributes to our high Caesarean section rate, currently second in the nation.
Other states have been in our situation and addressed these market changes. In 2003, Texas stood on the brink of a profound medical crisis. The number of newly licensed physicians dropped with each passing year, and 150 of its 254 counties did not have a single obstetrician; 120 did not even have a pediatrician.
But a package of medical liability reforms enacted later that year delivered startling results: 60 percent more doctors are being licensed post-reforms than before. Specialized medicine has become increasingly available with each passing year. An appointment with an orthopedic surgeon doesn’t require a waiting list. And Texans now enjoy greater availability of medical providers. With doctors’ potential overhead costs reduced, Texas and other reforming states lured New Jersey’s own physician pool out from under us. And, as a result of Texas’ changes, the number of obstetricians practicing in underserved rural areas increased by 27 percent.
We need to do a better job of keeping New Jersey’s medical school graduates in the state that groomed them. Legislators are advocating a task force to assess just how deep the Garden State’s doctor shortage will grow by 2020. This is a start, but it is not enough. Ask lawmakers to support medical liability reform. Otherwise, we will continue to educate other states’ doctors at the expense of our own access to health care. And no Supreme Court decision will get us out of this looming mess.