NJ spending more to add new doctors, but many leave
New Jersey is boosting spending for the training of future physicians by almost half in the upcoming budget, an effort that could help narrow a shortage of doctors.
Problem is: Lots of those new doctors take those New Jersey educations off to another state.
Assemblyman Gary Schaer said at Monday’s budget hearing focused on the Department of Health that when he started on the budget panel 11 years ago, half of med-school students who benefited from the state’s graduate medical education program wound up leaving New Jersey.
Now, he says, it’s 70 percent.
“It seems to me that we’re spending precious resources for people who are going to other communities, other states,” said Schaer, D-Passaic.
“I don’t mind knowing that some students are leaving,” Schaer said. “Seventy percent seems an inordinate figure, number one, but more importantly, it seems to – 10 years ago, it was at 50 percent. We’ve been in the wrong direction. Despite good intentions, it doesn’t seem like we’re getting there.”
Acting Health Commissioner Cathleen Bennett didn’t dispute Schaer’s numbers. But she said a robust graduate medical education program is effective at retaining medical residents.
And New Jersey’s effort in that area is growing. In all, $188 million in state and federal funds will be spent on graduate medical education in 42 teaching hospitals in the upcoming budget year -- $62 million in state money and $126 million in federal money.
That’s up from $127.3 million in the current budget year; from $100 million in the 2014 and 2015 budgets; from $90 million in the 2012 and 2013 budgets; and from $60 million in 2010 and 2011.
Bennett said New Jersey is funding 898 first-year residency slots, compared with 2,064 in Pennsylvania and 3,873 in New York.
“If we don’t make the investment, our residents will go to one of those other states and never come back here,” Bennett said.
Schaer noted that even with the program, 70 percent are leaving for other states now.
Bennett said hospitals are making changes to retain residents, such as peer mentoring and more research opportunities. She said the emphasis on university-affiliated hospitals helps.
“These university hospitals provide something that is really important to med students today, and that is the ability to do clinical work but also the ability to do research.”
Bennett said hospitals are also adapting their practices to accommodate a change in how new doctors want to practice medicine.
“One of the things I’ve been hearing from the medical students in our med schools is that unlike years in the past, they don’t want to be, as one put it, ‘I don’t want to be like my father. I don’t want my children to learn to ride a bike and not be there for it. I don’t want to be like my mother. I want to be at home when the kids are growing up. I want some balance,’” Bennett said.
“And part of that balance comes by changing how we deliver care. And that’s something that you’ve seen the hospitals do, where they’re hiring more hospitalists, and that gives some of the certainty in terms of the hours that you’re working. So it’s the lifestyle piece as well,” Bennett said.
Schaer wanted to know whether the 70 percent figure would be lower a year from now. Bennett said it’s probably going to be a more gradual evolution.
“I would hope that we would see improvements in it. I don’t know that it is something that is a flip of a switch,” Bennett said.
“At least for the past 11 years, ma’am, forgive me, in all due respect, the switch has been turned but in the wrong direction,” Schaer said. “I’m just looking for it to go to neutral.”
Forty-two hospitals are going to receive graduate medical education funds in 2017, with 38 hospitals getting more money than in the current year but four receiving less. The most substantial loss, in dollar terms, is a $543,469 drop at Morristown Medical Center.
Cooper Hospital/University Medical Center gains $10.9 million more, more than any other hospital. University Hospital gains $7.1 million; Robert Wood Johnson University Hospital adds $6.1 million; Inpira Medical Center-Vineland gains $5.6 million; and Newark Beth Israel Medical Center adds $5.4 million.
In percentage terms, Inspira Medical Center-Vineland, Deborah Heart and Lung Center, Lourdes Medical Center of Burlington County and Raritan Bay Medical Center will more than double their subsidy, among the 20 hospitals seeing increases of 50 percent or more.
In past years, spending on graduate medical education was divided evenly among state and federal dollars.
That has been bumped to a split in which the state provides one-third of the funds and the federal government two-thirds because of the number of patients seen by hospitals that are eligible for a 100 percent federal match from Medicaid.