2007 industry report: health care

To stay patients, state will need more doctors
By Edward Martin

Current prognosis

TREND: North Carolina's population is growing so fast that its ratio of physicians to patients is suffering.

OUTLOOK: The state will prescribe steps to produce more doctors.

For most of 2006, Tar Heel health care appeared to be on the mend: Malpractice angst eased, physicians dodged a cut in government payments, and hospitals were building. Then as the year closed, a fresh wound opened. A study concluded North Carolina will run short of doctors within 25 years.

Besides obvious concerns - patients facing delays for care and medical practices trying to outbid one another for doctors - the report had regional and political implications. "There needs to be more medical students," says Darlyne Menscer, president of the 11,500-member North Carolina Medical Society. "North Carolina needs to decide how to deal with that. It's not going to be cheap."

One option surfaced in December when Charlotte-based Carolinas HealthCare System said it and the UNC School of Medicine in Chapel Hill were studying whether to start a satellite medical school in Charlotte. A new campus could increase the number of UNC med school graduates each year by 50, to about 210.

However, the last time the state started a medical school - at East Carolina Uni-versity in Greenville in 1974 - the money came only after a fight that pitted Charlotte, Greensboro and other urban sites against largely rural Eastern North Carolina. ECU won, but political scientists say the bitterness created still colors state politics.

What's clear is that North Carolina, with a population of nearly 9 million, is outgrowing its pool of doctors. It has about 18,000 - 21 per 10,000 residents, roughly the national average, according to the Cecil G. Sheps Center for Health Services Research in Chapel Hill. But a report by the North Carolina Institute of Medicine, a Durham nonprofit set up by the General Assembly to study health trends, concluded that the ratio will fall nearly a fifth by 2030.

The institute recommends increasing enrollment by a third at the four medical schools in the state and expanding programs that can relieve physicians - such as training more nurse midwives.

But those aren't the only gaps in the state's $60 billion-a-year health-care delivery system. Nurses already are in short supply. "A lot of people want to be a nurse, but there's not enough capacity at colleges and community colleges," says Stephanie Strickland, a spokeswoman for the 135-member N.C. Hospital Association. The 16-campus UNC system and the General Assembly last year started to fix that by expanding nursing programs at Fayetteville State University and UNC Pembroke.

On another front, doctors, who wanted a $250,000 cap on noneconomic damages from lawsuits, along with caps on lawyers' fees and other malpractice curbs, made little progress in the General Assembly. But malpractice premiums and the number of cases filed have stabilized, easing the pressure by doctors for tort reform.

Doctors breathed easier, too, when Congress halted scheduled reductions in Medicare payments that would have totaled about 26% by 2012. A third of the state's doctors were expected to quit taking Medicare patients if the cuts held. Linked to the legislation were programs that will begin measuring the quality of doctors' work. That issue grabbed attention in Raleigh, too.

The General Assembly authorized the state Medical Board, which licenses and disciplines doctors, to take stronger and quicker action. Bad doctors will be dealt with more decisively - and publicly. Previously, the board could only yank a doctor's license or restrict it - and the public would know nothing of the latter. "Now we have the extra power to issue public reprimands, monetary penalties, public letters of concern or require completion of treatment programs," says Dale Breaden, the board's spokesman. The board sends private letters of concern to about 250 doctors a year.

Hospitals faced continuing pressure on the bottom line from managed-care insurers wanting rate discounts and rising charity-care bills - about 1.3 million North Carolinians, not counting the elderly, were uninsured last year. Yet they kept builders busy. Carolinas Medical Center's $85 million Levine Children's Hospital is expected to be finished this summer. NorthEast Medical Center in Concord opened its $11 million Jeff Gordon Children's Hospital, named for the NASCAR driver, in December.