San Diego Magazine / January 2004 / The Doctor Dilemna

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The Doctor Dilemna

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Dr. Ted Mazer, a well-established San Diego ear-nose-throat specialist, says he receives offers every week from medical headhunters that would double or triple his annual income—if he’s willing to set up shop out of state. At

45, he isn’t interested, but in a few years, when his kids are through school, he says he’s likely to give it serious consideration.

If Mazer leaves, he would join the ranks of what physicians refer to as "the disappearing docs." This growing group—increasingly unhappy with managed care, escalating government regulations and soaring malpractice

premiums—are retiring, changing careers or relocating. Replenishing their ranks is becoming more and more difficult, medical officials say, because of the very same conditions that are driving doctors away.

A doctor shortage? Here? The hassles of managed care and the excruciating problems of Medicare are national in scope, and most California physicians actually pay less in malpractice premiums than in many parts of the country because of a limit on noneconomic damages in medical-negligence lawsuits.

Besides, San Diego has always been a magnet for doctors. Who wouldn’t love to work and live here? Lord knows the docs are knocking down the big bucks, so they can afford it.

Still, between 30 and 33 percent of local physicians say they’ll leave within the next three to five years, and 39 percent will reduce their patient-care hours.

"The problem is that a doctor shortage is not yet obvious to the ordinary consumer, " says Tom Gehring, executive director of the San Diego County Medical Society. " But just wait till it takes the average Joe, who has no connections, more than a month to get a urology appointment. By the time the public wakes up to that problem, it’s going to take 10 years to fix it. People need to see there’s a big problem right now."

To that end, the SDCMS—with members like Mazer, who work on economic issues—publishes prolific reports to examine the problem, educate the public and offer solutions for legislative reform. A recap of findings from recent surveys of the society’s membership includes data that show:

* While the county as a whole currently has a respectable doctor-to-patient ratio, such populous areas as inland North County, East County and the South Bay have a doctor shortage, especially in certain specialty areas.
* By 2006, the county faces a 10 percent shortage in primary-care doctors and a 50 percent deficit in the specialty areas of allergy/immunology, emergency medicine, general surgery and urology.
* The OB/GYN field—with its high exposure to litigation—is looking at a 60 percent shortfall by 2006, and notable shortages likely are in store for neurosurgery, orthopedics, otolaryngology and psychiatry.
* Meanwhile, 71 percent of physicians say they have major difficulties in recruiting doctors to join their practices, a problem faced by all local hospitals as well.
* The population of San Diego continues to grow, and the medical needs of residents increase.

While these and other statistics are sometimes couched in such phrases as "likely to" and "may face"—and often pooh-poohed for it—anecdotal evidence from the average Joe and Josie is mounting. Try it yourself: In any gathering of people, ask if anyone has personally had a problem finding a doctor or getting an appointment or knows of someone who has. There are plenty of real-life stories.

LaDonna Harvey, a longtime news anchor with KOGO-AM 600 radio, admits she felt "desperate and abandoned" when, within the course of a few months, both her ear-nose-throat specialist and her psychiatrist pulled up stakes in San Diego and moved out of state.

"It was horrible," she says. "I make my living from the neck up, so this is something I really, really care about."

Harvey says her throat doc left because of what he called the "super-bad business climate for doctors in San Diego," while the psychiatrist relocated her family for a better environment.

Realtor Roxanne Baer had an enviable patient-doctor relationship. Her family physician of more than 20 years was the ever-caring, fatherly sort who always made time to see her. In May 2003, he took an early retirement, saying he’d had his fill of aggravation over insurance billings and Medicare.

When Baer then signed on with her husband’s HMO, it was, she says, "a real eye-opener and very discouraging." Finally finding a doctor who was accepting new patients, she was told it would be three months before she could see him.

While many local doctors’ complaints reflect problems common to the country, "on the average, San Diego is worse off than other places," says the medical society’s Gehring. He cites some reasons: Reimbursement for Medicare patients (to which private insurance is tied) is 10 to 20 percent less than elsewhere in the state, and malpractice premiums are increasing by 20 to 30 percent a year, with the average yearly premium currently at about $25,000. Also, local physicians’ salaries don’t match up to the area’s exorbitant living costs.

A little clarification: Knocking off the low and high ends, a San Diego physician with five to 10 years of experience averages between $140,000 and $150,000 annually, says Gehring.

"Although this is greater than the average person, it’s a relativistic issue," he adds. "We need to ask if we’re getting the right qualified doctors, and are we getting them to stay."