Specialty doctors in short supply in state
It's a tale of two specialties.
For dermatology, it's the best of times. There are very few skin doctors, so demand is always high.
Demand will likely remain high, too. Although lots of medical students want to become dermatologists, highly competitive residency programs are graduating only a handful of the specialists each year.
Endocrinology isn't doing as well. While it might not be the worst of times, things aren't looking good.
Demand for endocrinologists is high and will likely remain that way. Very few of the doctors are trained each year, and that's because very few medical students are interested in the field. Endocrinologists don't make as much money as other physicians so most young doctors shy away.
For patients, both stories end the same way. There are only so many appointments to go around, so patients end up waiting a long time to see their doctors.
"It creates access issues," said Dr. Glenn Crotty, Charleston Area Medical Center's chief operating officer. "It slows down the time for patients. Sometimes the condition can't wait. It might cause a progression of someone's problem."
Dr. Joseph Shapiro, dean of Marshall University's medical school, said even in areas with large numbers of practicing dermatologists, patients rejoice like Powerball winners when they snag an appointment.
"It's bragging rights. 'I got in to see my dermatologist next Tuesday,' " he said.
Shapiro said dermatologists are so scarce, even doubling their numbers in the U.S. probably would not extinguish demand for their services. But don't look for a dramatic increase in the number anytime soon.
"It's an underserved specialty that's fiercely protective of its domain," Shapiro said.
Shapiro said dermatologists maintain control of the market by limiting the number of new doctors trained each year.
West Virginia University School of Medicine's dermatology residency program, the only such training program in the state, accepts one student each year.
Dr. Norman Ferrari, chairman of WVU's medical education department, said it would be difficult for the university to increase the size of the program because its accrediting body, the Accreditation Council for Graduate Medical Education, limits the number of graduates member schools are allowed to produce.
To increase its number of graduates, WVU would have to prove to the council there is a need for more dermatologists in the state and that the university has enough qualified faculty to accommodate a larger program.
"They determine how many you're authorized to have. We're not at liberty to summarily increase that because there's a need," Ferrari said.
As with dermatology, there is big demand, especially with the epidemic levels of obesity and diabetes nationwide. Residency programs are competitive but more plentiful than in dermatology.
Yet very few endocrinologists graduate each year. Young doctors just aren't interested.
Endocrinologists diagnose and treat diseases affecting the glands. Their patients suffer from diabetes, thyroid diseases, metabolic and hormone disorders, as well as certain cancers.
Shapiro said most patients with endocrine disorders can be managed by family doctors or general practice physicians. Endocrinologists, then, are left to treat patients with advanced disorders. And because these patients require much more of a doctor's time and effort, endocrinologists cannot treat as many patients per day as other physicians, and therefore cannot make as much money.
Shapiro said endocrinologists also do not perform as many procedures as other specialists, and that cuts into their bottom line.
So for young medical students graduating with tens of thousands of dollars in debt, there's little incentive to pursue the specialty, even if they are interested in endocrinology.
It's a question of love or money, and Shapiro said money usually wins.
"You make less money as an endocrinologist than you would as a general practice physician. Why would you want to train more to make less?" he said.
Shapiro said doctors of his generation did not face this dilemma because many were not in deep debt after graduation.
He said in recent years international students have filled the gaps in endocrinology programs. They typically do not owe as much money as their American counterparts because the government in their home countries often subsidizes their education.
But as the number of U.S. students attending medical school increases, the number of spots available for international students is decreasing.
Ferrari said with America's population growing steadily older and more doctors retiring every year, the need for endocrinologists is only growing. But until the doctors either begin making more money or graduate from medical school with less debt, he worries interest in the specialty will continue to decrease.
"Will students end up picking specialties based on the availability of that specialty to help them pay off their debt quicker? It's hard to know how much that weighs into (their decision)," he said.
Shapiro said there is an 80 percent chance doctors will set up their practices near the place they last trained.
Ferrari said that's because many new doctors are hesitant to venture away from "the mother ship."
Doctors are often hesitant to relocate after completing their residency training because, after four years of undergraduate study, four years of medical school and three years in a residency program, many have settled down and started families, Ferrari said. He said physicians also have become comfortable with the local medical community.
"You know who to refer patients to, who to call up and ask for help," he said.
While that makes it difficult to convince doctors to pick up and move their practices, it doesn't stop Crotty and Carol Wamsley, the hospital system's director of new physician recruitment, from trying to lure doctors here.
"It does not matter to us whether they're recruited to the community, to the university or employment at CAMC. Our main goal is to get physicians to the community," Crotty said.
The job requires a wealth of patience. Last week, the hospital hired a new pediatric surgeon. The position had been open for eight years.
Competition is stiff. Wamsley said some doctors already have 10 or 12 offers before CAMC comes knocking. The hospital system is currently looking to bring four endocrinologists to town, but Crotty said there are only about 3,000 in the whole country.
CAMC tries to recruit doctors using medical society and job hunt websites, as well as print advertisements in medical journals and direct mailings to doctors. Wamsley also keeps in contact with people she knows in different training programs, to see if any of their students might be interested in moving to West Virginia. She also stays in touch with doctors who previously trained in Charleston.
Wamsley said she tries to tailor her pitch to the specialty she's targeting, emphasizing CAMC's large medical center, along with the city's low crime rate, good schools, outdoor activities, local symphony and ballet.
"We sell cultural diversity, too," she said.
Crotty said he does not expect specialist shortages to go away in the near future.
There are currently four dermatologists on CAMC's medical staff, and two at Thomas Memorial. There are two endocrinologists on the hospital system's medical staff, and 10 more in the community.
While those may seem like large numbers, Crotty said the area's roster of specialists is far from full. CAMC serves 500,000 patients in Kanawha and its surrounding counties.
"It's very difficult to recruit anywhere. There's just not enough of them," he said.