12 July 2010

In Ventura County, Half of Doctors Nearing Retirement Age

Ventura County Star

Out of a group of more than 750 doctors in Ventura County, half will turn 55 or older before the end of the year, according to a local medical association. One of three will turn 60 or older.

The doctors aren’t growing crow’s feet alone. About half of the registered nurses in Ventura, Los Angeles and Orange counties were 50 and older in 2008, according to the California Board of Registered Nursing. About 18 percent of the nurses were in their 60s, more than those who were 34 and younger.

The graying numbers don’t surprise Dr. Gary Proffett, the 62-year-old medical director of an Oxnard-based physicians network who has decided he can’t retire because of the economy. But he is alarmed at the number of healthcare professionals who could pack away their stethoscopes before hospitals and clinics are flooded by aging baby boomers with longer life expectancies and the uninsured people who will be covered by federal healthcare reform in 2014.

“Who’s going to see them?” he said. “Who’s going to see millions of people? I don’t know.”

There are 1,095 doctors in Ventura County. The Ventura County Medical Association has birth dates for its membership of nearly 300 doctors and, through the Medical Board of California, 471 other physicians. The median age of the doctors is 55. About 50 percent were born in 1955 or earlier; 33 percent were born in 1950 or earlier.

Some doctors suggested the data could be skewed by the demographics of the medical association membership or by medical school and residency requirements that mean almost no doctors are practicing on their own before their 30th birthday. The statistics also could be affected by doctors who are still licensed but no longer practicing.

A 2008 study from the California HealthCare Foundation suggests a more modest trend with about 36 percent of the doctors in Ventura County 56 and older. But a forthcoming report from the foundation suggests 29 percent of California’s doctors are 60 or older, higher than any other state. Data from the Association of American Medical Colleges suggests 39 percent of the nation’s doctors — 43 percent in California — are 55 and older.

The numbers vary. The bottom line is the same, said Edward Salsberg, director of the Center for Workforce Studies at the Association of American Medical Colleges.

“You need to be worrying about the next decade,” he said, predicting a deepening shortage of healthcare professionals. “When the recession ends and the economy improves, I think millions of Americans, not just doctors, will say I’m ready for retirement.”

Theories to explain the aging trend sprout like, well, gray in a salt-and-pepper beard: Enrollment bottlenecks at medical schools and residency programs, cost of living expenses that push new doctors away from expensive California coastal areas and economic pressures that delay retirement.

“What we get paid for surgery now, for tonsillectomy, is what we got in 1980,” said Dr. John Edison, focusing on Medicare reimbursement. The Ventura ear, nose and throat doctor is 71, has been practicing in Ventura since Jimmy Carter brought peanuts to the White House and is old-school enough to wear a head mirror.

He’s not retiring but is making the transition this month from full time to part time, providing more opportunities for backpacking and skiing in Mammoth.

Edison doesn’t think the math is all that complicated. Retiring doctors combined with an infusion of new patients through healthcare reform adds up to more patient care being delivered by physician assistants and nurse practitioners.

“I think it will be harder to see certain specialists and family doctors, too, probably,” he said.

Nursing numbers add to the same connect-the-dots sketch. The California Board of Registered Nursing reported the average age of RNs in the state jumped from 43 in 1990 to 47 in 2008. About half of the state’s nurses are 50 and older, the same as in the region comprising Ventura, Los Angeles and Orange counties.

Forget about Carter. Greg Thayer started his career at the Ventura County Medical Center in 1974 when Gerald Ford was trying to stabilize the country.. Thayer was a 20-year-old orderly surrounded by other people his age and a handful of older nurses who served as mentors.

Things are different now. The newbies are in their 30s and 40s and they’re dwarfed by the veterans.

“Two thirds of the work force are the old war horses,” said Thayer, who at 56 counts himself in that category. “I’m a swayback. I don’t know if anyone would ride me to war.”

Thayer echoes doctors who predict the aging trend will bring more reliance on healthcare workers imported from other countries.

A waiting list for a nursing program at Ventura College stretches 12 months or longer and at CSU Channel Islands, 314 people applied for 33 spots in its nursing program.

But Joanne Spetz, a researcher at the Center for Health Professions at UC San Francisco, said state-supported efforts to expand nursing programs are generating more young nurses. Provisions in healthcare reform are designed to boost doctors and other health professionals dedicated to primary care.

She thinks the efforts along with the infusion of immigrant health workers could limit the damage of shortages.

“It could have a negative impact on healthcare, but I don’t think it’s a done deal,” she said, suggesting a wild card will be the availability of state and government funding to create more slots in medical schools or provide other fiscal support.

Others predict a work force tilted heavily toward retirement age will mean people waiting longer for appointments and depending more on professionals who don’t have an M.D. after their names.

A system that relies heavily on physicians in their 60s may struggle because studies show older physicians spend less time on patient care and more on administration, said Craig Paxton, a health economist and primary researcher for the upcoming California HealthCare Foundation report on doctor demographics.

Other solutions have trapdoors, too. Outsiders want to dramatically expand training programs but don’t understand that schools struggle to find nursing faculties, said Joan Beem, director of the nursing program at Ventura College.

She is one of many who thinks D-Day will come when healthcare workers feel confident that the recession is over despite growing California health insurance quotes. They’ll retire and the system designed to provide their replacements will still be crimped.

“I think we’re going to have significant problems,” she said.

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