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02/17/2008

First in a four-day series.

From staff reports

Seven years ago, the Maine Recruitment Center listed about 100 openings for physicians in the state. This year, that number is up to 212.

That is reason for concern, if not alarm, those in the health-care industry say.

Just ahead, beginning in earnest in 2011, the tidal wave of retirement-age baby boomers will hit, placing demands on the health-care system that are unprecedented.

Add the fact that most of the physicians and nurses in Maine are baby boomers themselves and the prospect of maintaining adequate access to health care becomes even more bleak.

MaineGeneral Health Executive Vice President Barbara Crowley is not ready to say the sky will fall, but she does see storm clouds on the horizon -- and some already overhead.

Consider primary care:

The state has 32 vacancies for these general practitioners right now, and all indications are that number will grow, probably significantly.

"Yes," Crowley said, "we have a crisis in primary care. And, yes, we have a flawed system that will make it difficult to turn this around. Having said this, all of us ... are working toward how we do better to support primary care."

Crowley, a doctor who specialized in pediatrics, considers primary-care physicians as the point guards of the health-care system, the practitioners most adept at assessing overall health and then directing -- if necessary -- patients to the appropriate specialists.

But medical students are increasingly reluctant to enter the field, she said, and that reluctance is understandable.

"Look at what is happening with primary care (doctors) right now," she said. "They are being asked to see more people, do more paperwork, answer more phone calls, and to do all this for either similar or less pay."

At the same time, students are graduating from medical schools with as much as $250,000 in loans to pay back.

Faced with such huge debt, she said, those students increasingly decide to pursue specialty fields that provide better pay and less work.

"All of those things go against building a strong foundation in primary care," Crowley said, "and yet a healthy health-care system needs that strong primary care foundation."

Mary Mayhew, executive director of the Maine Hospital Association, said the oncoming wave of baby boomer retirees is just the next challenge -- albeit a mighty one -- facing a health-care system already ailing.

"In terms of demand on health-care services," she said, "that issue absolutely has to be part of a broader discussion around health-care reform. Right now we are putting Band-Aids on the system, and that is without the full impact of that baby boomer generation demanding more health-care services."

NURSES NEEDED

Health-care shortages are not limited to physicians. Nursing, too, is a major concern, although the situation is a bit more complicated.

Vanessa Sylvester of the Maine State Nurses Association said the current shortage is in acute care hospitals. Many registered nurses, she said, don't care to work in such settings.

"The working conditions are very hard on folks," she said. "The ability for nurses to provide effective, safe, therapeutic care is hard when the nurse-to-patient ratio is so high."

Sherri Woodward, a senior vice president of patient services at MaineGeneral Medical Center, confirms that the need for nurses at hospitals is always strong.

"We hired 69 new graduates this year," she said, "which is the most I believe we have hired in a long time to fill positions of people who had retired, left or moved -- or to fill new positions."

Woodward, a registered nurse herself, as well as chief nursing executive at MaineGeneral, said MaineGeneral employs 862 registered nurses, including 765 who are involved in patient care directly.

The average age of that population is 45.5, she said, including 15.7 percent who are 57 and older. That 15.7 percent represents 136 nurses who are nearing retirement.

Given the work demands at a hospital, Woodward said, many nurses elect to retire when they become eligible.

To counteract this, MaineGeneral is looking to lighten caseloads as well as taking steps to prevent injuries by reducing the amount and magnitude of lifting nurses do on the job, Woodward said.

"We also have to think beyond what we have always done," she said, "and be creative and flexible in allowing shifts that nurses are willing to work."

Woodward said MaineGeneral has increased nursing pay in recent years to remain more competitive. The average wage of the RN staff, she said, is about $26 to $27 an hour, with a starting wage of $20 an hour.

MaineGeneral also is looking at the other side of the equation: encouraging young people to consider nursing as a career.

MaineGeneral has started a puppet program called the "Great Hospital Adventure" as part of a long-term recruitment initiative.

Geared for children kindergarten through fourth grade, the Great Hospital Adventure is meant to stimulate an interest in the health-care field in very young children.

Too often, Woodward said, students don't consider nursing until too late in their school career and thus lack the math and science credits critical to enter nursing programs.

But generating interest in the profession is not the only problem. Another issue is obtaining the higher education needed to become a nurse.

"There are waiting lists for nursing (programs) right now in most community colleges, colleges and universities," Woodward said, "and that is because there are not enough instructors to go around."

BOOMERS BEWARE

Growing shortages of doctors and nurses?

This is not what aging boomers want to hear.

Even boomers who take steps to care for their health cannot escape the realities of aging, the fact that they are more apt to fall prey to chronic illnesses and other medical issues as they get older.

Lorna Hatch, 55, of Gardiner realizes this.

"Staying healthy is very important to me for several reasons," she said. "Hopefully, it will help deter any major illnesses. I have a strong family history of cancer, and I want to avoid that as much as I can."

Hatch exercises regularly and pays close attention to her diet -- a trait, she said, that older generations in her family did not practice.

The trouble, she said, is that most of her contemporaries don't make regular exercise and sound nutrition a lifestyle either.

"For the most part," she said, "I think I am the exception. I don't know of any other 55-year-old women playing softball -- and pitching no less."

Hatch also teaches aerobics.

The married mother of two said her healthy lifestyle and medication -- paid in part by health insurance -- helps her control high blood pressure.

Mayhew of the Maine Hospital Association said convincing Mainers to better manage their health is a critical component of meeting the medical challenge posed by the retirement of Baby Boomers.

"You're going to hear a lot about the chronic-care model," she said, "and how we are not only targeting the population that currently suffers from chronic diseases to ensure they get the right care and are managing their care, but how well are we doing on our prevention efforts.

"That is going pay off -- if we can improve the health status of folks in Maine and reduce some of the costlier (health-care consumers)."

Colin Hickey -- 861-9205

chickey@centralmaine.com

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