Southwest Florida hospitals prepare for 42 physician residents this summer following "Match Day"

Southwest Florida’s largest hospitals are adding 42 resident physicians to their staffing rolls to address a worsening doctor shortage that makes access to care challenging for many patients.

The seven-county region of Southwest Florida is projected by 2035 to have the greatest shortfall of physicians among the state’s 11 Medicaid regions unless steps are taken to mitigate the looming crisis, according to a study released in December. 

The publicly-operated Lee Health, the largest hospital operator in Lee County, is adding 20 residents, which includes 12 residents for an internal medicine residency program that is debuting this year at Cape Coral Hospital.

The remaining eight residents are joining the family medicine residency program at Lee Memorial Hospital near downtown Fort Myers that began in 2012.

In Collier County, the NCH Healthcare System is adding 22 residents. Sixteen are for the internal medicine residency that began in 2017 and six residents are for a new one-year transitional program for advanced clinical experience, according to the nonprofit NCH.

Many residents stay in the communities where they did their residency training, which helps resolve an ongoing dilemma nationwide of physician shortages that is increasing year after year, and is especially acute in primary-care fields.

At Lee Health, 21 of the 40 physicians who completed the family residency program since 2012 have stayed in the community to practice.

Data for how many of NCH’s residents have stayed in the community was not readily available.

Florida will need nearly 18,000 more physicians by 2035 to meet population growth and an aging population, along with a “steep cliff” of physician retirement, according to the study released in December on behalf of the Florida Hospital Association and the Safety Net Hospital Alliance of Florida.

Florida’s population in 2019 was 21.2 million and is expected to reach 25.4 million by 2035.

Nationwide demand for physicians is projected to outstrip supply by as much as 124,000 physicians by 2034, according to the Association of American Medical Colleges.

How competitive is it for new doctors?

The residents were matched at the two Southwest Florida hospital systems through the National Resident Matching Program, a private organization based in Washington, D.C. The organization announced “match” results nationwide on March 18.

Lee Health’s residency programs, which are affiliated with the College of Medicine at Florida State University, received a total 3,100 applications this year, according to hospital officials.

There were 1,706 applications for the new internal medicine program at the Cape hospital and 1,430 applicants for the family residency at Lee Memorial.

Lee Health is one of the largest public health systems in the state but does not receive direct taxpayer support. It operates four acute care hospitals with a combined 1,865 beds and has an operating budget this year of $2.5 billion.

Dr. Alfred Gitu, program director of the family residency program at Lee Health, said the program has strong interest among graduating medical students from around the world.

“The majority of our residents have stayed here in Southwest Florida following their training to continue to serve patients in our community. We look forward to welcoming our newest class of exceptional residents when they arrive this summer,” he said in a news release.

NCH’s academic partner for its residencies programs is Mayo Clinic College of Medicine and the University of Central Florida.

The nonprofit NCH has two campuses in Collier with a combined 713 beds and reported $791 million in revenue for the year ending Sept. 30, 2021.

“This program continues to advance the quality of the services we offer the community here at NCH while allowing these physicians to further develop their talents and hone their skills,” Dr. Mark Rasnake, director of the internal medicine program at NCH, said in a news release.

The residents for both Lee Health and NCH will start in the summer.

How dire is the shortage in Southwest Florida?

The need for more physicians in Southwest Florida has been ongoing for years and will heighten as the region continues to grow and more retirees spend their golden years here.

For the seven-county Medicaid region of Southwest Florida that includes Collier and Lee, the shortage in 2019 was 1,412 physicians, which includes 843 primary-care physicians.

The other counties are Sarasota, Charlotte, DeSoto, Glades, and Hendry.

By 2035, the region will have the most dire shortage in Florida with a projected shortfall of 3,076 doctors, according to the study released in December.

Close behind is the 16-county region of north central Florida, spanning from Hamilton County at the Georgia state line south to Lake County, which will be short of 3,040 physicians.

The state hospital groups have lobbied state lawmakers to heed the warnings of hardships that patients will face if action isn’t taken.

Florida currently has 6,400 residency slots which increased substantially from 3,562 since 2013 when the state Legislature began earmarking Medicaid funding to expand residency positions, according to the state hospital association and the safety net alliance.

Both groups called on the state Legislature this year to allocate an additional $38 million in general revenue money to the gradate medical education program.

Lawmakers increased the overall funding for graduate medical education this year by $6.6 million and maintained funding levels of nearly $200 million combined to current and start-up residency programs.

“Research shows that physicians are most likely to practice medicine where they complete their residency, which is why it is critical to invest in quality education and training programs here in Florida,” Mary Mayhew, president and CEO of the state hospital association, said.

“(We) will continue advocating for the state to remain committed to building and retaining a quality health care workforce equipped to meet the ever-increasing needs of Florida’s growing population," she said.

How are graduating medical students matched?

The national residency matching organization uses an algorithm to match graduating medical students to post-graduate training which last three to seven years, depending on the medical specialty. The algorithm attempts to match the residents to their first- choice residency program but that is not always possible.

 A record 39,205 positions were available this year across the U.S., of which 36,277 are for first-year positions. That represents a 3% uptick in the number of first-year slots, by 177 slots, compared to last year.

The increase was greatest in emergency medicine, family medicine, psychiatry and internal medicine, according to the national residency organization.

There are 1,100 teaching hospitals in the U.S. and 90,000 graduate medical education slots supported by Medicare, which provides the crux of funding, followed by Medicaid and private entities.

National funding increase for residency training

The U.S. Centers for Medicare & Medicaid in December established 1,000 new residency slots nationwide, targeted for rural and underserved regions where people are most at risk without access to medical care. The agency plans to phase in 200 of the slots yearly over five years.

CMS estimates the cost at $1.8 billion over the next 10 years once all the slots are phased in, the largest increase in Medicare-funded slots in 25 years