Local medical providers struggle to fill need

Delaware stands last among states nationwide for access to primary-care physicians, meeting the needs of only 14.85% of its residents, according to figures released this month.

A Feb. 7 news release from Becker’s Hospital Review, a medical industry trade magazine, noted Delaware is in need of 71 primary-care physicians to meet the current needs. Sussex County alone needs more than 21 providers, according to figures compiled Dec. 31 by the U.S. Health Resources and Services Administration that were used in Becker’s ranking.

Delaware directly trails Alaska, which met 20.17% of its primary-care physician needs and requires 73 more doctors, according to the report. The state that best meets its residents’ needs is Vermont, at 77.83%, and it does not need any additional doctors.

Federal regulations state that an area has a shortage of providers when there are at least 3,500 residents for each physician.

Craig Polasky, senior director of communications for KFF, said his organization compiled the data on areas with physician shortages but was not involved in creating the ranking released by Becker’s Hospital Review.

A nationwide shortage of physicians and a growing population in Sussex County that mushrooms by tens of thousands of people during the tourist season are stressing the local healthcare system. 

Dr. Paul R. Sierzenski, senior vice president and chief physician executive for Beebe Healthcare, and William Albanese, CEO of healthcare provider Atracare, have seen the need up close and have been working to fill the demand. Bayhealth officials could not be reached for comment.

“Based on how they ran the numbers, I think that’s accurate,” Sierzenski said of the primary-care physician shortage ranking. “I think there are a number of reasons that we have that disparity.”

The high cost of a medical degree pushes more young doctors to go into specialties that pay more than primary-care practices, he said.

Beebe has established a team to handle recruiting and expanded its efforts nationwide. Two years ago, it established its own residency program to train physicians, Sierzenski said. Beebe is nearing completion of a facility in Long Neck that will accommodate the growing family residency program, which will be expanded to include other disciplines. It is scheduled to open this summer. There are four physicians in the program’s first class, who are scheduled to graduate in 2026.

“There is good data that show if someone trains somewhere, they are more likely to stay in the area,” said Sierzenski, who noted residencies last three to five years, during which someone is growing roots in the community and the facilities where they learn.

Atracare has struggled to fill physician jobs, relying on its contacts through the American Academy of Family Physicians, Albanese said. The company touts the lifestyle in the area when trying to attract physicians.

Technology is helping to ease the burden on physicians and improving care, Sierzenski and Albanese said.

Electronic record-keeping systems that have become the industry standard in recent years are freeing doctors to spend more time with patients. Telehealth visits have also saved time and allowed people greater access to physicians.

Albanese blamed much of the shortage of primary-care physicians on low insurance reimbursement rates in Delaware, compared with neighboring states. Sierzenski agreed it is a significant factor.

For example, insurance companies in Maryland pay reimbursement rates more than 30% higher than Delaware, and some other states pay 40% more, Albanese said.

“Primary care in Delaware has a reimbursement problem,” he said. “We have an unmet need [for physicians] and no money to meet that need.”

Highmark Blue Cross/Blue Shield insurance covers slightly more than half of the residents of the state, Albanese said. The state should take action to raise reimbursement rates, or it should encourage other insurance companies to do business in Delaware to create competition and help drive up rates, he said.

The state General Assembly passed legislation in 2018 intended to raise insurance company reimbursement rates, but it proved ineffective, Albanese said.

Low reimbursement rates discourage doctors from beginning practices in the state or remaining here, he said. It is also driving many who do stay to move into concierge care, where they charge patients what amounts to a membership fee of several thousand dollars, and doctors can earn more money seeing fewer patients.

Atracare is considering initiating a fee to join, which would help cover costs, Albanese said.

The physician shortage has present and long-term implications for Delaware residents, he said. Many are not receiving routine care that would help prevent serious medical conditions, which are more dangerous and costly to treat. 

In addition to primary-care physicians, Delaware also has a serious shortage of medical specialists and clinicians, Albanese and Sierzenski agreed. Several doctors also retired during the COVID-19 pandemic, increasing the need for physicians.

There has been talk about creating a medical school in Delaware – one of only three states without one – but Albanese said that would not solve the physician shortage. It would be an expensive project, and many graduates would still take higher-paying jobs in other states, he said.

The dramatic population increase in Sussex County clearly is making the need for primary-care physicians even more acute in the county than the statewide average, Sierzenski and Albanese said.

Albanese, a Cape Henlopen High School graduate who received a doctor of pharmacy degree from the University of Maryland, has seen Delaware’s physician shortage worsen over the years.

“It’s always been a little behind,” he said. “The population growth has turbocharged the shortage and the effects of this.”

In the past five years, Sussex County has been by far the fastest-growing county in the state, as the population climbed to 263,509 in July 2023, the most recent figure available from the U.S. Census Bureau.

The state’s population has seen steady growth since 1950, when it was about 350,000. It topped 1 million for the first time only recently and is projected to continue the trajectory over the next two decades.

Albanese said he hopes angry and frustrated residents who are waiting weeks and months to see a primary-care physician will demand action by the Delaware General Assembly and state insurance commissioner.

“It’s like a Third World country down here,” he said.