State university officials and medical organizations say they have a plan that's just what the doctor ordered to cure Indiana's physician shortage.
They hope to introduce legislation next year to increase the number of medical residencies, or graduate training positions, across the state. Indiana, like much of the country, faces a deficit of physicians in the coming years because of the aging population and increase in demand created by the Affordable Care Act.
While there are currently 1,500 medical residencies in Indiana, most are in Indianapolis. Advocates for the expansion note that doctors tend to stay in the area where they did their training, which would help overcome the dearth of physicians in urban and rural areas alike.
"Indiana is way behind other states in terms of residency positions," said Pat Bankston, associate dean of the medical school at Indiana University Northwest in Gary. "Indiana is deficient compared to the rest of the nation, and Northwest Indiana is deficient compared to the rest of the state."
If a medical student who was raised and educated in Indiana does her residency in the state, she is 20 percent more likely to stay here to practice, according to the Association of American Medical Colleges.
Indiana ranks among the bottom third of states in the number of active physicians per 100,000 population. The state is said to need thousands of additional primary care doctors over the next few years to meet the growing demand for services.
To take on the physician shortage, IU recently increased the class sizes at its medical schools and Marian University in Indianapolis established an osteopathic-medicine college. But there soon won't be enough residency slots in the state for all the new graduates. According to IU, the state will be short 500 such slots by 2020.
Paul Evans, dean of the college of osteopathic medicine at Marian University, calls the situation a "train wreck moving slowly down the tracks." The elderly population is expected to double by 2020. Obesity and diabetes are at historically high rates. The Affordable Care Act is adding tens of millions of Americans to the insurance rolls.
While IU and Marian University project to have about 500 medical school graduates a year, there are less than 400 first-year residency slots available in the state, Evans noted.
"So what does that mean?" he asked. "It means IU and Marian are going to be training doctors for Ohio and Illinois and Michigan and New York because there aren't enough residency spots to keep the doctors in Indiana."
Under the proposal, the state would provide $112.5 million in funding through 2023 to establish 500 additional residencies. The report projects that each resident costs an average of $140,000 with the federal government reimbursing about two-thirds of the money.
The task force developing the proposal includes representatives from IU, Marian University, the state hospital association and state medical association. Northwest Indiana has the second-most hospital beds of any region of the state, so it would likely receive a large share of the new residents. Some hospitals in the region currently host medical residents from Chicago-area universities but none from any Indiana schools.
State Rep. Tim Brown, an emergency room doctor from Crawfordsville, has drafted a bill to create the board that would divvy out the residency funds.
"We know that over 50 percent of people who train in an area tend to stay where they train," said Brown, a Republican. "If we don't have anywhere to train graduates after medical school, we're going to lose them from the state of Indiana."
Regardless of what happens at the state level, IU Northwest's Bankston plans to encourage local hospitals, inpatient mental health facilities and federally qualified health centers to form a consortium to host medical residents, which would save each institution money on administrative costs. Four hospitals in the Evansville area recently banded together to host medical residents in a similar arrangement.
"That's our goal: to have residents based in Northwest Indiana so the likelihood is they'll train here full time and develop relationships and help us stay well," Bankston said. "This increases quality of life and has economic-development implications for Northwest Indiana."
He said the selling point to hospitals is that medical residents, by being up on the latest in medicine and constantly questioning their attending physicians, improve the overall quality of care at the facilities. That will make Northwest Indiana's hospitals more attractive to region residents who seek care at university hospitals in the Chicago area because they perceive the quality to be better there, he said. Under the consortium, participating hospitals would become official partners of IU.