Lawmakers are proposing a bill that would offer physicians who either attended medical school or completed their residency in Connecticut a 20 percent reimbursement for federal and state loans each year that they practice in Connecticut. Lawmakers also discussed incentives, limits on malpractice claims and non-compete agreements required for doctors.
The legislation aims at least in part to address the state’s difficulty retaining medical students who begin their training in Connecticut.
Over half of the approximately 4,000 doctors who completed their residency in Connecticut last year left the state to practice medicine somewhere else.
That number places Connecticut 47th out of 50 states in its ability to retain and recruit physicians, according to a report from the American Association of Medical Colleges. According to Dr. Robert Russo, president of the Connecticut State Medical Society, the conditions for practicing medicine in Connecticut make it less appealing for students to remain in the state once they finish their residencies.
“These students have spent four years in Connecticut. They know Connecticut, they know the life and the lifestyle, and yet they still leave,” said Russo.
State Sen. Saud Anwar, D-South Windsor, who is also a physician, said that he was concerned about what the healthcare landscape would look like in 5-10 years if the state did not do something to keep its young doctors.
“I do feel that a lot of people like to be here because of the quality of healthcare, but we are going to lose that unless we make some drastic strategic changes,” said Anwar.
Russo said that the biggest problem by far is student loans. He said that many medical students were trying to pay off both college loans and loans from medical school.
Dr. Khuram Gumman, the director of primary care clerkship at Quinnipiac University’s medical school, also emphasized the need for loan forgiveness. He said that medical students often have over $500,000 in debt by the time they finish residency.
“I hear the same story from our medical students I work with. They want to stay here to practice in Connecticut, but the high cost of living combined with the lack of loan forgiveness and other factors make it almost impossible for them,” he said.
For doctors who were educated outside of the state, the bill offers $20,000 in incentives to doctors who move to the state and practice medicine in Connecticut for at least two years.
But Russo said that this amount wasn’t nearly enough in comparison to the amount of debt that medical students have.
“If you’re talking about debts that are $400,000 to a million, offering $20,000 is … you’re not going to make the top ten of a list of where I would want to practice,” said Russo. Instead, Russo said that Small Business Association loans should be opened up to physicians.
Commissioner of Public Health Manisha Juthani said that while she supported the idea of a student loan reimbursement program, she believed that it should be available to more than just physicians. She noted that the governor had included $17 million in his budget this year for a program that would forgive student loans for healthcare providers that are classified as in “shortage areas.”
The bill also proposes temporarily eliminating licensing fees for physicians – $565 for first-time applicants and $575 for renewing a license. However, Juthani said that eliminating the licensing fees would mean a loss of $9 million annually in revenue for the department.
“That would be a very heavy hit for us,” said Juthani.
About half of the funding the department gets for licensing fees is used to fund HAVEN, the state’s organization supporting doctors struggling with physical illness, substance abuse or mental health disorders.
Another challenge to practicing medicine in Connecticut, Russo said, are the state’s malpractice laws. He said that years ago the state years ago convened a task force that made nine recommendations for changes to malpractice, none of which were implemented.
The bill would establish a task force to look at malpractice policies and “certain insurance industry practices” in the state. Daniel Freess, legislative president of the Connecticut College of Emergency Physicians, said that the task force would be a positive way to bring different sides together to create a solution.
Freess told CT Examiner that he felt that when deciding malpractice cases, the standard should require the plaintiff to prove that a physician had committed a “malicious and willful act.”
“I think the majority of malpractice cases have nothing to do with medicine. It has to do with a bad outcome,” said Frees. “So I think we need a standard and a reasonable judicial system that looks at the intent rather than the outcome.”
Russo said the state should also consider a provision that would protect doctors’ homes from becoming part of the settlement of a lawsuit.
Frees said that he has heard from colleagues in OB-GYN and some surgical practices that malpractice insurance costs are particularly high in Connecticut when compared to other states. In the public hearing, Ghumman made the same point.
“[The] medical liability climate in Connecticut continues to have some of the highest judgments in the country,” said Ghumman.
Ghumman also said that the insurance market, which he described as “highly concentrated” makes it difficult for physicians with private practices to negotiate with insurers. He also suggested that the legislature consider providing small private practices with tax incentives for recruiting physicians.
The bill also asks the state to partner with medical colleges and hospitals in the state to create a plan for how to increase residencies for certain specialities, and it prevents large hospitals and medical practices from requiring physicians to sign non-compete agreements.
Both UConn and the Connecticut State Medical Society opposed the non-compete language in the bill. UConn said it would make them vulnerable to “cherry-picking” of physicians by competitors, create a “revolving door” of physicians that would take continuity away from patients and mean a loss of initial investments when recruiting new physicians.
Russo said that in 2016 the legislature had created language regarding non-competes that was already working well.
Ghumman said that, despite the challenges of practicing medicine in Connecticut, he would go back and do it over again if given a choice.
“The most beautiful part of being a physician is when you’re able to serve a community,when you are able to be there for them, when they need you,” he said. “So, yes, It is challenging, no denying, but at the end of the day, this is the best part of my day. And this is still something that I will recommend to anyone, any young physician who is training to be in primary care.”