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Florida State University

Residency program aims to combat Fla. doctor shortage

Frank Gluck
The (Fort Myers, Fla.) News-Press
Dr. Elizabeth Midney-Martinez checks for flexibility while tending to one of her patients, Donna H. Fecik on Wednesday, March 11, 2015, as Dr. Mark Farmer supervises in the background. Midney-Martinez is one of 13 members currently participating in the Family Medicine Residency Program at Lee Memorial Hospital.

FORT MYERS, Fla. — A new medical residency program in southwest Florida aims to train young physicians as family practice doctors in an already medically under-served community, and ideally, persuade them to set up shop in the area once their residency is complete.

As part of post-medical-school-training requirements, new doctors work for three years in hospitals and medical clinics to learn about medical specialties and to get a real-world education in treating patients. Doctors must successfully complete residency programs before they are free to practice on their own.

The program at Lee Memorial Health System/Florida State University focuses on a "cradle to grave" spectrum of medical care. The doctors deliver babies, treat patients in outpatient clinics, see them in the ER and visit elderly patients in the hospital. They generally handle 140 patient visits their first year. The following two years, they will be present for nearly 10 times that amount.

Without such efforts, medical industry experts say the region faces a shortage of hundreds of doctors — including those specializing in family practice medicine, cancer treatment and surgery.

Dr. Carl Nyberg, 29, is one of 13 recent medical school graduates fulfilling their training at Lee Memorial.

In his 8-month career in seeing patients, he has learned it's better not to argue with parents. For parents who want to wait to do their own research on vaccinations, Nyberg will give them pamphlets and encourage them another time.

"You don't want to be too forceful with patients," Nyberg said. "You want to give them as much information as possible so they can make a good decision."

Doctors such as Nyberg are ideal. He attended medical school in the Caribbean but has always planned to settle in Southwest Florida.

A willingness to stay in the region is a factor in selecting residents every year. The goal is to keep at least 50% of them in the area once they are ready to practice on their own, said Dr. Gary Goforth, who oversees the program for Florida State University and Lee Memorial.

"We know historically, across the country, most residents stay where they actually did their training," said Goforth. "The idea behind this residency (program) is that we would train our own."

DESPERATE NEED

The doctor shortage is a problem for much of Florida.

A study commissioned by the state's teaching and safety net hospitals concluded Florida will be short nearly 7,000 doctors by 2025 if more residency programs and training slots aren't created.

Southwest Florida and much of the Panhandle will see some of the sharpest shortages.

Doctors specializing in general surgery, cancer treatment, anesthesiology and endocrinology will be in the shortest supply here, the study found.

Demand for family practice doctors, the focus of Lee Memorial's residency program, is expected to outstrip supply by 54% by 2025 — roughly 260 doctors.

Dr. Carl Nyberg tends to one of his youngest patients. Nyberg is one of 13 members participating in the Family Medicine Residency Program at Lee Memorial Hospital in Fort Myers, Fla.

But it's not all bad news. Florida will probably have plenty of plastic surgeons, pediatricians, doctors specializing in treating the elderly and, outside Southwest Florida, family practice doctors, the study found.

Last week, the teaching and safety net hospital groups formally asked state lawmakers for $20 million in recurring funds to create new programs and training slots for medical specialties in particular short supply. They hope to capture an additional $30 million in federal matching funds.

This $50 million would add to the $80 million in state and federal dollars financing such programs in Florida.

If the Legislature signs off on the plan, hospitals would be eligible for one-time $100,000 bonuses for every new training slot created for high-demand medical specialties, such as psychiatry, general surgery, rheumatology and thoracic surgery. Some of the money also would provide financial support for existing slots.

Florida now has roughly 4,000 residency slots. The funding could theoretically finance as many as 500 additional ones in its first year, said Ron Bartlett, a spokesman for the effort.

It's too early to tell whether the proposal will gain support of a majority of lawmakers or whether they will agree to the full $20 million a year. But Bartlett said he's confident that they understand the need.

"They seem to concur that the physician shortage is a growing problem and that Florida has a pressing need for more residency slots to help close the gap," he said. "They are taking this seriously and want to address the issue."

'REAL HEART'

Lee Memorial's residency program, created through a 2011 partnership with Florida State University, welcomed its inaugural class last year.

The program is based in a Lee Physician Group clinic in Lee Memorial Hospital near downtown Fort Myers.

For now, it only provides training for family practice physicians but may eventually allow for other, still-undetermined types of physician training. The number of available slots will probably also increase, possibly to 30 residents a year.

It probably won't be hard for the program to find interested applicants. Goforth received nearly 1,600 applications this year for six open residency slots.

But they don't just want anyone.

Aside from good grades and clean backgrounds, the program seeks doctors who want to practice family medicine, Goforth said. Failed neurosurgeons hoping to fall back on being a family doctor need not apply.

"We were looking for people that had a real heart for family medicine," he said. "I don't want to train somebody who sees this as a back up specialty."

COMING HOME

Dr. Elizabeth Midney-Martinez, 28, was on her second day at work at the Fort Myers clinic to get a crash course in orthopedic medicine — big business in a region where more than a quarter of the population is 65 and older.

Today she's getting tips on assessing the source of Donna Fecik's shoulder pain. She stretches both of Fecik's arms and probes for the precise spots causing trouble. Dr. Mark Farmer, an orthopedic surgeon and chairman of Lee Memorial's orthopedic department, watches her closely.

Patients don't seem unnerved by the presence of an extra doctor in the room. Fecik said she doesn't mind.

"It's OK with me," she says later. "I love students."

It's like this for much of the day. She will visit with patients with Farmer to get a broad knowledge of orthopedics and how to identify those who need to see specialists like him.

She said she also is learning more mundane, but critically important, aspects of the profession: how to negotiate with insurance companies, how to convince patients they need certain tests, medical coding and so on.

Midney-Martinez, who was born at Lee Memorial Hospital, grew up in Immokalee, Fla., and went to medical school in Dominica, hopes to eventually practice in her home community.

"I just have this dream that I'm going to work there and help a lot of people and keep people out of the hospital," she said. "It's probably a little bit naive but, I don't know, it's just a dream. We'll see how it all pans out in the end."

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