In a Jan. 28 guest column, we discussed the severe shortage of physicians in Hampton Roads. Local residents struggle to find primary care doctors, wait countless hours to be seen in crowded emergency rooms, and experience major delays in getting needed specialty referrals. Our physician shortage crisis is magnified by the retirement of many senior physicians, our older and sicker population, and medical school graduates leaving Hampton Roads.
Could these aforementioned factors be part of the reason why many of our Hampton Roads cities are ranked by the Robert Wood Johnson (RWJ) Foundation in the bottom half of Virginia as healthy places to live? Keep in mind that the RWJ rankings are more than just numbers. They represent early deaths, unmanaged chronic illnesses and infant mortality, all of which are more common in Hampton Roads than in other parts of Virginia.
Meanwhile, Sentara, operating as a not-for-profit, tax-exempt health care system, dominates the South Hampton Roads hospitals scene, runs one of the largest health insurers in Virginia, is thriving financially and has seemed more interested in acquiring out-of-region hospitals and insurance companies than reinvesting our health care dollars back into Hampton Roads.
Let’s examine the financial facts. According to publicly available disclosures, Sentara’s profits were $1.3 billion for fiscal year 2023, nearly half of that generated by its Hampton Roads hospitals. Additional profits of $600 million came from earnings and appreciation on Sentara’s $6.4 billion investment portfolio (again largely funded by care delivered in Hampton Roads). Do we see a disconnect between Sentara’s health and our own?
After much pressure, Sentara finally committed $70 million a year to match state support for the Old Dominion University-Eastern Virginia Medical School merger. It was a positive, though long-delayed investment in our health, but overshadowed by Sentara’s recent purchase of AvMed, a Florida based HMO, for $225 million. According to publicly available disclosures, that Florida operation lost more than $100 million during its first year under Sentara’s management.
Could that money have been better used? Do the math: Each year EVMS graduates 150 new physicians, most of them with debts of more than $200,000 for tuition alone. For $10 million yearly, 50 of those new doctors could have had full-ride, pay-to-stay scholarships in exchange for working seven years in this region in pediatrics, family medicine, internal medicine or other needed specialties. And can we keep the rest of their classmates here by finding innovative ways to match the compensation packages offered by competing metropolitan areas?
With a regional shortage of more than a thousand doctors, according to an ODU report, what else can be done right here and now? Could EVMS shorten the path through medical school to three years for those going into primary care, thereby reducing their student debt and encouraging more candidates to say yes to that career path? Remember that 50 years ago EVMS graduated doctors in just three years.
This year, Gov. Glenn Youngkin signed a law allowing experienced doctors from other countries who pass the stringent exams, like our doctors pass, to work in underserved areas under supervision. EVMS will need funding to mentor them to work here.
Plainly stated, we desperately need more doctors. Fixing this will require full-on commitment by EVMS and both commitment and investment by the governor, our legislature and by this region’s dominant health system. Sentara, tell us how you are going to spearhead this effort in a way that is different from past efforts and that matches the benefits of your nonprofit status and market domination.
Finally, to Sentara’s governing board and management: Make this region’s health your first priority. Base your management bonuses on that rather than on the amount of income falling to your bottom line. Remember that your mission statement is “We improve health daily.” Do that in Hampton Roads. Remember that your home is here. Remember that we want to live in a healthier home, one that proudly leads the rest of Virginia. Start by producing, recruiting and retaining the physicians that this area so desperately needs.
You have the power. You have the funds. And you have the responsibility.
Bruce Holbrook of Norfolk is president of Bruce Holbrook Consulting, Inc. Armistead Williams, M.D., is a neurologist and a former board member of Sentara Hospitals Norfolk and of Sentara Health System Medical Advisory Board.
