Notice a few more gray hairs these days when you visit your doctor?
Not on you on the doctor.
Be warned: Those silvery strands could be a sign of a physician shortage on the horizon.
Various studies are predicting a national shortage of doctors ranging between 85,000 and 200,000 by the year 2020.
The cause is a complex mix of issues that spans generations.
But much of the concern stems from the fact that a large group of baby-boomer doctors in their mid-50s and 60s are contemplating retirement as the nation grows older and needs more medical care.
At the same time, experts say, new doctors want a more balanced life than their predecessors had, particularly as more women
enter the field.
''It's going to take more doctors to fill those shoes of the retiring doctors, because the younger generation of physician is looking at greater flexibility in their schedules,'' said Dr. Joseph Zarconi, vice president for medical education and research at Summa Health System in Akron.
''They want more opportunities to have balance between their private and professional lives. Hours worked is trending down, which may be a good thing, frankly, because doctors were overworked.''
During the 1960s and '70s, medical school enrollment doubled to about 16,000 annually, said Edward Salsberg, director of the Association of American Medical Colleges' Center for Workforce Studies. Since then, enrollment has been stagnant.
''Our most current estimate is about 36 percent of the physician work force is over the age of 55,'' Salsberg said. ''Clearly, over the next 10 to 20 years, that very large cohort of physicians will be approaching retirement. ''
Nationwide, nearly half of all doctors are 50 or older, according to the American Medical Association.
The average age of staff physicians at Akron General Medical Center and Summa is about 47. In Canton, the average is 48 at Aultman Hospital and 49 at Mercy Medical Center.
In one to three years, nearly half of the doctors 50 to 65 plan to retire, cut back to part time, switch to jobs that don't involve patient care, close their practices to new patients and/or significantly reduce the number of patients they see, according to a new study.
It's part of Dr. John McBride's job as interim chairman of the department of pediatrics at Akron Children's Hospital to keep tabs on physician staffing.
At age 62, he's also among that large group of doctors envisioning life after medicine.
''I do not intend to work full time after 65,'' he said. ''There are a lot of things I'm looking forward to.''
Hospital officials are planning to make sure the graying of their medical staff doesn't create gaps in patient care.
Summa has taken aggressive steps in recent years to boost its physician recruitment and retention efforts, said Dr. T. Clifford Deveny, vice president for physician alignment.
Summa offers help managing practices, grants for electronic medical records and, in some cases, employment for doctors, he said. Some doctors nearing retirement work with the system to help plan the transition.
Akron General also tracks retirement plans among its 591 physicians, as well as needs by each specialty, said Dr. Richard Streck, the hospital's senior vice president for medical affairs.
In one case, he said, Akron General saw a future need for an endocrinologist and recruited a young doctor to the area. Shortly after the new doctor arrived, a doctor who said he planned to retire in the next seven years instead moved to California.
''It's something you need to pay attention to on an ongoing basis,'' Streck said. ''You can't just wait until the doctor is ready to retire.''
Children's constantly recruits pediatric specialists to the region.
''There are fewer people finishing their training than there are getting ready to retire,'' McBride said. ''It's a particular problem trying to match people up with opportunities. It's not so hard finding someone to be a pediatrician in Palm Beach, but in Dover or Ashland, it's a challenge.''
What can be done?
To fully address the potential shortage, Salsberg said, the medical field needs to embrace technology, improve efficiency and use nurse practitioners and other professionals to assist doctors in caring for patients.
In addition, the Association of American Medical Colleges is calling for enrollment to increase 30 percent.
Dr. Lois Margaret Nora, president of the Northeastern Ohio Universities Colleges of Medicine and Pharmacy (NEOUCOM) in Rootstown, is proposing a new affiliation with Cleveland State University for a combined bachelor of science and medical doctorate degree.
NEOUCOM already has that program with the University of Akron and Kent State and Youngstown State universities.
If the plan is approved, NEOUCOM eventually would add 35 medical students each year, bringing the annual class total to 150.
An increase in medical students at NEOUCOM is likely to translate into more local doctors.
Of NEOUCOM's 2,346 graduates since 1981, about half practice in Ohio. A third (784) are in Northeast Ohio.
Residency programs also help increase the local doctor supply. More than a third of the 930 doctors on Summa's active medical staff completed their training at Summa's hospitals.
But Summa's Zarconi suspects new doctors faced with increasingly higher medical school debt are less likely to stay in Northeast Ohio, where reimbursement tends to be lower than in other regions.
Still, doctors who were born, trained or ever lived in Ohio ''are usually the best candidates to try to entice them to return,'' said Jan Peach, Mercy Medical Center's director of physician relations.
''Keeping in close contact with our medical staff, we've found out that many of them have children who are in medical school,'' she said. ''We're kind of excited about the fact that we have this second generation of physicians who were born and raised in this community.''
As a teenager growing up in the Canton area, Sara Vance used to watch her father, Dr. David Brandau, perform medical procedures or deliver babies when patients agreed.
''I just always wanted to go into medicine,'' she said. ''I think it did start out as wanting to be like my dad, and as I went through school, it was confirmed by the fact that I liked the sciences and anatomy and biology.''
Several months ago, the 30-year-old new doctor joined her 55-year-old father's medical practice, Atrium Ob/Gyn Inc. in Jackson Township.
With the help of family in the region, Vance juggled two pregnancies while finishing medical school at NEOUCOM and a residency at Aultman Hospital.
''For me, I think at least here in Canton and Northeast Ohio, it is a fairly family-friendly outlook toward females in medicine,'' she said.
Her father never pushed her to follow in his footsteps.
Nevertheless, he said, he's thrilled she chose his career path and can experience the ''terrific rewards'' that come from helping people.
''I hope she can carry on the tradition of our group's reputation,'' he said. ''I'm just so delighted to, at some point, let her carry that on.''
Just don't expect him to hang up his stethoscope anytime soon.
''It just is such a joy to work with her,'' he said. ''I don't want to quit.''
Cheryl Powell can be reached at 330-996-3902 or firstname.lastname@example.org.