loyal admitters - Modern Healthcare

Hospitals vow niche fight not over
Page 4
CMS outpatient regs target doc pay
Page 5
Growing your own rural physicians
Page 10
Editorial Features
News . . . . . . . . . . . . . . . . . . . 4
Briefly . . . . . . . . . . . . . . . . . . 6
Opinion . . . . . . . . . . . . . . . . . 8
First Person . . . . . . . . . . . . . . 9
Special Report . . . . . . . . . . . 10
By the Numbers . . . . . . . . . . 12
Business news and information for physician-executives, leaders and entrepreneurs
Vol. 10/No. 9 • September 2006
News Makers . . . . . . . . . . . 13
Michael Marcotte
COV E R STO RY
BY JAY GREENE
Recruiting “superstar” doctors from competing hospitals has been a concern in the
past decade because of confusion over
Stark laws relating to the size and scope of
financial packages that can be offered and
the size of the geographic area in which top
doctors can be recruited. But with the final
regulations issued for Stark II in 2004 and
a greater need by hospitals to recruit superstar doctors—who bring potential business
along with their reputations—experts
believe in-town recruiting is beginning to
flourish once again.
Case in point: In December 2005, the
585-bed University of Chicago Hospitals
pulled off a major coup when it recruited
seven members of the 12-member lung
transplant team at 505-bed Loyola
University Medical Center, Maywood, Ill.
The two hospitals, which are approximately
18 miles apart, offer the only lung-transplant services in Chicago.
Continued on p. 2
James Madara, M.D. (center)
lured physicians Sangeeta
Bhorade, M.D., and Edward
Garrity, M.D., away from a
competing hospital
HOW MUCH
DO YOU BID FOR THESE
LOYAL ADMITTERS ?
COV E R STO RY
Continued from p. 1
The team includes Medical
Director Edward Garrity, M.D.,
Associate Medical Director
Sangeeta Bhorade, M.D., surgeon
Wickii Vigneswaran, M.D., anesthesiologist Irene White, M.D., and
three nurses.
Recruited by James Madara,
M.D., dean of the university’s
Pritzker School of Medicine, and Joe
“Skip” Garcia, M.D., chairman of
the school’s department of medicine, the team’s hiring was a strategic move to improve the hospital’s
financial, quality and research activities. “Lung transplantation is a
good investment of resources,”
Garcia says. “Only major academic
medical centers can offer these
unique treatments.”
“UCH offered us a much larger
infrastructure, and the research
side was a big draw,” Garrity
says. “We hope to conduct a wide
range of pulmonary research”
focusing on ameliorating the
effects of lung transplantation.
Madara says the hospital expects
to recoup the $3.35 million initial
investment in the new lung transplant program within three years.
The funding would help cover anticipated financial losses over that time
along with supporting the salaries of
the transplant team. “This is a program that has the potential, over
time, to operate in the black,”
Madara says. Garrity’s team “is
known not just for getting good clinical results but also for using
resources efficiently.”
Modern Physician | September 2006 • 2
Garrity says initially he was not
interested in leaving Loyola when
contacted by two University of
Chicago Hospitals physicians about
relocating. “I felt for a number of
years I had reached the top of the
learning curve at what I was doing
at Loyola,” he says. Over 23 years,
Garrity’s team had conducted more
than 500 transplants. Their one-year
survival rate of 90% is above the
national average of 80%, he says.
Greg Spencer, a physician
recruiter with Kendall & Davis, says
using a go-between to initiate contact with a potential recruit is a good
tactic. “A little distance can allow
the hospital to maintain some confidentiality and not feel like they
Federal law puts limits on offers
to physicians to change hospitals.
poached another hospital’s doctor,” prohibitions of Stark I and the socalled 100-mile Hermann Hospital
Spencer says.
rule—actually a 1993 opinion from
Garrity says he doesn’t believe
HHS’ inspector general’s office on
there was any bad blood over his
doctor-stealing incidents—put a chill
departure at Loyola. “Sure, there
on in-town recruiting, say legal and
were questions about why and why
recruiting experts.
now,” he says. “As often happens,
The Hermann rule began in 1994,
when you have been at a place for a
when what is now called Memorial
long time, word of discussions gets
Hermann Hospital in
out. When I made the
Houston entered into a
decision, I talked with my
closing agreement with
department chair. … I
the Internal Revenue
didn’t feel any hostility.”
Service to pay nearly $1
Madara says that sevmillion in fines and to
eral years ago Loyola
stop paying recruited
recruited one of the
physicians excessive
University of Chicago
incentives and tying those
Hospitals’ top electrophyspayments to referrals.
iologists to head its cardiHermann admitted providology section. “We
ing newly recruited physiremained cordial throughGarcia: Lung
cians in their market area
out,” he says, adding: “All transplantation
such free incentives as
academic medical centers is a good use of
income guarantees, office
share common concerns
resources.
personnel salary support,
… yet we compete with
free office space, subsidized parkeach other for patients, staff and
ing, malpractice insurance and
faculty.”
phone allowances.
Recruiting superstar physi“Recruiting competing doctors
cians—cardiologists, heart surfrom competitors used to happen all
geons, neurologists, orthopedic
the time,” says Brian Rogers, execusurgeons or other big patienttive vice president and principal with
admitters—from a competitor
Jackson & Coker, a physician search
across town is hardly new. For
years, doctors have been offered a firm. “For the longest time, Stark
variety of financial and work-related and the Hermann Hospital rule
caused administrators to instruct us
recruiting arrangements, including
higher salaries, low-interest loans, to build a hedge around physician
relocation expenses, a department recruitment and not even call or
submit a doctor within 100 miles.”
chairmanship or a more extensive
Jed Morrison, a partner with law
work environment.
But during the early ’90s, the dual firm Jackson Walker, says the Stark
effect of the physician self-referral
Continued on p. 3
COV E R STO RY
lematic to recruit people from within
the same practice area, but there
laws made administrators skittish
about recruiting “because providers are rules to follow now,” he says.
began to realize that (the CMS) was “The (1987) anti-kickback statute
has always lurked out there as a
serious about fraud and abuse.”
check on egregious arrangements.”
In 2004, the CMS clarified some
In the first case to apply the federal
of its existing rules on physician
recruitment under Stark II. For exam- anti-kickback law to physician recruiting, Tenet Healthcare Corp.’s 151ple, the CMS created a “bright line”
bed Alvarado Hospital
test that clearly defines
Medical Center, San Diego,
what a hospital may offer
agreed to pay $21 million
a physician to relocate. It
in May to settle charges it
re-emphasizes the existing
paid “excessive amounts”
prohibition on requiring
to recruited physicians.
physicians to refer
Rogers says he has had
patients to the hospital
clients tell him: “We canand the ban on tying
not pay relocation costs
recruiting payments to
for this doctor, and they
referrals.
blamed Alvarado. … They
But new language in the
are overly concerned.”
final Stark II regulation
Rogers: In-town
Once Garrity accepted
redefined physician “relorecruiting is
the University of Chicago
cation” to mean where
picking up.
Hospitals’ offer, he sent
the practice is located
letters to patients about the move.
rather than where the physician
“We have not gone out of our way
lives. Now, a physician is considto re-contact patients. Our practice
ered to be relocated if the practice
plan at Loyola would be shocked,
is moved at least 25 miles, or if at
and we would be overstepping our
least 75% of patients in the new
bounds if we did that,” he says.
area are new.
Rogers says recruiting star doctors
“For years you rarely heard of a
is still more likely to occur in larger
hospital recruiting from a competitor
cities than in smaller or mediumacross town,” Rogers says. Now,
sized towns. “Hospitals still are
however, he says in-town recruiting
leery of recruiting a local doctor and
has picked up. “It is more common,
ending up with a lawsuit,” he says. ■
but a recruited doctor can’t bring
more than 25% of their patient
base,” he adds.
Jay Greene is a former Modern
Morrison says Stark II created spe- Healthcare reporter and now a
cific rules that can be built into
freelance healthcare writer based
recruitment contracts to protect hos- in St. Paul, Minn. Contact Greene
pitals and physicians. “It is still prob- at [email protected]
Modern Physician | September 2006 • 3
Continued from p. 2
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NEWS
Modern Physician | September 2006 • 4
Hospitals vow to fight on
AHA, FAH ask CMS to reconsider specialty ban
BY MATTHEW DOBIAS
The two heavyweights of the hospital lobby collectively took one on
the chin last month, when the
CMS landed a knockout blow by
allowing a moratorium on specialty
NEW RULES OF
THE GAME
The CMS will now require physician-owned
specialty hospitals to:
■ Disclose physician ownership and
compensation arrangements to the
CMS and patients.
■ Be subject to a $10,000-per-day fine
for failing to make those disclosures.
■ Comply with all federal physician
ownership and anti-kickback statutes
and regulations.
■ Provide emergency care for patients
regardless of their ability to pay.
Source: CMS
hospitals to expire Aug. 8. But
both the American Hospital
Association and the Federation of
American Hospitals say they are
reluctant to put away the gloves
just yet and vow a rematch.
“We will continue to fight physician ownership of hospitals,” says
Mary Beth Savary Taylor, vice president of federal relations for the
AHA. “We believe that physician
self-referral to limited-service hospitals should be banned.”
“Payment reforms are one thing,”
says federation spokesman Richard
Coorsh. “But they do not address
the underlying problem, which is the
conflict of interest in the area of
physician-owned hospitals.”
In the other corner, however, the
victors are celebrating. In a statement, Jim Grant, president of the
American Surgical Hospital
Association, said, “This day has
been a long time coming, and we are
glad to finally witness its arrival.”
In lifting the ban and issuing a
final report on the matter, the CMS
says it found little evidence supporting the hospital lobby’s claim that
specialty hospitals self-select healthier and better-insured patients, leaving sicker and lesser-insured
patients for acute-care hospitals.
They also claimed that physicians
are economically motivated to refer
patients to facilities in which they
have an ownership stake rather than
to other facilities that may offer
comparable or even better care.
“This final report is a comprehensive review of the evidence on specialty hospitals and a comprehensive path forward to address concerns that have been raised,” CMS
Administrator Mark McClellan says.
However, the CMS did place some
disclosure requirements and business restrictions on physician-owned
specialty hospitals that treat Medicare
and Medicaid patients (See box). ■
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To learn more about how the Accreditation Association for Ambulatory Health Care can put your organization
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NEWS
Modern Physician | September 2006 • 5
One for you, two for me
Physicians, ASCs hit hardest by proposed reforms
would cut the full marketbasket
allotment by 2 percentage points for
The CMS proposed a set of farthose that don’t participate.
reaching Medicare outpatient payment regulations last month that
■ Pay ASCs 38% less for the same
would greatly alter the way the govtype of procedures done in hospital
ernment pays for ambulatory care.
outpatient settings.
Hardest hit in the pocketbooks by
The CMS made its proposals in
the changes would be physicians
two sets of regulations: its proposed
and free-standing ambulaMedicare outpatient
tory surgery centers.
prospective payment sys“This latest Medicare
tem rule and its proposed
physician payment rule
Medicare physician-fee
again highlights the need
schedule. The agency pubto fix the fatally flawed
lished the regulations in
physician payment systhe Federal Register on
tem, with next year’s
Aug. 8, with a 60-day pubMedicare physician paylic comment period. Final
ment scheduled to be cut
regulations will be pub5.1%,” said Cecil Wilson,
lished later this fall.
chairman of the American Wilson: System
In the past, Congress
Medical Association, in a
has stepped in to reverse
is fatally flawed.
statement. “Seniors who
proposed cuts in Medirely on Medicare and the physicians care payments to physicians—and
who care for them are stuck wonder- is likely to do so again this year.
ing if 2007 will be the year access
More surprising are the CMS’ drato care erodes as we wait for conmatic payment reforms for ASCs,
gressional action to stop the
which would greatly affect physicians.
Medicare payment cuts.”
The CMS says it wants to revise the
Specifically, the proposed regulasystem for the centers using outtions for 2007 would:
patient PPS relative payment weights
as a guide. Rates would be based on
■ Impose a congressionally manthe ambulatory payment classificadated 5.1% cut to physician reimtions used to group procedures
bursement.
■ Update by 3% Medicare payments under the outpatient PPS, but payments in the ASC setting would be
for outpatient services.
38% lower than the payment for the
■ Expand the list of quality meascorresponding procedure in hospital
ures both inpatient and outpatient
outpatient departments. ■
departments must report, and
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B R I E F LY
Modern Physician | September 2006 • 6
Docs to open hospital in Indiana …
… and one in Florida (maybe)
Prexus Health Partners,
Cincinnati, filed plans to build a
medical complex that would
include a 30-bed surgical hospital
in New Albany, Ind., across the
Ohio River from Louisville, Ky.
Tentative plans call for a 60,000square-foot facility and a separate 10,000-square-foot building.
Prexus, formerly known as
Premiere Healthcare Partners, is
a physician-owned company that
operates surgery centers in the
Cincinnati area, as well as the
Butler County (Ohio) Medical
Center in Hamilton, a small forprofit surgery hospital co-owned
by local physicians.
Nemours Foundation, Jacksonville,
Fla., continued its pursuit of
approval to build a children’s hospital in Orlando, filing a second certificate-of-need application. A CON decision is expected in December. The
state rejected Nemours’ first
request in June, saying the pediatric
specialty group had not established
a need for the $270 million, 95-bed
hospital. The proposal faced opposition from pediatric-service providers,
chiefly Orlando Regional Healthcare,
which operates Arnold Palmer
Hospital for Children. Nemours and
Orlando Regional had discussed a
joint project, but talks fell apart.
Docs warm to ASPs
… and two in Texas …
A physician-owned acute-care hospital is slated to open in Texas
this month when Houston-based
University Hospital Systems’
University General Hospital is completed. That $50 million, 10-story
hospital is the company’s first,
says University President and CEO
Kamran Nezami, the only nonphysician partner in the company.
Former Memorial Hermann
Healthcare System administrator
Jerel Humphrey will serve as hospital CEO. University also says it
will partner with Houston developer
Park 8 to build Chinatown General
Hospital, a $68 million, acute-care
hospital. University will lease the
80-bed hospital from Park 8 and
will partner with about 80 physician-owners.
The application service provider
model of distributing computer software has long held promise as a
low-cost method of providing healthcare information technology to small
physician offices. The problem was
few physicians bought electronic
health-record systems in the past
decade and far fewer still wanted to
touch ASP-based EHRs. But physician resistance to ASPs appears to
be easing, and with recent legal
safe harbors and exceptions established by the Bush administration for
IT sharing, use of ASP-based EHRs
could grow much more common,
according to a report at last
month’s work-group meeting of the
American Health Information
Community. So far, Masspro, which
is running an HHS pilot program in
Continued on p. 7
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SOURCE CODE: S276
B R I E F LY
Continued from p. 6
Massachusetts to extend IT to small
physician offices, has helped with
16 ASP-based IT implementations
out of a total of 56 installations,
says Chuck Parker, vice president
and chief technology officer at
Masspro.
Emdeon wants out
Emdeon Corp., Elmwood Park, N.J.,
says it will sell its Emdeon Practice
Services unit, which makes medicalrecords and practice-management
software, to Sage Software for
$565 million in cash in a deal
expected to be completed this
month. Emdeon, formerly WebMD,
also says it continues to explore
strategic alternatives for its business-services unit—Emdeon’s medical-claims clearinghouse—and
expects to make an announcement
shortly. Sage is part of the North
American subsidiary of Sage Group,
Newcastle, England. Emdeon also
reported second-quarter net income
of $23.2 million on revenue of
$354.9 million. Emdeon Practice
Services had revenue of $77.3 million during the quarter, down from
$78.6 million in the year-ago quarter.
Coming clean with patients …
About 98% of physicians surveyed
said serious medical errors should
be disclosed to patients, but about
60% said they will be less likely to
do so if they “think the patient
would not understand what I was
telling him or her,” according to a
study in last month’s Archives of
Modern Physician | September 2006 • 7
Internal Medicine. The study included
anonymous responses from 2,637
U.S. and Canadian physicians
between July 2003 and March
2004. Other factors the doctors
said that might inhibit disclosure
included: “If I think the patient
would not want to know about the
error” (30%); “if the patient is
unaware that the error happened”
(21%); and “if I think I might get
sued” (19%). According to a second
article examining other responses
from the same physicians, there
exist wide variations in how physicians disclose medical errors. For
example, 56% of respondents
would mention the adverse event
but not the error, and 19% would
volunteer no information about the
error’s cause.
... and with provider peers
A new national study reiterates a
widely accepted maxim: Communication is one of the keys to any
good relationship—especially those
involving hospital administrators
and physicians. These sometimes
“volatile” relationships call for
added focus on both collaboration
and communication, according to a
study by consultancy Mitretek
Healthcare and the American
Hospital Association’s Society for
Healthcare Strategy and Market
Development. The report provides
benchmark data on more than 60
strategies that hospitals are using
to strengthen ties with physicians,
including a focus on economic alignment between the two groups.
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OPINION
All-out blitz
Recruiting stars is key for football and healthcare
One of the most common excuses or running back from another team in
the free-agent market. By luring away
for escalating healthcare costs,
a star player, the team hopes to
shoddy care and limited access to
increase attendance, ticket revenue
services is that healthcare is differand championships. One twist of a
ent. Traditionalists argue that the
typical economic forces that lead to knee (or scalpel) can be disastrous.
This issue’s special report (p. 10)
improvements in other industries
by reporter Jessica
simply don’t apply in
Zigmond tackles the
healthcare. After reading
issue of physician
this issue’s cover story
recruitment in medically
and special report, both
underserved rural marof which focus on physikets. One strategy being
cian recruitment and
deployed by rural hospiretention, I know one
tals, practices and medindustry that healthcare
ical schools is that of
is like. And that’s pro
grooming homegrown
football.
DAVID BURDA
talent. They’re creating
As I write this, the
Editor
incentives for newly
start of the regular seaminted physicians to
son is just around the
return to their home towns or praccorner and the 32 NFL teams in
tice in the communities in which
training camps are doing everything
they received their medical training.
from minor tweaking to wholesale
Again, it’s reminiscent of professhuffling of rosters to find the right
mix of players. It’s not that much dif- sional football, which relies on universities and colleges to train and
ferent from what hospitals do with
their medical staffs or practices with prepare the next crop of rookies
available in the annual draft. Scouts
their doctors.
from professional teams constantly
This issue’s cover story (p. 1) by
hunt for local college players who
frequent contributor Jay Greene
could make a splash in the pros.
revisits the topic of doctor stealing,
So the next time you’re trying to
which occurs when one hospital or
attract a prominent physician to your
practice lures away a prominent
medical staff or practice, or groomphysician from a rival in the hopes
ing a future superstar doctor, just
of increasing patient admissions,
read the sports page or watch a few
revenue and prestige.
games on Sunday. You might just
It’s much like one football team
learn something.
stealing away a veteran quarterback
Modern Physician | September 2006 • 8
LETTERS
Carilion’s smart move …
Putting the control of a health system back in the hands of the physicians—as Carilion Health System
in Roanoke, Va., intends to do—
makes perfectly good business
logic (“From system to clinic,”
August p. 10). Decisionmaking in
most large health systems moves
at glacial speed and rarely has support from a majority of the medical
staff. Without physician leaders at
the helm, there cannot be an alignment of goals; with that said, the
community should have input at
the board level. The political characteristics of a voluntary medical
staff will be transformed into a collective, collaborative voice so long
as rules and systems are in place
that create equity, fairness and
consistent decisionmaking.
David Disbrow
Administrator
Pain Management Center
Cleveland Clinic Foundation
… doesn’t make sense
Where were the executives of
Carilion the past 20 years when we
got “paradigm shifted” to the tune
of billions of Wall Street’s dollars
wasted trying this “integration”
idea to change the economics of
healthcare? No doubt the Einsteins
at Carilion have well-paid consultants who put visions of Mayo,
Scripps and Ochsner in their
heads. They need to be reminded
that those powerhouses grew over
generations by building reputations,
not by merging foundering entities
and declaring themselves institutes. They gradually attracted
endowments that allowed them to
handpick the physicians who continued this success. There’s little
doubt Edward Murphy, the physician figurehead who announced
this project, is being driven by hospital execs salivating over Part B
and other outpatient revenue. It
won’t work. The physicians are
actually earning all that revenue
(and more) and good ones won’t
be drawn to or remain on a “team”
that is sucking them dry. There are
a minority of unambitious doctors
out there—they are already working
for the Veterans Affairs
Department, group model HMOs
and second- and third-tier teaching
hospitals. The ones worth big
salaries are the ones Carilion
needs, and it won’t attract them by
simply corralling local physicians
onto their letterhead.
Jeffrey Denning
Principal
Practice Performance Group
La Jolla, Calif.
What do you think? Let us and your fellow
Modern Physician readers know. Send your
letter to the editor to [email protected].
FIRST PERSON
Modern Physician | September 2006 • 9
Stroke of genius?
venously delivered tPA to dissolve
blood clots obstructing coronary
arteries were shown to decrease
patients’ mortality.
The National Institute of
Neurological Disorders and Stroke
was at the forefront of testing the
efficacy and safety of tPA for
A major barrier to stroke care
has been financial. Despite the
nation’s estimated $57 billion in
yearly direct and indirect costs
related to stroke, it was only in
October 2005 that the CMS decided to reimburse hospitals for the
additional expense of reperfusion
therapy for acute stroke.
Prior to the 2005 coverage
decision, Medicare paid hospitals
a set amount per patient treated
Koroshetz
Emr
Added reimbursement could bring widespread tPA treatments
BY WALTER J. KOROSHETZ, M.D.,
ERICA SEIGUER, MARIAN EMR
AND NANCY HART
In the decade since it was
approved by the Food and Drug
Administration, tissue plasminogen
activator, or tPA, a reperfusion
therapy for cardiac and stroke care,
has revolutionized the treatment of
stroke—the third leading cause of
death in the U.S., and the leading
cause of adult disability.
Until the mid-’90s most physicians were trained to believe that
little could be done to alleviate the
severe neurologic disability that
occurs with a stroke. However,
laboratory work in animal models
of ischemic stroke and studies in
patients using positron emission
tomographic imaging demonstrated
that the process of permanent
brain injury, or cerebral infarction,
occurs over a variable time course,
usually measured in hours.
Reports began to appear of
“Lazarus-like” patient improvement
with rapid removal of a clot
obstructing a cerebral vessel. In
patients with acute coronary
syndromes, multiple trials of intraIf you’re a physician and you’d like to tell
your business story, please contact us at
[email protected]. Submissions should
be no longer than 1,000 words and should
include a color photo of the author.
Seiguer
stroke. A carefully designed clinical
trial of acute-ischemic-stroke
patients found that those treated
with tPA had a statistically significant better chance of a good recovery status by three months—a
benefit that was sustained at follow-up. In 1995, the FDA approved
tPA use within three hours of
ischemic stroke onset.
Safe tPA administration requires
systems to be in place. An effective infrastructure for emergent
care includes an acute-stroke team
able to respond around-the-clock, a
specialized unit dedicated to stroke
care, appropriate laboratory services and a staff that undergoes regular continuing medical education.
Hart
for stroke, whether reperfusion
therapy was used. Members of the
Brain Attack Coalition—a group of
professional, voluntary and governmental organizations working to
improve stroke care—argued that
patients who receive reperfusion
therapy require more hospital
resources than patients who did
not. Increased intensity of patient
monitoring; laboratory, pharmacy
and neuroimaging costs; and hospital infrastructure costs have all
been cited as barriers to the
appropriate use of clot-busting
drugs and devices.
The standard stroke payment
code, DRG 14, gave hospitals about
$5,600 per stroke patient, and
Medicare reimbursed hospitals
$2,000 per administration of tPA to
cover the costs of the drug itself. It
is believed this reimbursement
level, along with the cost of the
infrastructure associated with
establishing a system for using tPA
safely, were financial disincentives
for hospitals to give tPA.
Brain Attack Coalition members,
along with other stroke leaders,
presented data to the CMS showing
patients treated with tPA were
twice as expensive to care for as
the average stroke patient coded
under the standard stroke DRG.
In its 2005 ruling, the CMS recognized this disparity and instituted
DRG 559 for acute stroke patients
treated with a reperfusion agent.
DRG 559 doubles the payment—
now approximately $11,500. ■
Walter Koroshetz, M.D., is vice chairman of the department of neurology at
Massachusetts General Hospital, Boston, and professor of neurology at Harvard
Medical School. He has served as chairman of the Reimbursement Committee of the
Brain Attack Coalition for the past four years. Erica Seiguer is an M.D.-Ph.D. candidate
studying economics in Harvard University’s doctoral program in health policy. Marian
Emr is the director of the Office of Communications and Public Liaison at the National
Institute of Neurological Disorders and Stroke, National Institutes of Health. Nancy Hart
is coordinator of the Brain Attack Coalition at the National Institute of Neurological
Disorders and Stroke, National Institutes of Health.
SPECIAL REPORT
Help wanted
Modern Physician | September 2006 • 10
concern for their spouses, families and children’s education, Mason says. In West Virginia,
she emphasizes what she calls the state’s
“relaxed, nature-loving” lifestyle, which is a good
Benefits include friendly community and help paying off student debt
fit for physicians and family members who enjoy
hiking, biking, camping, kayaking and rafting.
practice in rural communities and make them
BY JESSICA ZIGMOND
“We are getting better at shopping centers—
want to stay.
As the demand for qualified physicians and
within an hour or so,” Mason says. “It might not
At WVU, funding from the medical school
other healthcare professionals in rural communibe in their backyard.”
and the West Virginia Rural Health Education
ties outweighs supply, local leaders continue to
Last year, WVU’s program assisted 94 resiPartnerships-Area Health Education Centers
seek solutions. Rural rotation programs during
dents, of which 52, or about 55% of the total,
helps provide the resources to target medical
medical school and residency training, greater
stayed in the state, while 41 left West Virginia;
residents, fellows in all specialties, alumni
attention to finding “homegrown” talent, and
placement for one resident is still unknown. The
and medical students to fill vacanassistance with repaying student loans
overall percentage of retained physicians has
cies. If students or residents prefer
are among the ways some underbeen dropping in recent years: 43 residents, or
to leave West Virginia, Mason says
served areas are working to attract
61%, remained in West Virginia in 2002, and 18
she refers them to an appropriate
and retain medical professionals.
residents, or 62%, remained in-state in 2000.
source to find placement.
“A big challenge is that when physi“As much as I want to find (placements for)
The university’s efforts include
cians are working in rural areas, they
rural locations, if they come to me and want to
career guidance and support through
are often alone and isolated,” says
work in an urban area, there is not much I can
presentations, a job search e-mail
Elaine Mason, director of the West
do to change their mind,” Mason says.
service and a Web site, as well as an
Virginia University Health Sciences
Hurst, of the University of Louisville, says her
annual career seminar and job fair.
Placement Service. “We’re working
school receives money from the state
“I have long said that peohard at improving that situation.” One
to help place physicians. According to
ple
who
wind
up
in
rural
way for areas to keep an adequate
Mason: Rural
Hurst, rural areas can be an attractive
healthcare are both mavernumber of caregivers is to “grow their
physicians can
option because physicians have less
icks and missionaries,” says
own,” an approach that emphasizes
feel isolated.
competition, and the setting is more
Hilda Heady, executive direcencouraging students to give back to
personalized. “You do have more
the rural areas of the states where they received tor of the West Virginia Rural Health
power, or a voice, if you want to have
Education Partnerships-Area Health
their medical education.
an influence,” she says.
Education Centers, which works to
Earlier this year, at the annual National Rural
One major recruitment tool for
Health Association conference, Mason joined Jan retain West Virginia-trained health scistates is medical school loan-repayence graduates in underserved rural
Hurst, director of physician placement at the
ment programs. Hurst says many of
areas of the state through partnerships
University of Louisville (Ky.) School of Medicine,
the university’s graduates have “at
with communities, schools, healthcare
and Mary Amundson, assistant professor at the
Heady: Rural
least $100,000 in debt” when they
providers and government agencies.
Center for Rural Health at the University of North
physicians are
graduate, and it’s likely twice that
“They have a passion to make a difDakota School of Medicine and Health Sciences,
“mavericks and
for a private-school education. Loan
to highlight the most important aspects in recruit- ference, and, with a missionary zeal,
missionaries.”
forgiveness can be an attractive facing and retaining physicians and other healthcare can move into these settings. They
tor when residents and physicians are considhave to be mavericks if they are in a solo situaproviders in rural communities.
ering placements.
tion—there is not a large social system.”
While the programs have slightly different tarAt the University of North Dakota, Amundson
The “social system” issue is a significant chalget audiences and are not funded the same way,
their missions are similar: to attract physicians to lenge in attracting physicians because of the
Continued on p. 11
SPECIAL REPORT
that in addition to an increasing demand for
physicians in all areas, it’s difficult for physihas worked on the Student/Resident
Experiences and Rotations in Community Health, cians to turn down a higher-paying opportunity in
a nonrural setting.
or SEARCH, program for the past 16 years. It
“It’s hard not to go to a site where you may
takes an interdisciplinary approach and encourwork less hours. It’s hard to walk away at 5 p.m.
ages health-professional students to work
when you know there are people still to be seen,
together in rural communities.
“We try to show the medical students that they or on a weekend, when there is a need. Students
want better balance in terms of personal time
are not alone out there and to rely on the social
workers, nurse practitioners, physician assistants and professional time,” says Crouse, who adds
that the typical workweek is longer in rural areas
and psychologists in their regional-access area,”
because there tends to be less backup.
Amundson says.
The University of Wisconsin at Madison is
This year, the SEARCH program had 23 students, which includes students in their first year preparing to admit the first students to its
Wisconsin Academy for Rural Medicine in the fall
of medical school, as well as students training
to be social workers and nurse practitioners. As of 2007. The school-within-a-school is expected
to expand the medical school’s student populapart of the program, students work with a varition to 175 from 150 and admit students from a
ety of providers and try different specialties,
geographically diverse cross section, Crouse
including long-term care and public health.
says. The program hopes to identify
Amundson says the program stresses
students who have a great affinity for
a community component. In one
rural practice and place them in rural
instance, Amundson says two stuareas. They will follow the traditional
dents “who did not have compatible
curriculum during the first two years
personalities” worked together to
and then spend the majority of their
launch a bike helmet safety program
third and fourth years at rural sites.
spanning five counties.
“People from a rural area or an
“I have seen a more critical shortunderserved urban area are more
age—it is so difficult to recruit physilikely to return,” Crouse says.
cians for very rural states,” Amundson
According to Terry Hill, executive
says, who added that physicians now
director of the Rural Health Resource
prefer less-frequent on-call duty than
Amundson: It’s
Center in Duluth, Minn., one way rural
doctors in the past. “They are also
so difficult to
areas can succeed in keeping their
looking for employment for spouses,
recruit in very
physicians and other caregivers is by
which is more difficult in rural commurural states.
considering what it takes for caregiver
nities, (and) they are looking for curricuretention during recruitment.
lum in the school system for their children. They
“We recommend a community recruitment
also want to be close by urban amenities. ...
and retention committee to monitor how (the
They are forgetting about the great quality of life
physicians) are doing in the community,” Hill
that you can have in a rural community.”
says. “If you’re mindful about the fact that they
Byron Crouse, M.D., associate dean for rural
are a community asset and they can leave at
and community health at the University of
any time, then you’re going to retain (them),
Wisconsin at Madison School of Medicine, says
Continued from p. 10
Modern Physician | September 2006 • 11
and you won’t have to recruit.”
The Rural Health Resource Center works with
the University of Minnesota at Duluth Medical
School to assist students and place them in
summer internships in underserved areas. In
addition to its connection with the university, the
center’s Minnesota Health Professional
Placement and Retention Program works with
about 69 communities in the state. Program
Coordinator Angie LaFlamme says the program
A state program has helped fill vacancies at facilities
such as the Littlefork (Minn.) Medical Center.
works with an average of 90 candidates each
year, of which about 80% are medical school residents. She estimates there are about 200 physician vacancies in Minnesota.
Hill also says rural physicians are less isolated
today, now that access to the Internet and satellite television has narrowed the gap. But there
are other problems that could serve as a barrier
to attracting physicians to rural areas. “I think
we’ve improved on the problem of isolation, but
still the problem relates to the school system,”
Hill says, adding that students might not be
steered toward careers in science and medicine.
“Rural schools (especially at the secondary level)
are not generally able to offer the same level of
science courses. We have to find rural kids, but
the rural kids have to be competitive. It becomes
a community issue and a community problem.” ■
BY T H E N U M B E R S
Modern Physician | September 2006 • 12
WHAT RECRUITERS SAY ABOUT RECRUITING PHYSICIANS
Most difficult to recruit specialties
Percentage of time spent
recruiting physicians
Orthopedics
20%
4.8% 1.9%
Cardiology
19%
Neurology
14.3%
25% or less
About 33%
42.9%
13.3%
14%
About 50%
67 to 75%
Psychiatry
22.9%
12%
About 80%
90 to 100%
Radiology
9%
Note: Numbers may not equal 100 due to rounding
Source: LocumTenens.com 2005 survey of ASPR Members
Primary care
8%
Surgery
7%
Obstetrics
5%
Based on a survey of 106
members of the Association
of Staff Physician Recruiters.
Percentages for all charts are
percentages of respondents who
cited each answer.
Time required to fill a
staff physician vacancy
2.9% 2.9%
19.1%
29.5%
Anesthesiology
7 months to a year
4%
45.7%
Pediatrics
12 to 18 months
18 months to 2 years
2%
Source: LocumTenens.com 2005 survey of ASPR Members
6 months or less
Other
Note: Numbers may not equal 100 due to rounding
Source: LocumTenens.com 2005 survey of ASPR Members
NEWS MAKERS
ASSOCIATIONS
Russell Holman, M.D., senior vice
president and national medical
director of Cogent Healthcare, was
named president-elect of the Society
of Hospital Medicine, Philadelphia.
Holman, 39, is a longtime member
of the group and previously was secretary for the board of directors.
EDUCATION
The interim chairman of the
Cleveland Clinic’s cardiology program now holds
the job permanently. Steven
Nissen, M.D., was
chosen by a
search committee
to succeed Eric
Topol, M.D., 52,
who left the clinic
in February to
Nissen
become a genetics professor at nearby Case
Western Reserve University after a
dispute with clinic leadership.
Nissen, 57, says he wants his doctors to continue to develop preventive therapies and do more community outreach, particularly in terms of
access to care. … T. Samuel
Shomaker, M.D., acting dean at the
University of Hawaii’s John A. Burns
Making news? Send your personal and
personnel stories to [email protected].
Please attach a color photo of your
Modern Physician News Maker with
your submission.
Modern Physician | September 2006 • 13
School of Medicine, was named
dean of Austin programs for the
University of Texas Medical Branch
at Galveston School of Medicine,
officials said. Shomaker, 52, takes
over as dean on Sept. 1.
GOVERNMENT
Surgeon General Richard Carmona,
M.D., 57, stepped down and the job
will be filled on an interim basis by
Deputy Surgeon
General Kenneth
Moritsugu, M.D.,
61, until the White
House names a
successor.
Carmona’s fouryear term expired
July 29. An HHS
spokeswoman
Moritsugu
said Carmona
plans to return to civilian life. Prior to
becoming surgeon general,
Carmona was chairman of a regional
emergency medical system in southern Arizona and a professor of surgery at the University of Arizona.
Among other activities, the surgeon
general oversees the 6,000-member
U.S. Public Health Service
Commissioned Corps, which in
2005 saw its largest deployment
ever after hurricanes Katrina and
Rita struck the Gulf Coast.
M.D., 52, will serve as board chairman and managing shareholder.
… Craig Samitt,
M.D., was named
president and CEO
for Dean Health
System, Madison,
Wis. Samitt, 42,
will assume the
position this
Sammit
month. He succeeds Allen Kemp, M.D., who has
assumed the role of CEO emeritus
and will represent Dean nationally.
and senior vice president at the
medical center.
HOSPITALS, SYSTEMS
SUPPLIERS, VENDORS
Laura Forese, M.D., has been
appointed chief
medical officer of
New YorkPresbyterian
Hospital/Weill
Cornell Medical
Center. Forese,
45, will continue
to serve as chief
medical officer
Forese
Michael Hawkins, M.D., has joined
Cogent Healthcare as regional
medical director-Southeast.
Hawkins, 51, is a fellow of
the American College of
Physicians. … Pathologist and
physician-executive Dennis Morgan
Smith Jr., M.D., was named to the
board of directors of Clarient, an
Aliso Viejo, Calif.-based developer
of oncology products.
RESEARCH
Justin Starren, M.D., was appointed
director of the Marshfield (Wis.)
Clinic Research Foundation’s new
Biomedical Informatics Research
Center, which will include a focus on
the use of information, data and
knowledge in biomedical domains.
Starren, 47, was associate professor in the departments of biomedical informatics and radiology at
Columbia University, New York.
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GROUPS
Michigan Medical, a Grand Rapidsbased physician group, named Ted
Inman, 51, vice president of operations and general counsel, its new
CEO. Former CEO James Buzzitta,
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