Doctors make more money elsewhere, official says

Published 9:25 am Monday, September 10, 2007

JACKSON, Miss. (AP) — Lack of financial resources and fierce competition among academic institutions across the nation are making it hard to attract and retain physicians at the University of Mississippi Medical Center, school officials say.

The state’s only teaching hospital started the fiscal year in July with an 18 percent vacancy rate, with many of the empty spots in sub-specialty areas and critical surgical staff.

Recently announced plans to increase faculty by 50 percent, which will mean adding between 200 and 230 positions — though not all of them will be doctors — within the next five years made recruitment more urgent.

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But a growing uninsured population, dwindling monetary support from the state and federal government and a nationwide doctor shortage aren’t making the vacancies easy to fill.

It’s a problem many academic health centers are facing, said Dr. Dan Jones, vice chancellor for health affairs and dean of the School of Medicine.

“It has been a struggle,” said Jones, citing pediatric surgery, neurosurgery and trauma as areas suffering the most. “All of those areas now have new physicians here with ambitious plans to recruit us up to a full slate of what we need in the state, but it’s been difficult.”

Treating patients, teaching residents and making time for research, all while balancing a personal life — it takes a certain kind of doctor to do the work, said Dr. Andrew Parent, chief of the Department of Neurosurgery.

“I’m really proud of the people we have here, the quality, but over and over again we’ve lost people. For a while I was up to six neurosurgeons and I felt so great. Then we just lost three like that,” said Parent, snapping his fingers.

“Sometimes I feel like a used car salesman trying to sell this product over and over again.”

Budgeted for six neurosurgeons, the department is down one, but that means some of the physicians stay on call for entire weekends because there is no backup.

Inequalities in pay between teaching hospitals like UMC and private practice — mostly because of the increasing cost of care for the uninsured — have a lot to do with recruitment issues, Parent said.

“My residents, when they leave this program, they can make three to five times what I make in an annual salary. So why would people stay in academics?” he said. “It’s a reality in this world.”

Each year, UMC spends about $86 million on care for the uninsured, recovering only two-thirds from the federal government.

By law, at least 50 percent of the patients at a public hospital must be uninsured or on Medicaid.

But nearly 67 percent of UMC’s patients fall into one of those categories, Jones has said in the past.

“For example, let’s take a radiologist. … Typically, radiologists who practice in a place like this see a much larger number of uninsured patients than at a community hospital,” he said. “So, that radiologist, doing the same amount of work in a day will see less money … and there will be a lot less money in the system to pay that doctor.”

With every sub-specialty currently covered, UMC’s Department of Orthopedic Surgery is in a better position than most.

“It would be nice to have two or three in each discipline for holidays, vacation — anything,” Dr. Bob McGuire said. “But I think we are unique in the fact that we are full.”

Still, even the strongest departments face funding challenges.

“The salary lines that we’re able to offer here in the state can hurt sometimes,” McGuire said. “A lot of people will head where they’re getting a bigger salary.”

Jones said officials at UMC are continually trying to “balance the books” by further developing clinical programs that appeal to insured patients and depending on the state for support.

Although the state allocated $219 million to UMC for fiscal 2008, which is about $43 million more than the previous year, Jones has said that money was more for “catch up” than anything else.

CEOs at public academic health centers across the United States are feeling the same strain on financial and faculty resources, a recent report from the Association of Academic Health Centers found.

At the University of Tennessee Medical Center at Knoxville, many doctors who teach are also allowed to have a private practice on the side to supplement their salaries, said Steven Ross, the medical center’s senior vice president for strategic development.

“Is that good? I don’t know.” Ross said. “Eventually, if we all do that, there may not be enough academics to go around.”

But with the baby boomers getting ready to retire and the reimbursements from the federal government for the uninsured not getting any higher, “it’s a reality,” he said.

“I think (the next generation of physicians are) saying, ‘I want to do all these things, but I want to be compensated and have a life, too,’ ” he continued. “And I think that’s a fair request, so we have to deliver that.”

There are some things about a teaching institution that will always attract certain doctors, Ross said.

“There is a great sense of fulfillment for some people in helping someone who cannot get help anywhere else,” he said.

Parent agrees.

“For me, personally, one of the thrills I get at an academic institution is teaching. I get to start off with a rather roughly finished medical student,” he said. “And seven years later, I can be able to say about that same person, ‘I would let that doctor operate on my brain.'”