Doctors find a long wait to see patients in Texas

By BRETT BRUNE
Houston Chronicle

Dr. Swarna Balasubramaniam is an experienced surgeon hired by Kelsey-Seybold Clinic, which graded her as an “A candidate” for her top-tier surgical training, bright personality and practice-building acumen.

But the Mayo Medical School graduate, who applied five months ago for a Texas medical license, is still waiting for permission to pick up a scalpel in Houston.

“The bureaucracy has gotten to the point where it’s obstructing physicians from practicing here,” she said. “If another doctor asked me whether they should move to Texas, I’d have to tell them, ‘If you can get a job somewhere else, I’d think about it.'”

Statistics from the Texas Medical Board and interviews with care providers show the glacial pace of the state’s license-review process.

Doctors slog through a system that relies more on old-fashioned paperwork than the Internet, slowing care for patients and depriving the physicians of months’ worth of income, according to doctors, hiring managers and a Texas Medical Association official.

It also threatens to throw up a roadblock for physician recruiters — in a state ranked among the lowest in the country in terms of the number of doctors per capita, the experts said.

The long license delays took hold after a surge in applications by doctors wanting to move to Texas.

The number of doctors applying has jumped 57 percent since Texans voted in 2003 for Proposition 12, which put a limit on doctors’ medical liability, according to the medical board.

105-day process

The medical board, which has not increased the number of people processing the applications since the vote, now takes 105 days to process even the most straightforward of applications — after all the required papers have arrived in Austin, which can also be time-consuming. That is up from 18 days at the end of 2002, said Dr. Donald Patrick, the executive director of the medical board.

All hospitals recruiting doctors are experiencing “very substantial delays” that sometimes stretch to a year, said Charles Bailey, general counsel for the Texas Hospital Association.

Patrick has proposed a simple fix: an emergency appropriation by the Texas Legislature of less than $200,000 a year. He said the board needs to add at least six people to the 20-member team working exclusively on licenses for doctors — and add computers.

Joe Nixon, the former state representative who sponsored Prop 12, said the Legislative Budget Board should allocate at least $400,000 to boost the medical board’s staff.

Robert Black, a spokesman for Gov. Rick Perry, said the issue has not yet been declared an emergency item for action. Such a designation means the Legislature can take up the issue in the first 30 days of a session, which would allow for a quick cash infusion.

Patrick said the board also hopes to secure a $50,000 grant to pay for a computer-system upgrade that would allow doctors to access their files on the Internet, to see what is left to be done. “Right now, the only way a doctor can find out if he’s short something is to call one of us. We have to look it up and tell him. All that takes time, and time is the killer.”

Can’t keep pace

Texas has long struggled to staff emergency rooms and fill other holes in health-care-delivery systems, said Jon Opelt, executive director of the Texas Alliance for Patient Access.

Physician recruiters have had an easier time since Prop 12 passed because Texas physicians have since seen their malpractice insurance premiums drop sharply, he said.

“Now, we have an opportunity to make great gains, but the medical board can’t keep pace with the number of applicants,” Opelt said.

Karen Rakers, a family-practice physician who joined a medical group at Memorial Hermann Northwest in October, said the cost of malpractice insurance in Texas has been a plus since she and her fiance moved from the Chicago area. But the five-month wait for a license was a negative, she said.

Dr. Charles Ardoin Jr., who hired Rakers, said it is easy to find doctors interested in moving to Houston — “because of the world class nature of the Texas Medical Center and the Sun Belt-city weather, etc.” — but once the doctors are under contract, they all have to wait at least half a year to get a license.

Texas ranked 42nd out of 51 in the American Medical Association’s 2005 measurement of patient-care doctors per capita, said Marcia Collins, director of the medical education department at the Texas Medical Association. The ranking includes the District of Columbia.

In 2003, Texas had the lowest number of newly licensed doctors in a decade, Collins said. “We really were alarmed by that because as long as we’ve been tracking licensure data, Texas has been a net importer of physicians. We’re dependent on immigration, so when it doesn’t happen, it’s very alarming.”

The Prop 12 surprise

Opelt said when Prop 12 was passed, nobody foresaw the “immediate and dramatic rise” in applications.

“Texas immediately became a magnet for physicians who were graduating from a residency program or who were dissatisfied with where they were practicing,” including states with rising medical liability costs like Oklahoma or Pennsylvania, he said.

Dr. James Thompson, who leads the Dallas-based Federation of State Medical Boards, said Texas’ situation is extraordinary: “To the best of my knowledge, this is unprecedented to have this level of increase in applications and have it sustained for this long.”

Dr. Spencer Berthelsen, chairman of the board at Kelsey-Seybold Medical Group, said his organization has in the past few months had to send patients needing Balasubramaniam’s specialized surgical skills to an outside group. When this happens, he said, the delivery of care is slowed because outside surgeons have their own patients to look after and do not have ready access to Kelsey-Seybold records.

Delays in getting doctors on board reduce the group practice’s efficiency — and hurt the bottom line, Berthelsen said, declining to be specific.

Balasubramaniam, who has been practicing medicine for 15 years, said it took her four months to get a license in New York and less than seven weeks to get one in California.

“I’m not desperately poor, but every month I don’t work is $25,000 less for me. And I don’t have any health insurance,” she said of her situation. “These are the kind of things that drive people away from medicine.”
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