Recruiting doctors difficult

By KIM BARTO – Bulletin Staff Writer
http://www.martinsvillebulletin.com

Memorial Hospital in Martinsville is exploring new ways to recruit more doctors and reduce stress on its current staff.

It can be hard to get a doctor’s appointment locally because many practices are closed to new patients, said Darren Aaron, director of growth and business development at Memorial Hospital. A nonemergency such as a physical exam could take “four or five months� to work in, he added.

“The way health care is changing is making it a lot more difficult to attract primary care doctors,� Aaron said, noting that medical school graduates are seeking out other specialties and want “a better quality of life.�

Primary care physicians are in short supply across the country. The field includes internal medicine, pediatrics and family practice.

Recruiting remains a priority for Memorial Hospital, Aaron said. In particular, the hospital is trying to beef up its cardiology staff and hire four more primary care doctors.

“Our existing primary care doctors just can’t absorb the patients,� Aaron said, adding that one physician who left over the summer had been practicing for 14 years.

Now, Aaron added, there are “a lot of patients now looking for primary care doctors.�

To address the issue, “We’re looking into avenues we haven’t really explored before, like foreign medical school grads and visa workers,� Aaron said.

The option has not been used in the past because of red tape, he said. Foreign doctors need to attend an accredited American school and go through a medical residency in the United States. They also go through a credentialing board and are tested for competency.

This option still is being investigated. In general, Memorial Hospital works with national recruiting firms to find talent, Aaron said. Most of the hires come from outside the area.

“We look at about 50 physicians a year and probably offer contracts to about 30, and of those, about 10 commit,� he said. “We’re not just looking for warm bodies. We want to provide the best care we possibly can in this area.�

To gauge how many doctors are needed, the hospital does not follow a set ratio.

“It’s more just talking to the medical staff and finding out wait times,� Aaron said. “Are doctors getting the referrals they need? Are we able to absorb the patients from primary care doctors who leave the community?�

With about 93 total physicians on the hospital staff, and an estimated dozen more in the community without hospital privileges, Martinsville is not considered “medically underserved,� Aaron said. The underserved designation factors in the ratio of primary care physicians to the population, infant mortality rate, poverty rate and age of the population.

However, the federal government considers parts of Henry County to be underserved, including Bassett, he said. This means the government can give money to supplement hiring packages to attract doctors, forgive loans and give certain tax advantages to clinics, such as Bassett Family Practice.

So far in 2008, Memorial has recruited 10 doctors in different specialties, Aaron said. Six doctors have left this year, including a husband and wife team. In 2007, the hospital recruited 13 doctors and lost nine.

Recent hires include a new orthopedic surgeon, Dr. Thomas Allen, who starts this month.

“Orthopedics has been a challenge for a while because we’re down to two (orthopedists),� Aaron said. “They only have to be on call one out of every three days, so we do have a third of the time when we just don’t have an orthopedic surgeon covering.�

Orthopedic doctors handle broken bones, fractures, strains and sprains, and spinal issues.

With the addition of Allen, “that’s going to finally get us back to three orthopedic surgeons and 24/7 coverage,�

Aaron said. In the meantime, when no one is on call, “We’ve had to work hard with primary care doctors in getting more comfortable admitting orthopedic patients,� he said.

For simple fractures, hip injuries and conditions that do not involve a lot of blood loss, primary care doctors can admit the patients to the hospital, follow their progress and consult with the specialist the next day, he said.

“We can stabilize any patient,� Aaron said, but there are certain conditions where patients are transferred to other hospitals.

“For a patient who needs a trauma center, the closest ones are Roanoke and Baptist,� he said, the latter referring to Wake Forest University Baptist Medical Center in Winston-Salem, N.C.

Patients are shipped out if they have multisystem trauma, need a burn unit or have paralysis. Seriously injured children are often transferred as well, he said.

“Any kids in trauma really need specialized surgeons and intensivists that we just don’t have in our area,� Aaron said, adding, “That’s very common for community hospitals. We try to make it as smooth a process as possible.� An intensivist is a physician who specializes in the care of critically ill patients, usually in an intensive care unit.

Another recent hire is gastroenterologist Dr. Bennett Fein, who opened his practice Aug. 4. Gastroenterologists treat digestive tract problems. Hiring someone in that field was a high priority for the hospital because its last gastroenterologist left in January 2007, Aaron said.

Fein, who practiced in Asheboro, N.C., before moving to Martinsville, said staying in a small town in the Piedmont area was a draw for him. Earlier in his career, he worked at a clinic in New York City.

“I’ve been in the big city, where you have to see a patient every five minutes, and I don’t like that,� Fein said. “The way medicine is nowadays, we get reimbursed less and less for doing things, so there can be pressure to see more and more patients.�

Fein said he wants to “have enough time to see patients and connect with them.�

Potential hires make several visits to meet hospital staff, spend one-on-one time with future colleagues and tour the area. The hospital offers an “attractive and competitive� hiring package, Aaron said.

Generally, doctors receive relocation assistance, sign-on bonuses and help with the cost of educational loans, marketing and setting up a practice.

In return, doctors are expected to be active members of the hospital’s medical staff, take their share of unassigned patients and unassigned calls and stay in the area for a certain length of time, Aaron said.

“The hospital does a good job selling itself,� Aaron said.“The medical staff is great about welcoming in new docs and telling them about the opportunities here. It’s also about selling the spouse, selling the area.�

When doctors turn down contracts and take jobs elsewhere, Aaron said, the hospital tries to follow up with the recruiter and find out why.

When he first visited the hospital, Fein said he was impressed by the patient assistance department, which works with drug companies to get medications for patients who may not be able to afford them.

Also, the hospital “seemed to be willing to work with me,� Fein said. “The big advantage here is I can run my own practice to a big extent, with a lot of support from the hospital with paperwork and billing.�

The doctor shortage is not limited to Martinsville, but certain aspects of the area make it harder to recruit and retain doctors, Aaron said.

“We have the hardest time finding office space in Martinsville for some of our doctors,� he said.

Also, much of the physician population is aging and may want a lighter workload, he added.

“A lot are in their 60s and thought by now they’d be able to slow down a little bit,� Aaron said. “We have a lot of physicians whose children are just now graduating, or they feel they’re working harder than they want to work right now, so they’re being tempted to go elsewhere.�

Younger doctors can be easier to recruit, Aaron said, “but how long are they going to stay here?�

Recruitment is an ongoing cycle, he added.

“We need to have enough specialists in the area for the primary care doctors to feel supported and enough primary care doctors to send them those patients,� Aaron said. “We just have to keep our staff beefed up and try to stay ahead.�

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