JANE SCHNEIDER

What do the issues of crime, physician reimbursement, student debt, and medical malpractice have in common? They represent the challenges practice administrators face when recruiting doctors to the Mid-South.

“It’s more challenging today than ever before to recruit cardiologists,” said administrator Charles Locke, who hires one to two doctors every two years for the Sutherland Cardiology Clinic. “Because of the aging baby boomers, many groups are searching for cardiologists and there’s a finite number coming out of med school. We’re all competing for great doctors. Here in Memphis, our expectations are high,” he said.

While expectations may be optimistic, barriers like physician reimbursement rates and the rising cost of medical malpractice insurance make doctors think twice about practicing in the Volunteer State. Although 82 percent of Tennessee’s malpractice cases are settled without payment, medical advocates say tort reform is urgently needed. Recent passage of state legislation addressing meritless lawsuits is “a step in the right direction,” stated cardiologist Dr. Keith Anderson, president of the Memphis Medical Society. In the meantime, practices often pay doctors malpractice premiums as part of their recruiting package.

Kim Avery, a practice administrator who hires doctors for Mid-South Pulmonary Specialists, is all too familiar with these hurdles. Though reimbursement rates aren’t an issue for their practice (pulmonologists receive top dollar), Memphis’ high crime rate is. “Memphis has a bad rep,” said Avery. She told of a fellow from Eastern Europe who was finishing his residency in Sunnydale, N Y. “He seemed like a good candidate but he would read the news and call us saying he was worried about being gunned down here.”

Recruiting doctors to Memphis “is tough unless they’re homegrown at UT,” Michael Lachina, medical director at Saint Francis Hospital-Memphis noted in a 2007 Memphis Business Journal story on recruiting. “I think (non-local doctors) see it as a large city with socioeconomic problems, a high crime rate, a struggling school system, and racial tensions.”

Avery agrees. “We often ask why doctors are coming and they typically have some family ties that bring them back,” he said. “The majority did their fellowships here or has family within driving distance.”



New Doctors, Different Agenda

According to a 2007 survey conducted by the healthcare recruiting firm Jackson and Coker, the leading reason physicians gave for relocation consideration was the overall lifestyle a community has to offer. Other top responses included: potential income, immediate income, less call rotation, and favorable malpractice rates. Compare those replies to 20 years ago, when hospital facilities topped the survey, and recruiters will tell you — times have changed.

When new doctors scan the horizon for job prospects, cities with natural amenities like the mountains or ocean often win out. Yet such attractive locales frequently also mean more competition — for everything from jobs to housing. Recruiters sell Memphis as a mid-sized city free of the headaches of rush-hour gridlock, inflated real estate costs, and a higher cost of living. Once physicians get past Memphis’ gritty reputation and actually pay a visit, many are pleasantly surprised by what they find.

Clinical psychologist Caitlin Allen’s husband was recruited by St. Jude Children’s Research Hospital and said their move from San Francisco to Memphis was a “quality of life” issue. “Putting everything down in the pros and cons column, it was more advantageous to come to Tennessee. We could live close to work and afford to go on vacation to places we’d like to be,” said Allen.

“The pluses are that there are lots of school options, you can buy a nice house, and there are lots of trees … it’s pretty here,” added Avery. Another benefit for pulmonologists in particular, is that there are fewer physicians practicing medicine here, so “the sky’s the limit for earning potential,” she said. Avery and her peers often target cities like Atlanta, where insurance reimbursement rates are lower, and pile on incentives to get doctors to come west. Promises of more time off, higher compensation, and fewer weekend calls can attract potential candidates.

Others argue Memphis shouldn’t sell itself short.

“We’ve got a strong major hospital system, a tremendous research component, and Memphis is a major medical market when you consider the scope and type of work being done here,” said Memphis Orthopedic Group administrator Dan Hein, referring to the city’s growing biotech industry. Add to that mix, companies like Smith & Nephew and Medtronic as medical device producers and, “When you look at the whole picture, there’s a tremendous amount offered here.”



Tennessee’s Troubles Reflect National Trends

Ultimately, the issue of physician recruitment raises other, more troubling realities facing the medical profession today. As baby boomers age, the demand for doctors over the next two decades is projected to outstrip supply, a fact that would have significant impact on specialties such as cardiology, orthopedics, and internal medicine — fields already being squeezed by staffing shortages.

“There aren’t enough candidates going into specific fields like cardiology,” noted Anderson. He attributed some of the problem to plummeting insurance reimbursements. Anderson said physician reimbursements have dropped by nearly half since he started practicing in 1990. Currently, a 10.6 percent cut to physician fees paid by Medicare is expected to come July 1.

Residents themselves also have differing opinions about how their career choice shapes self-identity. “Younger physicians today are more lifestyle-conscious,” noted John Deane, CEO of Southwind Health Partners, a national physician practice management firm based in Nashville. Many aren’t willing to make the sacrifices their predecessors made, and are opting out of specialties that demand night and weekend work.”

Faculty at the University of Tennessee Health Science Center (UTHSC) see this firsthand. “Students from all over are coming to med school with the mindset that family and family time matters and they’re not wanting to give life up to their profession,” said Dr. Owen Phillips, associate dean of medicine with UTHSC. “Being a doctor is just their job, not their identity.”

Residents also begin their professional life saddled with considerably more debt. Phillips said the average medical student leaves UTHSC with $150,000 in student loans. Add to it other loans and credit card debt, and residents face a dilemma: choosing to follow their passion into specialties like family medicine that don’t offer as much earning potential, or opting for fields like radiology or anesthesiology that provide greater earning potential and more control over work hours.

Phillips said medical colleges like UTHSC, which graduates 150 students a year, are cognizant of the critical shortage in certain specialties. “When we admit students, we’re looking for ones who will be primary care physicians in Tennessee,” said Phillips. “We look for diversity: students who come from rural areas, who come from working class families, who want to come into the program, choose primary care, and stay in Tennessee.”

Whether they choose to practice here is an open-ended question. “You can’t practice medicine like you could 20 years ago,” noted Hein, “and there are fewer that want to practice because of the loss of autonomy.”





Top 10 Reasons
Physicians Relocate

1. Overall lifestyle of an area
2. Potential income
3. Immediate Income
4. Less call rotation
5. Favorable malpractice rates
6. Flexible/fewer work hours
7. Climatic conditions
8. Recreational opportunities
9. Preference for urban/rural location
10. Being in contact with other physicians