Las Vegas Business Press :: News : State still struggles to recruit doctors

State still struggles to recruit doctors

BY XAZMIN GARZA

BUSINESS PRESS

When the medical malpractice insurance crisis reached its nadir for local doctors two years ago, physicians all over town couldn't pack their bags fast enough. They felt neglected by their state and abused by the system and, consequently, ran away from home.

Southern Hills Hospital is among some of the local health care facilities that have geared up physician recruitment in years past.

Their exodus and the brief closing of University Medical Center's trauma center due to a physician shortage led to the Nevada Legislature passing AB1 in 2002 and more recently, the passing of Question 3 on ballots last November. Both were efforts to ease what was declared a medical malpractice crisis in Nevada. The question now is, "Will Nevada be able to retain the doctors who chose to stick it out two years ago and will recruitment be able to keep up with population growth?"

The most recent numbers available from the Nevada State Board of Medical Examiners show 5,474 physicians holding licensure in Nevada at the end of 2003. Of those, 3,616 were practicing within the state. According to Larry Matheis, executive director of the Nevada State Medical Association, these numbers are some of the worst the Silver State has seen in the past 20 years and are disproportionate with the number of total patients.

"In 2002 and 2003, a record number of physicians left the state. Our net increase for 2002 was 23 and in 2003 it was 76. For the last 20 years our net increase has averaged 150. We haven't kept up in the last two years. We should have net increases of 200 doctors a year," he says of the difference between doctors leaving the state and new ones arriving.

As far as the ratio of physicians to patients, Nevada ranks 49th in the nation. For some of the highly-specialized fields, such as pediatric heart surgery and orthopedic specialties, the Silver State comes in dead last.

Matheis says the most crucial step in preventing the flight of Nevada's doctors came with voters passing Question 3 on ballots during last November's elections. The initiative placed a $350,000 cap on medical malpractice lawsuits with no exceptions. The next item the NSMA will push for with Legislature is to restore the position of doctors within managed care.

"The reason physicians express most in not coming to Nevada is the tight managed care market and that's been since before the liability crisis," says Matheis.

The key for retaining existing doctors and recruiting new ones will be in sweetening the pot, according to Marc Bowles, VP of Physician Search for Delta Medical Consulting, a physician-staffing firm based in Dallas.

"If you look at ten years ago, the new thing was relocation; clinics started paying doctors to relocate. Then it became a question of how much they would pay. The next thing was sign-on bonuses, which are now expected. Loan repayment is now reaching that level and it's huge for new physicians," he says.

It's more commonly referred to as "loan forgiveness" in which the company recruiting the doctor will pay a percentage of his or her student loan. Bowles' figures show the average loan for a medical student runs $109,000 and 31 percent of his clients are getting some form of repayment on their loans.

The average repayment amount is $33,250 over a certain number of years. The longer the physician stays, the more is paid on their loan. Loan forgiveness programs, for obvious reasons, are designed to recruit new doctors, which Matheis says will be a concentration for Nevada in coming years.

"Most clinics trying to recruit are having huge problems," he says. "We're trying to attract young physicians to do their training here. I think we'll see a quantum growth of that after this legislative session. Almost every known method of recruiting and retaining are being employed now."

Bowles predicts Nevada will follow the direction other states have taken after dealing with a mass exodus of doctors: hospitals supplementing malpractice insurance. Florida, Texas and West Virginia have all adopted this practice and it may not be too far in the horizon for Nevada, both Bowles and Matheis agree. "It's something that's being looked at by managed care organizations too," says Matheis. "It's put relief in other places but there's a trade-off because physicians take more discounted payment rates."

Although he predicts the next couple years to be the most challenging in the process toward completely ridding Nevada of its crisis status, Matheis is optimistic for the future. "Nevada's one of the few places with dynamic growth across the population groups and also facing a crisis. It will take a couple, challenging years for things to take effect, but it will improve," he says.

xazmin@lvpress.com | 702-871-6780 x318

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