Grants aim to cure exodus of doctors

By Kate Moran
staff writer
http://blog.nola.com

Mordecai Potash was paying down his medical school debt by picking up evening shifts at the Veterans Affairs Medical Center in downtown New Orleans — before Hurricane Katrina destroyed it.

But Potash’s student loans survived the storm just fine.

Doctors like Potash who earned solid — and often enviable — incomes before Katrina have watched their prospects dim since the storm. Practices flooded, hospitals closed, and the population of uninsured patients has ballooned. Doctors are working under greater stress but making less money for their troubles.

To stanch an outmigration of doctors eyeing greener pastures and to lure recruits to Louisiana, the state has developed the Greater New Orleans Health Service Corps, a program that offers incentives of up to $110,000, including student loan repayment and income guarantees, to doctors, dentists and other medical professionals willing to work in post-disaster conditions.

In exchange, qualifying medical workers must agree to work in the metro area for at least three years and dedicate one-third of their practice to treating patients with Medicaid, Medicare or no insurance at all.

The federal government this year provided $15 million to finance the program, and the state already has made 81 awards to primary care doctors, gynecologists, psychiatrists, dentists and a handful of nurses and counselors.

The secretary of the U.S. Department of Health and Human Services announced last month that the federal agency would provide another $35 million to help the state recruit and retain health care workers. The state will use this latest infusion to target nurses, who can receive up to $55,000, and pharmacists, who can receive $50,000, in addition to doctors, dentists and medical school faculty.

‘A huge financial incentive’

Doctors such as Potash, who received a grant to pay off his medical school loans, say the money helps to counteract the hardships of practicing in New Orleans. He had been commuting to the veterans clinic in Baton Rouge after the downtown hospital closed, but with the grant he can practice full time in New Orleans, where his psychiatric services are sorely needed.

“It provides a huge financial incentive to stay in the area and continue my work,” said Potash, a clinical assistant professor at Tulane University. “As a doctor, I am not worried about surviving. I have a small house in a nice neighborhood. It is meeting the financial obligations of going to medical school that has been the struggle.”

Doctors say maintaining a practice in the New Orleans area has become more trying as colleagues have decamped for the north shore and for other states, leaving behind patients who are clamoring for a new doctor. Some doctors have tried to expand, only to run into a wall in trying to recruit a partner.

Ricardo Febry, who specializes in providing general care for hospitalized patients and is the president of the Orleans Parish Medical Society, said he has been on the hunt for a partner for almost a year. Though he has not advertised in national publications, he said recruitment is tough these days because local medical schools have produced a smaller crop of residents since Katrina.

Adding to the challenge of reeling in recruits from other parts of the country are the high cost of business and malpractice insurance and the large population of uninsured patients. Whereas indigent patients once relied on Charity Hospital for low-cost care, they are now showing up in private emergency rooms, where doctors usually have to swallow the cost of treating them.

“You are doing the work, you are taking care of the patient, you are not getting paid, and you are exposing yourself to the risk that the patient will turn around and sue you for bad outcomes,” Febry said. “If you are a young doctor deciding where you want to settle down and develop a practice, and you have that set of circumstances offered to you in New Orleans, then it is easy to decide not to come here.”

Diagnosing limitations

David Myers, a Metairie internist who has been seeking a partner for five months, sees serious limitations to the incentives dangled by the state. He thinks the requirement that doctors devote one-third of their practice to care for uninsured, Medicaid and Medicare patients will dissuade many possible recruits from applying for grants.

But patients are having trouble finding a doctor these days, regardless of their insurance status. At Myers’ office, the next available appointment for a new patient is July 25. With that bad a bottleneck, the state should not impose such stiff rules about how much time doctors are required to devote to patients who cannot pay them, he said.

“The most disappointing thing about the way the state and the feds have approached the health care crisis is that they have focused only on the fact that there are a lot of people without insurance,” Myers said. “There are also people with insurance who cannot find services quickly… .

“You start seeing these (uninsured) patients, and at the end of three years, you have this patient base you are taking care of who can’t afford to pay you. Who wants to come here and establish that practice?”

The state thinks enough primary care doctors are in the area to treat patients with private insurance, but 54 doctor recruits are needed to see the uninsured. Kristy Nichols, director of primary care and rural health for the Department of Health and Hospitals, said the state is on the way to closing that gap with the incentive program.

Monir Shalaby, medical director of the Excelth clinic in Algiers and a grant beneficiary, saw a large volume of uninsured patients before Katrina. But he said the clinic, which charges patients based on their income, has become a de facto Charity Hospital since the downtown institution closed after Katrina. These days as many as 80 percent of his patients lack insurance.

Shalaby said he has considered leaving New Orleans because he feels endlessly frustrated by the inadequate safety net for poor people who need advanced medical treatment or hospitalization. He recently saw a patient with an apple-size tumor on her neck. When he referred her to the charity hospital in Baton Rouge, the woman was told she would have to wait seven months for an appointment.

“It is very frustrating to work in a place where you do not know how to help your patients,” Shalaby said. “You have in your heart the mission to serve. It would be much easier to work in Florida or Alabama or Texas, where you have everything in place. I feel very fortunate that the state is doing something to help physicians stay in the area.”

Serving the underserved

Douglas Cross, a dentist, also received an income guarantee after losing his private practice in eastern New Orleans to the storm. He now works full time for the city Health Department, where he sees elderly and uninsured patients. He said the state’s grant program is helping disadvantaged patients by keeping providers in the area.

“A lot of people cannot afford dental care at this point. Their living expenses have increased, and they do not have a lot of disposable income,” Cross said. “It is extremely important for the Health Department to have these clinics because other options for low-cost dental care are gone.”

Though many local doctors said conditions in New Orleans are tough, at least one doctor who accepted a grant to relocate sees opportunity here.

Priya Velu is moving from New York to practice family medicine on the faculty of Louisiana State University. She said most grants designed to lure doctors to underserved areas require them to practice in a rural setting. She said she and her husband, an orthopedist, wanted an urban practice.

“We had a lot of reservations initially,” Velu said about coming to New Orleans. “What we see in the media is what everyone else sees. It is a little intimidating at times. When we went down there, what we saw ourselves is that there is so much potential. I can’t imagine a city like New Orleans not getting itself back together.”

Health professionals can learn more about the health service corps by visiting www.pcrh.dhh.la.gov.
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