Allison Connolly, Journal Staff (c) Boston Business Journal
Boston is renowned for its prestigious teaching hospitals, but insiders fear its reputation may be slipping as the area continues to experience trouble recruiting doctors who can afford to live here.
The cost of living is high, and reimbursement rates are low, and even the city’s best-known teaching hospitals are having trouble luring physicians.
Experts say Massachusetts’ managed care problems are scaring the talent away.
“You’re starting to hear that department chairs at Boston’s teaching hospitals are having trouble recruiting doctors to their staff, and hospitals are having trouble recruiting chairs,” said Dr. Virginia Latham, president of the Waltham-based Massachusetts Medical Society, which represents the state’s 17,000 doctors.
Latham said the Bay State’s lofty reputation as a center for health care and academia is no longer enough to attract and keep doctors here. While all hospitals in the country are feeling the pinch of cuts in Medicare reimbursement, she said the situation is worse here. And it is hurting Boston’s image.
“We’re on the precipice,” she said. “We haven’t fallen in.”
A new brochure published by the Massachusetts Medical Society reports an “unprecedented” number of unfilled medical jobs in the Bay State. Most notably, the area needs anesthesiologists, radiologists and primary care physicians, the report said. The staffing shortage directly affects patient care, meaning longer waits for tests and results. The society is in the midst of conducting a study detailing how many doctors are leaving the state and why.
In 1998, the national annual salary for a doctor was $194,000, according to the American Medical Association. But New England logged the lowest average salary in the country, with $179,000 per year, while the southeastern part of the country reported an average salary of $232,000.
So it’s little wonder, health executives say, that ads from hospitals and practices in other parts of the country are popping up in local newspapers and medical journals.
“In the last few years, we have begun to see physicians turn down offers from this hospital and others for economic reasons,” said Dr. Peter Slavin, chief executive officer of the Massachusetts General Physician Organization, a group representing more than 1,700 doctors, most of which are employed by Massachusetts General Hospital and its affiliated hospitals in the Partners HealthCare Inc. hospital network.
Headhunter Gene Corbett, president of Eureka, Mo.-based Physician Finders Inc., said he has a hard time sending doctors to the Bay State because salaries are so much lower here than in other parts of the country, when the cost of living is taken into consideration. For example, Corbett said, when figures are adjusted for cost of living, an anesthesiologist would make $240,000 per year in Illinois but only $170,000 here for working the same hours.
“Physicians are smart,” Corbett said. “They’re going to go where the money is.”
A study done by Deloitte & Touche PC for the Massachusetts Medical Society shows that the Bay State has the lowest reimbursement rates in the country, next to Los Angeles, for certain medical procedures.
Marilyn Leeds, director of graduate medical education at University of Massachusetts Medical School in Worcester, said her residents stay or leave based on the job market. Of the 100 residents who graduated from the residency program in 1998, the last year for which she had figures available, Leeds said half chose to practice in Massachusetts. She believes residents consider location first, and many leave the Bay State only because they can’t find a job in their specialty. And, she adds, the jobs may not be here because practices can’t afford to hire them.
“Practices have to make sure their bottom line can support hiring a physician,” she said.
Recently, a resident came to Leeds with a contract from a Boston-area practice that wanted to recruit her. Leeds said the resident was ready to sign on the bottom line when the group called her late one night to tell her to tear up the contract: The practice could not afford to hire her, and it would also be laying off some of its other staff.
“That was frightening because it came out of the blue,” Leeds said. “But it’s not unusual.”
To stop the doctor flight, Slavin and colleague Daniel Ginsburg from Mass General, say they are advising their doctors and practices to negotiate better contracts with HMOs and to find ways to cut the cost of running their businesses. They are also touting their hospital as a great place to work. But they are calling on the state government to improve Medicaid rates to better reflect the cost of care.
“I don’t think it’s reasonable to expect Massachusetts to retain the best doctors,” Slavin said. “If politicians want the level of care to be the tops, the reimbursement rates have to be more competitive with other states.”