Posted on Sun, Mar. 07, 2004
Kansas City struggles to keep, recruit doctors
Shortage can mean a long wait between visits
By ALAN BAVLEY
The Kansas City Star
Lung specialist Mary Wurtz sees 30 or more patients a day — young adults with asthma, smokers with lung cancer and the elderly suffering emphysema.
With hospital rounds and a growing number of office visits, her work days can stretch from 10 to 12 hours, six days a week.
For more than a year, Wurtz has tried to attract another doctor to her four-member practice in Independence. She is offering about $120,000 a year, but beginning specialists can command several times higher in other parts of the country.
“You can't begin to compete — unless none of us were to take a salary at all,” she said.
As Wurtz has discovered, it's getting hard to find doctors who want to come to the Kansas City area.
Low insurance reimbursement rates and high malpractice premiums, compounded by a developing national physician shortage, have created the toughest recruitment market here in years, experts said.
The Kansas City area has as many as 100 physician openings, two or three times the usual number.
The shortage means doctors burn out on long workdays. Patients' health deteriorates as waits for appointments drag out for weeks or months.
More ominously, the difficulty in recruiting doctors to Kansas City led to the elimination of emergency neurosurgery at Independence Regional Health Center and St. Joseph Health Center. Those hospitals could not find new neurosurgeons to replace ones who left.
“It's so hard to recruit unless it's a perfect position,” said Julie Sherriff, a Prairie Village-based physician recruiter with 20 years of experience.
Cardiologists, orthopedic surgeons, dermatologists, neurosurgeons and ear, nose and throat specialists are all in demand — and difficult to get.
Making matters worse, baby-boomer MDs are retiring just as the rest of their generation needs more health care.
“Getting critical access to specialty care could become a tremendous problem in the near future,” warned Charles Rhoades, a Kansas City area orthopedic surgeon.
Rhoades lost several potential recruits for his practice because they found better-paying jobs elsewhere.
Other areas, such as Seattle, Detroit, Chicago, Maine, Florida, Nevada and parts of California, also are having a tough time recruiting, Sherriff said.
But the metropolitan area is at a competitive disadvantage, even with smaller, nearby cities such as Springfield and Topeka.
“Just picture a young physician coming out of school with heavy debt,” said Independence cardiologist ***** Akin. “They look at the reimbursement rates and the malpractice premiums here and go elsewhere.”
Akin said cardiologists typically make $250,000 to $500,000 in the Kansas City area.
Several times a week, however, he gets solicitations touting jobs with an “attractive Southern community” or “universities” or a “new heart program” and substantially higher incomes.
“I could go somewhere else and make more money, significantly more money, guaranteed,” he said.
Pay lags other areas
At least two independent reports have concluded that Kansas City area physicians are poorly paid compared with their colleagues in other cities.
An assessment of local health services released in 2000 by the United Auto Workers and Ford Motor Co. found that insurance companies paid doctors here 11 percent less overall than the national average.
Some services, such as office visits, were reimbursed at about half the rates paid elsewhere.
A study in 2001 commissioned by St. Luke's Hospital looked at physician reimbursements closer to Kansas City. It found that health maintenance organizations in Springfield paid doctors 28 percent more and that preferred provider organizations in Topeka and Wichita paid 21 percent more.
Nothing has changed since to improve the situation for local doctors; reimbursements are 20 percent to 40 percent higher in other parts of the Midwest, said Kenneth Washington, vice president of HCA Midwest, the largest hospital group in the area.
“There is absolutely no question in my mind that rates are depressed here,” he said. “Yet we experience the same cost increases, inflation as anywhere else.”
One reason for the low pay, Washington said, is that most Kansas City doctors practice in small groups. In states such as Minnesota, Wisconsin and Illinois, it is not uncommon for group practices to have dozens or even a hundred or more physicians.
“They've got leverage; they've got clout,” Washington said. “We don't have that critical mass. No one can say to (an insurance company), ‘I am indispensable to your plan.' ”
The concentration of Kansas City area hospitals in just a few large systems also weakens doctors' bargaining power, said Mike Reardon, president of Kansas City Physicians Organization, a doctors' advocacy group.
“The (insurance) carriers would first