Hospitals find Boston area hard-sell for doctors
High cost of living, low reimbursement rates make hospital
recruiting a challenge

By Davis Bushnell, Globe Correspondent, 9/22/02

Despite their worldwide reputations for excellence, Boston's teaching hospitals and medical centers find themselves engaged in what is often a painstaking process to recruit midcareer and senior physicians.

Hospital recruiters say potential hires are put off by the Boston area's high cost of living, particularly home prices. And the state's high concentration of managed-care providers has meant that physician reimbursement rates are lower here than in other parts of the country, according to the Massachusetts Medical Society in Waltham.

As a result, it frequently takes area medical centers more than a year to woo highly credentialed job candidates. And many times, appeals to up-and-coming doctors with five to 10 years experience in academic medicine founder on financial issues, despite salary offers of more than $100,000 a year, recruiters say.

They also note that keen competition between medical centers in Greater Boston and others in major US cities for the same talented, experienced doctors makes the recruiting process even more difficult.

However, not all teaching hospitals are overly anxious about the lengthy, challenging recruitment process. Some say they can fall back on residents who go on staff.

''They're our farm team, which we have to rely on,'' said Dr. Peter Slavin, chief executive of the 1,700-member Massachusetts General Physicians Organization. A survey conducted this summer, he said, revealed that 741 of the 1,392 doctors on staff had had at least a year of training at Massachusetts General Hospital. The hospital hires 50 to 100 doctors annually, across all specialties.

On the other hand, concerns rise over Medicaid reimbursement rates that typically cover only 75 percent of a doctor's services (versus the national average of 97 percent), and fees of health maintenance organizations that reimburse more, but still not enough, said Slavin and others.

''Things have to be done to bring parity'' to the reimbursement process, said Slavin, who will become president of Mass. General next January. If that's not done, he said, many doctors will bypass the Boston metropolitan area for regions where fees are higher and living costs lower.

Boston Medical Center recently was unable to recruit a doctor who went to a New Mexico hospital ''for hundreds of thousands of dollars more a year than we could pay him,'' said Paul Drew, a vice president who coordinates physician searches for the center.

However, private payers in the Commonwealth have been increasing professional fees the last several years, asserted Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, a trade group representing HMOs. Buyse said she didn't know by how much fees have been raised.

Still, inadequate physician fees are largely responsible for a ''work force crisis,'' said Charles Welch, president of the Massachusetts Medical Society, and a psychiatrist at Mass. General. A survey released by the society last spring revealed that 46 percent of the 4,000 physicians, residents, and hospital department chiefs polled said they were having difficulty hiring doctors, especially in disciplines such as neurosurgery and gastroenterology.

The situation is most acute at medium-sized and small hospitals, Welch said. These institutions often don't have the academic affiliations with Harvard, Boston University, and Tufts medical schools that their larger counterparts do.

Boston's large medical centers pursue aggressively the most accomplished doctors wherever they are, said Anthony Whittemore, chief medical officer and a vascular surgeon at Brigham and Women's Hospital. The hospital is now looking for between 10 and 12 doctors ''at associate and full professor levels'' in several specialties, surgical and nonsurgical, he said. There are about 1,500 doctors on staff.

Harvard Medical School's salary guidelines, capped at $374,000 a year, are considerably lower than those in other parts of the Northeast and nation, Whittemore said. That's a consideration that hospitals associated with the medical school -- such as the Brigham -- need to factor into their hiring.

Dr. Arthur L. Day, who joined the Brigham early this summer, after months of negotiations, as chief of cerebrovascular surgery, provided some perspective.

If he were a doctor just starting to make a name for himself, Boston would not be an appealing venue because of housing and other costs, said Day, who also is a professor of surgery at Harvard Medical School. He had been a surgery professor at the University of Florida.

''As it was, it was a tough decision to come here because of the cost of living,'' he said. ''But I was looking for something other than financial rewards. It was an opportunity to build something here that wasn't present elsewhere,'' he added, referring to the cerebrovascular surgery division at the Brigham.

''In short, it was the right time and right circumstances for me,'' Day said.

Whittemore, who recruited Day along with Dr. Peter Black, chief of neurosurgery, said a full professorship at Harvard Medical obviously appealed to Day. But Day also was won over, Whittemore said, by the Brigham's ''very advanced imaging techniques'' used for neurosurgical procedures.

Unlike for-profit corporations, most major hospitals don't offer bonuses as enticements. They do pay for moving expenses and will assist a new, senior doctor with obtaining a mortgage at a favorable rate, Whittemore and others said.

Deeb Salem, chief medical officer at Tufts New England Medical Center, which has 350 staff doctors, said he is used to lengthy negotiations with highly valued physician prospects. It took a year, for instance, to find an individual for a top research position in molecular oncology, he said. Dr. Philip Tsichlis was the successful candidate. He had been with Jefferson Medical center in Philadelphia.

Less experienced doctors saddled with, say, debts of between $200,000 and $300,000, frequently settle in cities like New York and others in the South, where salaries and physician reimbursement fees are higher, Salem said.

To make up for salary shortfalls, Beth Israel Deaconess Medical Center, like other teaching hospitals, raises ''funds through grants and share these funds across disciplines,'' said Robert Moellering, chief of the department of medicine, which has 350 staff members. There are a total of 800 doctors at the center. In internal medicine, 35 to 40 doctors are hired yearly, Moellering said.

Burlington's Lahey Clinic also wishes physician reimbursement rates were higher so that it could offer heftier salaries to new doctors, said Joan Robbio, senior vice president for human resources. The hospital is seeking to fill 16 positions, ranging from radiology to cardiology, in its suburban offices. It employs 450 doctors.

''But being a physician group hospital, Lahey is able to attract doctors, though it may take some time, depending on the specialty,'' Robbio said. ''Our department chairmen are well-known for their excellence, and they help new doctors get patients.''

Although the physician recruitment process is problematic by its nature and by limited fee structures, the lure of ''intellectual vigor'' associated with Boston often appeals to doctors from other cities who have less stimulating caseloads, suggested Whittemore of Brigham and Women's.

Davis Bushnell is a freelance writer and can be reached at davisbushnell@compuserv.com.