The Economics of Being a Doctor in Rural Oregon

Doctors are being priced out this part of Oregon, and the some of the reasons aren't specific to our rural location.  The following article entitled "Low Pay is Discouraging M.D.'s" is from Friday's Grants Pass Daily Courier...dead tree-only.

The lure of the Rogue River, the Siskiyou Mountains and a small community isn't enough to bring doctors to Grants Pass.

"A young doctor starting out, with four years of under-graduate school, four years of medical school and five years of residency says, 'I worked my butt off and I have $150,000 of loans, and now I can't afford a house?'" said Dr. Mark Foreman, a Grants Pass orthopedist.

Paul Janke, Three Rivers Community Hospital administrator, said the hospital has interviewed four or five candidates to shore up the shortage of orthopedic surgeons during the last year, with no takers.

"The number one reason is lower reimbursement and payment levels in Southern Oregon," Janke said.

Oregon ranks 86th out of 93 payment regions nationwide for "fee for service" Medicare rate, according to Medicare.  For example, in 2003 a surgeon in Detroit was paid $1,750 for a knee surgery that cost $1,380 in Grants Pass. 

Doctors get paid nearly 27 percent more for the same surgery in Detroit, when the cost of living there is below the national average and ours is above.  How does that make sense?  Oregon's cost of living is higher than the national average, so how do only seven regions in the nation earn less than ours does?

An accompanying article noted that Bend, in a different region, also gets higher reimbursements than Southern Oregon.  Compounding the financial impact is that a greater percentage of patients here are dependent upon Medicare and Medicaid than in the average region.  That's what a modest economy dependent upon retirees gets us.   

A surgeon in St. Petersburg FL who does an appendectomy on a Medicare patient gets 25 percent more than a surgeon in Grants Pass who does the same procedure, said Jim Kronenberg, CEO of the Oregon Medical Association.

"There isn't any overwhelming logic to the system that exists now," Kronenberg said.  "It's not a rational system, but it's difficult to change.

Malpractice insurance rates have also gone up 240 percent in Oregon since 1999, Kronenberg said.  Orthopedic surgeons pay $70,000 to $80,000 per year, and neurosurgeons about $100,000, he said.

We can't hire anybody because people are offering higher salaries to start with than what we get paid here," said Dr. Donald Ross, a Medford neurosurgeon.  "I make less money as an established, busy surgeon than they're offering the first day of practice."

There aren't enough orthopedic surgeons in Grants Pass to provide full coverage.  Patients are shipped to Medford or Portland 4-5 days per month.  Things are far worse when it comes to availability of neurosurgeons.  Medford is the regional center for that expertise, but it's lost half its neurosurgeons the last two years.  Three days every two weeks, people needing such emergency care are flown to Portland...and that's with Medford's neurosurgeons working a grueling schedule. 

If you're an auto accident victim down this way who needs rapid spinal or cranial care on an uncovered night, good luck.

FYI, I have a relative who's a doctor in Washington who'd like to relocate to Oregon, but the malpractice insurance rates and reimbursements here continue to keep him away.

Doctors owe more today for student loans, so are less likely to take rural, lower-paying jobs. 

"Doctors are coming out of school with $100,000 and $200,000 in debt," said Lyle Jackson, medical director at the Mid-Rogue Independent Physicians Association.  "When I came out I was debt free."

Asante and the Mid-Rogue IPA are doing their best to get more doctors here.

Oregon Health Science University's "Rural Rotation" program sends interns to rural areas such as Grants Pass.  And Three Rivers has set up an orthopedic follow-up clinic with a nurse practitioner to take the load off existing surgeons.

But Ross doesn't see a quick solution.

"We're just stuck," Ross said.  "I don't see anybody fixing this."

Even years ago, how did a surgeon come out of medical school debt free unless he/she had access to wealth or some great scholarships?

With the proposed elimination of OHSU's rural nursing programs (previous blog here), that could also weigh on medical care outside the WV.

Medicare is far more broken than Social Security is, yet the political debate is on the latter.  I don't begrudge the debate on Social Security reform, but it shouldn't be drowning out or displacing Medicare reform efforts.

Comments

[degustibus]

Any cosmetic surgeons complaining?

I didn't think so.

[Torridjoe]

My research indicates that not only are physicians not decreasing in OR and WA; they are INCREASING...and not only are they increasing, but they are increasing by about a factor of three vs the overall population.

Now, that's a statewide analysis; I don't doubt that rural areas are seeing slackenings. However, there are provisions for those doctors that are supposed to increase the reimbursement for Medicare procedures. If you are located within a MUA (Medically Underserved Area), you should qualify. Having worked on these designations in another state, my sense is that it may be less a matter of not getting what they deserve, but areas not being so designated that should be.

[RoguePundit]

I checked the MUA listings here for this area. The two listed areas for Josephine County encompass the entire county. For our bordering counties, all of Curry, rural Douglas, most of Jackson, and much of Siskiyou (CA) are also included in MUAs.

What could be the reasons for the low reimbursements when we're already an MUA?

[Torridjoe]

I'm afraid you've exhausted my supply of projected authority. :)

Maybe docs don't know they can use the higher reimbursement schedule? I'm just guessing, now.