The Fort Smith region is losing good doctors, nurses

Editor’s note: During the next several months, The City Wire will post reports on the regional medical community. Topics planned include economic credentialing, relationships between physician groups and self-funded insurers, and the emergence of specialty groups. This introductory story is an attempt to broadly outline a few fundamental issues facing the regional medical sector. Your thoughts, suggestions, information on future topics, issues, etc., would be most welcome.

story by Michael Tilley

Fort Smith Mayor Ray Baker has during the past several months voiced “deep concerns” about the condition of the Fort Smith regional medical sector.

Ditto for Cole Goodman, a Fort Smith city director and a plastic and reconstructive surgeon.

The issues threatening the health — no pun intended — of the area medical sector are many and complex, Baker and Goodman note, but the emerging impacts are seen in two broad areas: a continued decline in the number of area physicians and nurses and a deterioration in the financial health of area hospitals and individual physicians. Sparks Regional Medical Center recently had its credit rating downgraded by Moody’s to a rating that implies the hospital has “extremely poor credit quality.”

“We’re losing so many good doctors to other regions of the state,” Baker said.

To address the issue, Baker said he is working to schedule a community forum and hopes to have area doctors, health care administrators and others in attendance. As of Feb. 3, Baker had not scheduled the forum.

Although the forum will touch on sensitive subjects, Baker said forum participants must be “very positive” in terms of finding solutions.

“There is no reason we can’t all talk about this and be positive about what we can do. This needs to be a very positive thing,” Mayor Baker said of the forum.

Good luck with the positivity thing.

UNDERSTAFFED, UNDERPAID
Anecdotally, a growing number of people in the Fort Smith area or who use area health care services are unhappy with their medical care experience. Several people interviewed by The City Wire have stories like that of Sarah Hooper, who told of her problems in a letter to the editor published by the Times Record. Hooper entered a local hospital with a simple bladder infection only to spend one night on a gurney, have her medications fouled up and was repeatedly forgotten for meals.

“Having said all this, none of what happened to me was the fault of the nursing staff in any way. These things happened because the hospital is ridiculously understaffed, and the staff is overworked and underpaid,” Hooper wrote in the published letter.

Drs. Anthony Capocelli and Goodman see the situation Hooper faced from the opposite perspective. They are physicians in the Fort Smith medical community. And they would both agree with Hooper’s assessment that area hospitals and clinics are understaffed and the caregivers are underpaid.

“For the last few decades, we (Fort Smith region) had all the critical care specialties covered 24/7. We had the specialists in neurosurgery, urology, pulmonary and so on,” explained Goodman. “But that is over. If you need a surgeon in Fort Smith on a weekend, you might have a one in four chance they (a surgeon and the associated support nurses and technicians) will be on call.”

Goodman estimates that area pulmonologists and urologists are available 75% of the time, 25% of the time for neurosurgeons and 50% for reconstructive surgeons. According to Goodman, the two Fort Smith hospitals (Sparks Regional Medical Center; St. Edward Mercy Medical Center) once had up to 15 surgeons but today have less than 10 surgeons.

LIFE & DEATH, LITERALLY
It’s more than just a numbers game, say Goodman and Capocelli, a neurosurgeon with River Valley Musculoskeletal Center. The son or daughter or father or mother involved in a car wreck and suffering critical head injuries requires significant and specialized care within 2-3 hours. If the injured has to be flown to Tulsa or driven by ambulance to Northwest Arkansas, the time loss could lead to more severe brain damage, paralysis or death.

“That shouldn’t be a situation we have to consider, but it is,” Capocelli said of the possibility of the injured being rushed out of the Fort Smith area because of a lack of critical care doctors.

The problem, according to a 2007 report prepared by Goodman, has multiple causes. His 2007 study notes a nationwide shortage of 85,000 doctors, with the shortage growing to 200,000 by 2015. Add to that the fact that experienced nurses are leaving the Fort Smith area for better pay and working conditions in other Arkansas and Oklahoma communities, Goodman noted in the 2007 report.

“And it has gotten worse since” 2007, Goodman said recently.

About 130 neurosurgeons enter the national medical community annually, according to Goodman, with Fort Smith being one of about 365 U.S. metro areas competing for that talent.

“And we won’t get those doctors,” he said.

Goodman can tick off a litany of reasons it grows more difficult to recruit and retain doctors in the area.

• Doctors can get higher compensation in other metro areas in Arkansas. The federal Bureau of Labor Statistics proves this claim. Pay for doctors in the Fort Smith area is around $142,000, and about $164,000 for doctors in the Little Rock area.

• The shortage of doctors results in “unacceptable on-call rotations” that create “undesirable impacts on family life.”

• Higher number of non-paying patients in the Fort Smith area than many other metro markets. It’s not unusual for doctors to report that as much as 60% of their practice results in uncompensated care. “In other words, you do the work and don’t get paid for it,” Goodman explained. “It’s only going to get compounded with the loss of jobs (in the Fort Smith area) and the loss of insurance that goes with losing a job.”

• Shortage of nurses. Doctors don’t like to work in a nursing-shortage environment that, according to Goodman, frequently results in area hospitals closing entire floors.

SPARKS RESPONSE
In September 2007, Sparks Regional Medical Center CEO Ted Woodrell said the Fort Smith region could use up to 150 physicians. He said then the hospital would attempt to hire 30 physicians within 18 months. The hospital employed then about 90 doctors.

“Sparks has been heavily involved in recruiting for the past three years,” Woodrell noted in a recent e-mail exchange. “We have successfully recruited 34 physicians over the last 24 months.”

Those new hires include pulmonologists, with Sparks being the only full-service pulmo/critical care provider in the area, according to Woodrell.

“Like many hospitals nationwide, Sparks experiences physician shortages in primary care access (internal medicine, hospital medicine, and family practice), gastroenterology, cardiology (both non-invasive & invasive), geriatric medicine and geriatric psychiatry, and endocrinology,” Woodrell explained.

Woodrell said the hospital is sensitive to work loads and doctor and nurse pay, saying the Sparks providers receive pay comparable to their peers in other markets.

“Sparks reviews market-based compensation regularly for both physicians and nursing staff and strives to be consistent with national salaries,” he said.

ST. EDWARD RESPONSE
Officials at St. Edward, a hospital within the St. Louis-based Sisters of Mercy Health System, have hired 54 registered nurses, 32 licensed practical nurses and 66 certified nursing assistants between August 2008 and January 2009.

The hospital, according to a statement from St. Edward Director of Marketing Jill McMormick, spends about $200,000 each year in nursing scholarships.

Once closely partnered with Cooper Clinic for physician support, St. Edward formed the St. Edward Mercy Clinic in October 2007 and now has more than 60 doctors in the clinic, McCormick said. Cooper Clinic, according to its Web site, has 94 doctors working in 25 specialties.

“Our recruitment strategy is to add physicians as community needs dictate. We work closely with local healthcare providers, including Cooper Clinic, to address patient needs,” McCormick noted in an e-mail statement.