Monday, January 26, 2009

Surgeons-for-hire ease ER loads

For more hospitals, finding general surgeons to treat emergency room patients has become a bigger challenge as experienced doctors opt out of late-night call rotations or more physicians choose specialty practices to better control how many hours they work.

That reality has sparked the use of more temporary surgeons by hospitals, a trend that can prove lucrative for the doctors who work stints of a couple of weeks to a few months for take-home pay that can range from $700 to $1,500 a day.

Often, staffing agencies that arrange such assignments keep at least a third of a doctor's pay and pick up malpractice insurance and other costs. Some physicians see benefits to the setup, saying it frees them from the bookkeeping headaches of running their own offices and lets them work as much or as little as they like.

Consider Dr. Jennifer Peppers, a Franklin resident who's spending the next four weeks at a Kentucky hospital after staffing the emergency room at Horizon Medical Center in Dickson earlier this month.

Peppers, who left a group practice to work as a traveling general surgeon in May, has worked at seven hospitals since then, including at facilities in Kentucky, New Hampshire, Tennessee and Oregon.

"You have to really be a flexible person to be able to do that — step into any hospital and kind of assume the role," Peppers said, adding that her recent work in Dickson included performing three appendectomies.

Hospitals deal with shortage

Hospital administrators say hiring doctors for these short-term assignments helps compensate for the fact that comparatively fewer general surgeons are coming out of medical school and residencies these days.

Nationally, only 1,032 general surgeons came out of residency and were certified by the American Board of Surgery last year. That's roughly the same number that was produced 28 years ago when the U.S. had 79 million fewer people living here.

For years, nurses, primary care doctors and anesthesiologists have been hired on a temporary basis. But hiring general surgeons this way is relatively new. The trend has especially caught on in many rural areas where it can take longer or prove more difficult to recruit new full-time surgeons.

Nationwide, 365 rural counties don't have a surgeon living there, according to the American College of Surgeons, a Chicago-based trade group.

At the Dickson hospital where Peppers has worked, an ongoing search for a new general surgeon has already lasted three months, and officials say it could take more than a year to land a good prospect.

Some see benefits

Often, temporary surgeons are put to work via staffing agencies such as Staff Care of Irving, Texas, a company that has arranged a number of assignments for doctors in Middle Tennessee.

Hospital officials say the price tag varies.

"They don't come cheap," said Dr. Lanny Copeland, chief medical officer with LifePoint Hospitals, a Brentwood-based rural hospital operator that occasionally uses temporary surgeons. "But the flip side is they take a lot of work off the hospitals."

On average, Staff Care keeps 35 percent of a doctor's pay and handles such necessities as medical malpractice insurance and paying fees to get surgeons licensed in a state. Other travel costs are often absorbed by the hospital.

Peppers likes the routine of being a traveling surgeon in part because her take-home pay doesn't depend on wrangling with insurers over a patient's coverage.

"This is a little simpler life," said Dr. George Sheldon, a professor of surgery at the University of North Carolina at Chapel Hill and past president of the American College of Surgeons. "They just go and practice medicine, and the hospital will take care of the insurance — and they can have an assured income."

Others tout alternatives

Other health-care executives tout alternatives to surgeons for hire.

The Surgical Clinic LLC, a 27-surgeon group that staffs a half-dozen local hospitals, is close to an arrangement with three of those facilities to provide surgical hospitalists during the day and for some on-call coverage at night, said Bob McCorkle, its chief executive.

Such employees are full-time, permanent employees with somewhat limited duties. They free up other doctors to see patients in clinics or perform elective surgeries.

McCorkle said traveling surgeons' services cost too much and the surgeons don't have a long-term relationship with the community, which he sees as a shortcoming.

Other critics say there should be safeguards against the potential risk of miscommunication when a patient's care is handed off to a temporary surgeon.

But proponents see the trend as a way to leverage the use of part-time surgeons to do the jobs of full-times ones, who remain in short supply.

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