Doctors in demand
Growing nationwide shortage of physicians felt here in the North State, too
When Dr. Uzma Abbasi concluded her fellowship in gastroenterology last year, she could have gone anywhere in the country to practice medicine. Partly, that’s because her specialty is in high demand. Primarily, it’s because she has world-class credentials.
A native of Pakistan, where she received her medical degree, Abbasi completed internship, residency and fellowship programs at New York City’s Harlem Hospital Center. She received extensive training in a procedure called endoscopic ultrasound—essentially inserting a probe to get images of internal organs—making her an especially appealing physician for hospitals to recruit.
Of all the places to go, Chico would seem a long shot. She hadn’t heard of the city before learning about it secondhand. She had no ties to the North State; her closest relatives are in the Midwest. Much of her husband Zeeshan’s family lives in Indiana, where the couple already owned a house and Zeeshan had an established career in computer science.
Abbasi joined a Chico private practice, Digestive Disease Associates, in the summer of 2010 and earned hospital privileges at Enloe Medical Center. Zeeshan has found work, the couple have made friends, and they are putting down roots in their new hometown.
“When we came to visit, of course it was really beautiful and we really liked it,” she said. “It was below zero in New York, and it was 50 degrees here and everybody was apologizing for it being so cold! We really liked the weather in California, and we both knew we wanted to be in a university town in a smaller community where you don’t have to be stuck in traffic commuting.
“Coming out of training, I really wanted to keep my skills in all the procedures, so in all the places I was looking, I wanted to make sure they had endoscopic ultrasonography. Enloe was very forward-going with this and ensured that when I got into town they would already have the equipment set up and ready to go—so I already had a few patients before I got here.”
Abbasi isn’t the only new doctor in town. In fact, she’s not even the only new gastroenterologist. A month after she arrived, Dr. Shaheen Rasheed also relocated from New York to join Digestive Disease Associates.
Enloe has helped bring 26 physicians to the community since the start of 2010. Feather River Hospital recruited seven physicians to Paradise in the same period, and Oroville Hospital has landed 29.
These success stories come at a time when competition for medical practitioners is especially intense. The Association of Medical Colleges predicts a shortage of 150,000 doctors nationwide within the next 15 years. Within five years, just in California, health officials project that number to be 17,000.
“There’s already a shortage of eight- to nine-thousand physicians in the state,” Enloe CEO Mike Wiltermood said. “With health-care reform, there will be a push to get all people insured, and as those people get insured, that’s going to increase demand in an already difficult market.”
The figures pencil out most poorly in primary care: family medicine, internal medicine, pediatrics, obstetrics/gynecology. Insurers offer higher reimbursement rates to specialists, while often requiring patients to see a general practitioner first. More and more, medical students gravitate toward specialties with greater income potential and lighter patient loads.
Even so, Wiltermood said, “we’ve also seen significant shortages in neurosurgery, cardiology, urology and other specialties.”
At the same time, in Chico and Paradise at least, a sizeable number of doctors are age 60 or older. Oroville has a greater proportion of young doctors, but even there retirements loom large.
As a result, physician recruitment is a major priority. California law prohibits hospitals from directly employing doctors, but hospitals have a vested interest in bringing medical professionals to the community, plus they have resources that small private practices don’t.
“Most of the physicians coming out of medical school want to do either inpatient or outpatient—solely one or the other,” said Keith Stilson, Feather River’s vice president of ancillary services, who oversees recruiting. “They don’t want to be like Marcus Welby and do the whole thing, because they all want a life. I don’t blame them.”
Fortunately, lifestyle is a major selling point for our local communities. All three hospitals have landed top-tier physicians, such as Abbasi, who prefer the climate, surroundings and pace of the North State.
Interestingly, despite the stakes, North State hospitals don’t tend to compete against each other. Their efforts rarely overlap. Enloe, Feather River and Oroville each take a strategic approach based on specific needs, rather than casting a wide net for every top young doctor.
The competition comes from larger communities and other states. Umbrella organizations such as Kaiser are like hospitals in every state but California and Texas: They can hire physicians as employees. Thus, they can offer compensation packages that include insurance benefits and retirement plans.
“In general, the common thread for most physicians graduating from residency programs is they want a paid position as an employee with a guaranteed income,” said Enloe’s Wiltermood. “That’s a real frustration, because our model here is still largely built on the private-practice model with individual physicians or a small group of physicians. Considering the risk involved of setting up your own practice, when you’re already in debt hundreds of thousands of dollars from medical school, it’s easy to see why people want that security.”
Larger cities also mean greater professional opportunities for spouses, as well as larger social scenes for single physicians.
“We can’t compete against San Francisco or Los Angeles for shopping and restaurants,” Feather River’s Stilson said. “What’s hard, too, is we’ll recruit a physician who’s married to an engineer or computer specialist and there’s no job here for the spouse. We’ve lost a couple recruits because of that.”
Professional prospects for her husband did weigh heavily on Abbasi. Enloe’s recruiter helped set up interviews for her husband, but with only a few IT firms in town, options were limited.
It took six months, but Zeeshan finally found a position, so Abbasi—who originally made a one-year commitment to Digestive Disease Associates—isn’t planning to re-enter the job market, as rosy as it is.
“There are a lot of opportunities,” she said. “There are still a lot of underserved communities where physicians don’t want to go, and I think overall the U.S. is not producing enough [doctors] to meet community needs. I could actually pick and choose where I want to go.”