Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, June 24, 1990 TAG: 9006280659
SECTION: VIRGINIA PAGE: A-6 EDITION: METRO
SOURCE: CHARLES HITE MEDICAL WRITER
DATELINE: LENGTH: Long
They came at all hours of the day and night. It got to the point that LeBrun finally stopped responding.
The callers were professional recruiters and hospital officials looking for doctors to deliver babies. They were from all over the country. Connecticut, Washington, Florida, North Carolina, South Carolina and Virginia were a few of the places where LeBrun actually interviewed for jobs.
But LeBrun, a senior OB-GYN resident at Roanoke Memorial Hospital, isn't taking any of those jobs. She's decided to stay at Roanoke Memorial another year and teach while she looks for the ideal job.
She wants to be within a half-hour drive of a major city (at least a quarter-million population) that's near the ocean or a large lake. Her practice also has to be near a college town and have access to a major airport.
LeBrun can afford to be particular. Obstetricians are a highly sought commodity these days for two reasons: fewer doctors are deciding to go into the speciality, and many who do practice are deciding to retire. Rising malpractice insurance premiums, the threat of malpractice suits and the stress of an obstetrical practice are the reasons most frequently given.
LeBrun, 36, worked as a nurse before going to medical school. She's worked hard to reach her goal and figures she might as well find a place to work that will suit the active lifestyle of a professional who also is single.
"I only have me to look out for," LeBrun says. "So I might as well get what I want."
Bill James, administrator of Alleghany Regional Hospital, knows firsthand how difficult it is to attract an obstetrician, especially to a rural community.
For the past three years, hospital officials, knowing the caseload for their two OB-GYNs was too much, have been trying to recruit a third obstetrician. With last month's announcement that the two would be giving up obstetrics in a few months, James is under the gun to find replacements fast. Otherwise, the hospital will have to shut down its obstetrical floor, losing a significant money-making service.
Shortly after the obstetricians announced their decision, James sent letters to 3,200 obstetricians in private practice, encouraging them to relocate in Alleghany County. Letters also went to 830 program directors of obstetrical residency training programs across the country announcing a job opportunity.
Beyond that, James has on retainer two recruiting firms that are on the lookout for obstetricians who might be willing to come to Alleghany County.
Rural hospitals are not the only ones having problems attracting obstetricians, says Joe Thomure, president of OB-GYN Practice Services of St. Louis. Major hospital centers on the East Coast, he says, also have hired recruiters to fill obstetrical vacancies.
Part of the problem, Thomure says, is that many obstetric residents are choosing not to go into patient care. Some are looking for academic appointments. Some go on to advanced training in reproductive endocrinology or gynecology. Some have military obligations to fulfill.
Of the 1,000 OB-GYN residents who graduate nationally each year, only 700 end up going into practice, Thomure says. About 15 percent of the 700 choose to offer only gynecological services.
On top of that, obstetricians in practice are retiring earlier or significantly cutting back on their obstetrical caseload. In the past three years, Thomure says, about 8,000 OB-GYNs have dropped or significantly cut back on obstetrics, leaving about 20,000 practitioners nationwide to deliver most babies.
But the real crisis in obstetrics, Thomure believes, has resulted from the decision by family practice doctors to stop delivering babies. Nearly half of the approximately 60,000 non-obstetric specialists who delivered babies have stopped doing so in the past two years, he says. "It's this trend that has created the crisis," he says.
Alleghany County is a case in point. Five years ago, five family practice physicians there delivered babies. Today, none do.
As a result, OB-GYN residents are barraged with job offers. Persuading them to take up a rural practice is a difficult task, says Thomure.
For one thing, residents become accustomed to the lifestyle of living in a large city, where most residency training programs are located. "They get acclimated to being able to take in a Cubs game or going to the symphony," Thomure says.
Beyond that, the residents get used to the high-tech equipment and services available in a teaching hospital. "They feel a lot more secure and protected with the gadgetry available to them," Thomure says. "But that's a misconception. The more bells and whistles you have, the more tools you have to make a perfect baby." As a result, doctors in well-equipped regional centers are much more likely to be sued, he says.
Because of the shortage of doctors willing to deliver babies, obstetric residents can command big salaries. Thomure says he's heard of a few residents demanding $250,000 a year net income.
Those salaries are partly in response to the high cost of malpractice premiums, which in a few states can run as high as $120,000 a year.
LeBrun concedes that malpractice premiums are a factor for her and many of her colleagues in deciding where to practice. She also acknowledges that many residents want to practice at major medical centers where the latest technology is available along with the intellectual stimulation of a teaching hospital.
For many residents, she says, the decision is simply a matter of being in a familiar territory: They stay where they have done their training or go back to their home towns.
"It's a lot harder to establish yourself in a place where you are brand new," she says. And being in a group practice is almost a necessity these days, she adds, because most young physicians don't want to put up with the longer hours and responsibilities of a solo practice.
Money isn't a major concern, at least for her, LeBrun says.
"Money is not that important. You first need to be happy where you are. The money will come."
by CNB