Neurosurgeon Shortage in Florida: Crisis Averted
Putting neurosurgeons on the payroll has helped relieve a statewide shortage.
Surgery on a spine injury patient [Photo: Mayo Clinic]
Six years ago, neurosurgeons were in such short supply in Jacksonville that hospitals regularly shuttled sick patients across town to receive medical care. "If we had neurosurgeon coverage on a Tuesday night and St. Vincent's didn't, they would send a patient over to Baptist," recalls Hugh Greene, president and chief executive officer of Baptist Health. Some days, he says, emergency patients had to be sent all the way to Gainesville to see a neurosurgeon.
Jacksonville wasn't the only city in crisis. In Palm Beach County, the shortage of neurosurgeons willing to treat non-trauma emergency cases was so severe that patients were being diverted to hospitals in neighboring Broward and Miami-Dade counties. Occasionally, patients would have to be transported as far away as Tampa and Gainesville for treatment. In some cases, according to media reports, the delay in treatment was costing patients their lives.
Today, the neurosurgeon shortage has abated in northeast Florida thanks to the efforts of CEOs like Greene, who in late 2005 moved to a physician employment model to ensure 24/7 neurosurgeon coverage at Baptist Health. Instead of scrambling to get physicians in private practice to agree to on-call coverage, Baptist Health partnered with Lyerly Neurosurgery, a local neurosurgery practice, to provide services exclusively to Baptist Health.
The employment model, Greene says, has relieved pressure on both sides. The hospital is no longer turning away patients, and Baptist's financial investment in the neurosurgery practice has enabled it to grow from two surgeons in 2005 to the six it has today. Recruiting a new neurosurgeon can cost upward of $700,000, including salary and signing bonus.
The arrangement has also helped doctors grapple with two of the major factors that had been fueling the neurosurgeon shortage to begin with — namely, declining reimbursement rates and increased malpractice insurance costs. "We can help them negotiate, whether it be with reimbursement rates or malpractice insurance, and we can also capitalize their growth without it coming out of their own incomes," says Greene.
Hospital employment of neurosurgeons is becoming more the norm than the exception. In Jacksonville, St. Vincent's Medical Center, Mayo Clinic Jacksonville, Memorial Hospital and Shands Jacksonville all have neurosurgeons on staff.
Adam Polsky, a director with HealthCare Appraisers in Delray Beach, says he has noticed a "big push" by hospitals in Florida and elsewhere in the country to recruit physicians in short supply, such as neurosurgeons. Some Florida hospitals, he says, have taken other "creative steps" to ensure coverage. Both Good Samaritan Medical Center and neighboring St. Mary's Hospital in West Palm Beach "have many physicians on staff with privileges at both facilities and have tried some specialty call panels, where they split the coverage. The physicians provide coverage for both, and the facilities share in the compensation," says Polsky.
On-call pay and compensation for carrying a beeper has also become the norm, says Polsky, who has been examining on-call payments by hospitals for the past 11 years. Traditionally, private physicians would provide on-call coverage at local hospitals as way to "give back to the community" while building their practices. The patients they'd see in the ER would often become their patients in private practice. Today, most neurosurgeons can expect anywhere from $1,500 to $2,800 in "on-call" pay for a 24-hour period.
The justification for on-call payments, Polsky says, is that over the past five to 10 years, doctors have been faced with an increasing number of lawsuits, and being on call in an ER situation opens up their exposure to being sued. "They've built up a case for how burdensome it is to be on call, and they've built a pretty good case."