Wednesday, May 21, 2003

Key specialist groups lacking

Cincinnati lags in areas where care need critical

By Tim Bonfield
The Cincinnati Enquirer

Not only does Cincinnati lag behind other Midwest cities in 14 of 33 medical specialties - the local shortages occur in some of the region's most important medical categories.

Heart disease is Greater Cincinnati's No. 1 cause of death, killing more than 3,000 people a year in Hamilton County alone. Yet a report issued Monday by a task force of business and health care leaders reveals a shortfall in cardiovascular disease specialists, which includes cardiologists and cardiac surgeons.

John Barrett, chairman, Cincinnati Business Committee
L. Thomas Wilburn, chairman, Health Improvement Collaborative of Greater Cincinnati
Dr. John Tew, neurosurgeon
Paul Beckman, Anthem Blue Cross and Blue Shield; Gerry Domis, Procter & Gamble; Tom Farrell, Greater Cincinnati Chamber of Commerce; Dr. Joe Hackworth, cardiologist; Ken Hanover, Health Alliance of Greater Cincinnati; Mark Hoffman, St. Elizabeth Health Partners; Joyce Huber, GE Aircraft Engines; Dr. Roslyn Kade, gynecologist; Brett Lebhar, Procter & Gamble; Dr. William Martin, UC College of Medicine; James Pearce, Hilltop Research Corp.; John Prout, TriHealth; Dorine Seaquist, nurse, Cincinnati Children's Hospital Medical Center; Thomas Urban, Mercy Health Partners
Staff coordinators:
Lynn Olman, Health Improvement Collaborative
Laura Long, Cincinnati Business Committee
Lung cancer is the area's leading cancer killer, claiming more than 600 lives a year in Hamilton County. But the report shows a low supply of thoracic surgeons who operate on lungs, and of radiation oncologists who treat lung cancer and many other types of cancer.

Colorectal cancer, another leading form of cancer, claims more than 200 lives a year in Hamilton County. Yet the report shows a shortfall of colon and rectal surgeons.

"These are huge issues. They have a lot of public health implications," said John Prout, chief executive of the TriHealth hospital group. "I think the public wants the best health care they can get and wants to know why our city is not up to snuff with these other places."

The report, issued by the 17-member Greater Cincinnati Health Care Data and Trends Task Force, comes nearly a year after doctors and others began openly claiming that the Tristate has been suffering a brain drain of specialist physicians. The report compared doctor supply to 10 other cities: Columbus, Dayton, Indianapolis, Lexington, Louisville, Milwaukee, Minneapolis, Nashville, Pittsburgh and St. Louis.

The data in the report largely confirmed experiences reported by doctor groups of intense struggles to recruit and retain physicians.

In cardiovascular specialties, Greater Cincinnati has 5.7 doctors per 100,000 residents. Lexington has 10.3. Indianapolis has 9.0. Dayton has 7.7 and Columbus has 7.5.

In colon and rectal surgery, the supply of doctors in Cincinnati dropped 21 percent from 1995 to 2002, but soared 31.5 percent in Lexington and climbed 11 percent in Indianapolis.

In addition to raw supply issues, the report cited increasing age as a problem for several specialties.

The average age of doctors in Cincinnati is "significantly" higher than other Midwest cities for seven fields: allergy, child psychiatry, dermatology, gastroenterology, neurosurgery, psychiatry, and urology.

The only reason the age issue hasn't a bigger problem in Cincinnati has been the weak stock market of recent years has prevented some frustrated doctors from retiring early.

"In my group alone, we have guys aged 57, 60 and 62 who would have retired already if not for the stock market crash. If we see a return in the stock market, you could see a large dip in the number of doctors practicing in Cincinnati," said Dr. Russ Vester, chairman of Cardiovascular and Thoracic Surgeons Inc. and chief of surgery at Jewish Hospital.

Several factors influence doctor supply in Cincinnati.

Trends in medical education nationwide have affected interest in some fields. Soaring malpractice expenses are an issue in Ohio, especially compared to Indiana where tort reforms have slashed insurance rates for doctors there. Some recruits also are turned off by Cincinnati's national image - be it the post-riot racial tensions or the city's longer term reputation as a conservative town.

But money remains the main reason doctors aren't coming to town, Vester said. For example, two years ago, the group tried to recruit a surgeon from Chattanooga, Tenn., but the doctor already was making twice as much as his group could offer.

"I'm 45 now. My best year financially was when I was 38, and I did fewer procedures then than I do now," Vester said. "When I go to conferences in places like San Diego, people ask me, 'Why are you still in Cincinnati?'"

When doctors say they can't afford to practice in Cincinnati, it makes it harder for hospitals to provide all sorts of care, Prout said.

Efforts to expand trauma services to comply with a new state law already have been hamstrung by difficulties arranging back-up neurosurgical and orthopedic services. Last year, shortages of anesthesiologists forced some hospitals - including the renowned Cincinnati Children's' Hospital Medical Center - to close operating rooms.

With fresh data on the table, Vester said he hopes business leaders and other community leaders will start taking a more serious look at health issues.

"The health care system is a huge part of what makes a community a good place to live," Vester said. "There needs to be a much greater reinvestment in the system."


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