Amidst MD shortage, BFMC works to recruit
Sunil K. Dhunna, MD, talks with practice associate Brianna Fellows.
Dr Tim Lepore at 48 Sanderson St
BFMC CMO Gerda Maissel in her office
GREENFIELD — After a medical fellowship in New York City, Dr. Sunil Dhunna wanted a change of pace.
So the pulmonologist, now 34, logged onto the website of the American College of Chest Physicians in November 2011 to search for jobs. He found a number of openings across the country — in places like Florida, Virginia, North Dakota and Greenfield, Mass.
One month later, he visited Baystate Franklin Medical Center for a tour of the hospital and community. He signed a contract the following spring and began working that July.
Dhunna’s focus in critical care has allowed the hospital to treat some lung-related cases in Greenfield that were previously sent to Baystate Medical Center in Springfield. His hire also added support to the hospital’s previously lone lung doctor — a speciality that is among the top 10 hardest to fill nationally.
A nationwide doctor shortage has left hospitals and health providers across the country struggling to recruit doctors — in part because of a cap on federally funded residency positions and a growing patient population. The situation is worse for western Massachusetts recruiters than their eastern counterparts, according to a report issued last month by the Massachusetts Medical Society.
Baystate Franklin and other hospitals have a list of specialties they look to bring in to satisfy local patient needs. The hospital is currently recruiting for six specialists and one or two hospitalists.
The medical society’s reports said that recruiters have especially struggled to fill four speciality positions: family medicine, internal medicine, neurology and gastroenterology.
In three of those areas, Baystate Franklin has actually had success. Medical Director Gerda Maissel said that the hospital has brought in three family medicine doctors and a neurologist in the past three years. And internal medicine doctors have been easier to recruit because of a residency program at Baystate Medical Center, she said.
But finding a gastroenterologist to replace one who died last year has proved difficult for hospital recruiters, who also have come up short in month-long searches for a urologist and an orthopedic surgeon.
The absence of a urologist, in particular, has left a hole in the community’s medical needs. Pioneer Valley Urology — a private Springfield-based practice that had operated for a year in one of the hospital’s medical buildings — moved out of Greenfield in August, leaving the county without a urologist.
The hospital’s nurses, at community forums and rallies, have used urology as one example of Baystate Franklin officials failing to recruit and retain physicians.
Maissel insists that officials are trying, and that the national shortage — which gives doctors plenty of jobs to choose among — isn’t helping. Soon the hospital will roll out new recruiting initiatives to attract doctors, like brochures about Franklin County.
“We’re upping the ante ... looking to see what else (we can) do,” said Maissel. “Are we looking in the right places? Do we have the right incentives?”
Bringing in a new doctor, even when a qualified candidate falls into place right away, can take up to six months.
Doctors generally give a four-month notice before leaving their current job, said Maissel. And if they’re coming from out of state, it can take as long as two to three months to meet all of the Massachusetts licensing and credentialing requirements.
New doctors, who are finishing up medical residencies at hospitals like Baystate Medical Center in Springfield, won’t be able to start work until July.
Timothy “TJ” Lepore, a 34-year-old OB-GYN, finalized his contract to work at Baystate Franklin in October 2012. But because he was in his final year of a residency at Baystate Medical Center, he didn’t start working in Greenfield until this July.
Whenever a new position opens up, Maissel contacts recruiters for the Baystate Health system, who will take the first pass at candidates. She can give specific requirements that the candidates must meet to be considered.
For specialities where the hospital already has veteran doctors, like gastroenterology and orthopedics, Maissel would consider hiring a new doctor fresh out of medical school. But for urology, where the hospital is looking for two doctors, she would need to first employ an experienced doctor.
Recruiters attend job fairs, advertise in newspapers and journals and post entries on websites. When candidates reply about a job, a recruiter will explain more about Franklin County and the hospital and ask some basic questions, said Maissel.
They pass along the resumes of qualified candidates to Maissel, who will then elect whether or not to call the individual. From there, she may set up a time with the person to visit Greenfield.
The visit — which typically includes a formal interview, a tour of the hospital and a tour of the community — is a critical part of this courting process. The hospital, if it’s interested in the candidate, will try to address not only the doctor’s needs and concerns, but also those of his family, said Maissel.
Factors at play
Hospital officials say the facility is in decent shape except for its operating rooms. Surgeon candidates have often been discouraged when they see the aging operating rooms during their tour, said Baystate Franklin President Chuck Gijanto. The hospital announced its plans earlier this year to build newer, larger rooms.
And since doctors will become residents of the area, location plays an important factor. For some, Franklin County is a relaxed, inexpensive and nice place to live, said Maissel. For others, who come from other states or prefer city life, it’s too far off the beaten path, she said.
Joel Feinman — president of Valley Medical Group, which serves patients in Greenfield, Amherst, Northampton and Easthampton — said that people who have ties to the area are more likely to end up wanting to work in the Pioneer Valley.
When people from outside the area look to the Northeast, said Feinman, they typically are searching for jobs near Boston or New York City — not Greenfield.
“When they sit down and actually think about (it) ... in their heart of hearts, (some) want to have close access to all things urban,” he said.
And Flora Sadri, medical director for the Community Health Center of Franklin County, said that most of her new hires come from within the state.
Residency connection key
Baystate Franklin has brought in 33 doctors in the past three years, and 24 of those are still on staff. It employs 66 total doctors and there are 61 others who regularly work at, or have access to, the hospital.
The hospital has also increased its use of advanced practice providers and brought in 19 new nurses, nurse practitioners, physician assistants and midwives in that time. Twelve of those providers are still at the hospital.
Officials attribute part of their recruiting success to the connection with Baystate Medical Center’s residency programs — which the Springfield hospital has hosted since the 1940s, said Kevin Hinchey, the health system’s vice president for academic affairs.
Some of these doctors, after completing the program, stayed in Pioneer Valley hospitals and medical practices. In the past four years, Hinchey said that 16 of 72 program graduates in primary care and hospitalist programs stayed local. And 10 of 47 in emergency medicine residencies stayed in the valley during that time.
During his four years at Baystate Medical, Lepore spent a six-week rotation in Greenfield at the hospital’s Pioneer Women’s Health and enjoyed the experience.
During his time as a medical resident, Lepore and his wife bought a home in Northampton and started a family. He knew he wanted to stay somewhere in the Pioneer Valley and approached Pioneer Women’s Health directors about joining their team.
A conversation in July 2012 began what Lepore called “a slow dance” toward employment.
“It’s like a poker game in a certain sense,” he said. “You don’t want to put all of your eggs in one basket. ... You’re applying to a lot of different places.”
Lepore said that his six weeks in Greenfield cemented in his mind that he wanted to work for Baystate Franklin. He was already familiar with the health system’s computer software and said he was able to hit the ground running in July.
So if residency programs are so successful in driving doctors to local hospitals, why not start up programs in urology and gastroenterology today?
There isn’t the federal money available to do that, said Hinchey. It would mean more than taking away a few seats in one program to make way for another, he said. The health system would have to bring in new staff who are qualified to teach those specialties.
Supervisors do constantly review what programs they can offer, said Hinchey. Four years ago, the hospital added its newest residency program: psychiatry, the speciality with the third-highest shortage nationally.
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