Dallas / Ft. Worth, texas
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Dynamic Dallas
The young, energetic Dallas-Fort Worth
metroplex offers medical prestige and a vibrant lifestyle to go
with it.
It’s said everything is bigger in
Texas, which makes the fact that it’s third on the list
of states producing the largest quantity of physicians in the
country (born, trained, licensed, or graduated) unsurprising.
It also makes Nick Zenarosa, MD, the
chairman and director of the department of emergency medicine
at Baylor Medical Center at Garland, a member of a large club.
The Illinois native with a med school degree from the
University of Illinois-Chicago initially arrived in Dallas in
1991 for his residency in internal medicine at Parkland
Memorial Hospital. Although he next moved to Charlotte, North
Carolina for a second residency in emergency medicine, Dallas
held his heart. He returned to his adopted home in 2004 when
the Baylor position opened up.
“I came back as soon as I
could,” he says. “Dallas is a very easy city to
live in.” He and his wife bought a small ranch in the
northeast suburb of Sachse and settled in to the good life,
Texas style.
Administrators like Kent Tucker, the
vice president of ancillary services at Huguley Memorial
Medical Center in Fort Worth, love to color in that picture:
• The city offers outstanding
entertainment opportunities, ranging from major professional
and college sports to cultural events at the Myerson Symphony
Hall in Dallas and Bass Hall in Fort Worth.
• Myriad recreation facilities, such
as golf courses, tennis clubs, biking trails, and youth leagues
in a number of sports keep residents active.
• A number of good public and private
schools are located throughout the area.
• DFW Airport is conveniently located
in the middle of the metroplex, allowing easy access to most
destinations within the United States as well as international
locations.
• Housing options, from acreage in
the country to gated golf course communities, are all
affordable.
Yet the physicians say
these traits, while attractive, aren’t unique in the
recruiting game. What has them giddy about this 384-square-mile
city are the Texas-sized opportunities available for their
medical careers. For example, Zenarosa stepped into what the
American College of Emergency Physicians labeled a very poor
emergency medicine situation, not from a quality standpoint,
but because the huge shortage in this specialty meant limited
access.
“The only reason
we actually got one C in our report card was because we were
the first state to really pass a form of court reform for
litigation,” he notes. “We had scared away quite a
few malpractice insurers in Texas, so a lot of doctors left in
the early 2000s.”
However, the Texas
legislature passed Prop 12 and House Bill 4 in June 2003,
installing a $250,000 cap for doctors and $500,000 cap for
hospitals on non-economic damages in medical malpractice cases.
Since then, carriers have stampeded back into the Lone Star
state with physicians right on their heels. Still, the roundup
hasn’t sated the population’s appetite. At the time
the legislation passed, Texas had 25 percent fewer doctors for
its population than any other state.
Area economist Ray Perryman
estimates that medical liability reform will boost the
state’s annual gross product by $17.3 billion in five
years while personal income will increase by $10.9 billion.
Zenarosa is just tickled with the fact it means he has a shot
at filling his ranks. “Previously we tried to hire a guy
who had been in one lawsuit 10 years ago but couldn’t
because we couldn’t find malpractice insurance for him.
Now, that’s all changed,” he says.
Just the facts
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“You can saturate a market
like Chicago, New York, and Los Angeles. But we’re more
like an Atlanta—there’s not really a developed
downtown, so the city is sprawling out and they’re
building these big new hospitals 20 to 30 miles outside,”
says Marc Bowles, the executive vice president of the Delta
Companies in Irving, Texas. “You’ve got a lot of
physicians basically planting their stakes further out in
communities projected to grow over 10 years.”
Kurt Mosley, the vice president of
business development for the MHA Group, also in Irving, says he
“likes the even balance of profit and non-profit
hospitals in the area.”
Zenarosa embraces the competition
because “it usually raises the bar and the standard of
care” in his experience. “In order to compete, you
have to provide a service other hospitals don’t
have,” he says. In his emergency medicine department,
that means investing in new concepts with regards to
Baylor’s higher risk patients. For example, Zenarosa is
doing point-of-care testing as opposed to laboratory testing,
so he receives answers in minutes rather than hours. Doctors
there are also doing more bedside ultrasounds.
Meanwhile, at Medical City—a
598-bed tertiary care center on Dallas’ north side that
includes Medical City Children’s Hospital and Dallas
Craniofacial Center—the claim to fame is organ
transplants. The heart transplant center alone received
recognition from the Department of Health and Human Services as
one of the country’s premier programs. Totaled, Medical
City has performed 310 stem cell transplants, 229 heart
transplants, 22 kidney transplants, and 119 prostate seed
implants, according to its Web site. Surgeons here conduct
robotic-assisted microsurgery, beating heart surgeries, and
minimally invasive heart surgeries at their disposal.
Methodist Dallas Medical Center
advertises services like 24-hour hysterectomies, a Weight
Management Institute designated as a surgery center of
excellence by the American Society of Bariatric Surgery, as
well as a mock grocery store. This innovative tool helps rehab
patients navigate the shelves and aisles of real supermarkets
once they’re discharged from their stroke, head injury,
or joint replacement surgeries.
At Parkland, it’s not enough
to rack up accolades on service. Its president and CEO, Ron J.
Anderson, MD, has been dubbed 15th on the list of 50 Most
Powerful Physician Executives in Healthcare for 2006 by Modern
Healthcare. Thomas Royer, the president and CEO of Christus
Health in Irving, ranked seventh on that same list.
The employment situation for
physicians can get tricky in Texas. According to Bowles,
it’s illegal for a 501(c)(3) hospital to hire doctors,
but they get around this technicality by forming a separate
corporation that feeds into the hospital corridors.
Nevertheless, a majority of physicians choose to work
independently in single-specialty groups.
The graduating residents who learn
in these environments are treated like Hiesman trophy winners,
Mosley says, so his numbers show only 25 to 30 percent remain
in the Dallas area. “A lot of people count on their
residents staying, and low and behold, they’re gone in
the July exodus and then these hospitals need help,” he
says.
Candidates for these openings
usually have some tie to the area, including a spouse who hails
from the state. The next largest segment is the international
medical graduate level—Pakistani in particular—as
the international airport makes the city an excellent gateway
to home, wherever that is on the globe. California and Florida
natives report in large numbers, too. But by and large, medical
practices rarely pull from the East Coast or Midwest without
tapping into some family connection.
Those who do fly in for a visit find
a wide, open range of opportunities. Mosley says he’s in
dire need of ob/gyn, primary care, internal medicine, family
practice, and pediatrics physicians. Bowles’ clients are
asking for orthopaedists, cardiologists, radiologists,
geriatricians, and dermatologists with increasing frequency.
“We don’t ever hear of people having too many
physicians,” he says.
Mosley agrees, and he speaks from
experience—after breaking his foot in the fall of 2005,
his primary care physician said a specialist should set it. The
soonest he could get an appointment was 3.5 weeks away.
“And I had an angle because we know these doctors!”
he adds. Dermatology is even more booked up, thanks to the sun
damage to the over 40-crowd who grew up without sunscreen;
Bowles books his appointments in this specialty seven to eight
weeks out. “One of the physicians that a lot of the
people in our office see stopped taking insurance,” he
relates. “He didn’t have time to deal with the
paperwork. Patients pay in full up front and file on their own
behalf, and this dermatologist is still stacked up.”
One internal medicine physician
reports that 60 percent of his business stems from asthma
patients, and Type II diabetes has reached almost epidemic
proportions. “Folks here are overweight,” Mosley
says matter-of-factly. “When I first came here, I would
go out to dinner with people and it was like watching the
dietary intake of an adult puma. You eat steak in
Texas!”
Pediatricians bilingual in Spanish
can write their own ticket, as experts predict the Hispanic
population in Dallas will grow 40 percent in the next five
years, compared with 10 to 18 percent over the last two
decades. “And a lot of them are here legally and have a
nice insurance package,” Mosley says. But Spanish
isn’t the only language showing up in the classrooms
across the city—educators now work with a lot of
Caribbean dialects as well. Mosley likes to point out that
Dallas also shows up on the “most ethnically diverse
communities in America” lists.
“I came back as soon as I could.
Dallas is a very easy city to live in,” says Nick
Zenarosa, MD, the chairman and director of the department of
emergency medicine at Baylor Medical Center at Garland. He did
a residency here after medical school in Illinois. After
another residency in North Carolina, he returned.
©2006 reid horn