UO > Community > Dallas / Ft. Worth, Texas

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Big cities and the medical systems that serve them automatically come with a few imbalances and growing pains. Dallas is certainly no exception. But leaders in the medical profession are rolling out innovative solutions every month. For instance, new surgery centers are drawing surgeons and paying patients from the community-based hospitals, leaving administrators like Zenarosa with a call schedule riddled with holes and a higher-than-average uninsured load. “We may not have neurosurgeon coverage on a weekend. We may not have plastic surgery coverage other times,” he explains.

So cutting-edge hospitals have now begun paying doctors to be on call—and the move means specialists are offering to fill the schedules, since uninsured patients don’t cause as large a financial hit under those circumstances.

Physicians’ overbooked schedules also force large numbers of people, even those with good insurance coverage, through the E.R. doors, creating a strain on those departments. Mosley once took a friend suffering from a migraine to the nearby emergency room only to wait eight hours for treatment. As a result of such stories, some specialists have turned to open access scheduling, which leaves chunks of time available each day to see immediate needs patients.

Managed care never truly gained a foothold in Dallas, with Kaiser Permanente failing to make a profit. Mosley, in true Texas form, relays a story a physician once told him to explain the situation: “He was addressing an audience and asked everyone who had a dog to raise their hands. Next, he asked if their dogs liked bones. Everyone again said yes. But the physician came back with, ‘Your dogs don’t like bones. They like steak and settle for bones.’ The public here in Texas wanted the steak and was willing to pay for it.

“Patients with heart palpitations wanted to go right to a cardiologist, so they sort of revolted and said they wouldn’t go into a capitated system, and employers started dropping the insurance plans that dictated those models,” Mosley says.

The few HMOS still kicking, however, offer reimbursements lower than Medicare, particularly for practices based closer to the downtown areas. Dallas’ large corporations that wield economies of scale have some negotiating power when striking deals with medical groups.

Yet another challenge: salaries. Physicians across the board earn in the upper three-fourths of salaries across the nation, but that’s still less than groups in the Midwest and West are dangling. Mosley blames it on Dallas’ relatively young population (median age is 32.1 years), which isn’t into the three Bs: baby boomers, Botox, and bariatrics. Where someone practices also affects her income. According to Bowles, a family practitioner could expect to earn between $130,000 and $140,000 practicing in the city proper, while her counterpart two hours outside the city makes $220,000 for the same workload.

Yet income rarely becomes a sticking point, recruiters say. The fact that Texas has no state income tax means more dollars end up in doctors’ wallets. And Wetfeet’s statistics show that Dallas scores an incredible 93.06 on the ACCRA Cost of Living Index with the U.S. average at 100. “I understand from talking to physicians that they can’t keep up with the cost of living in most major metropolitan areas, but here you can stay ahead of it,” Bowles assures.

That’s just the beginning of the perks. Unfortunately, the myths about some parts of the state punish Dallas. No, it’s not humid, Mosley assures—that’s Houston and San Antonio. “Trace their latitudes and you’re as far south as Cabo San Lucas. Track ours and you hit San Diego,” he points out.

Residents passionately contend that the image of cowboy hats, spurs, and horses is just a surface look. Mosley admits he wondered how he would fit in after hailing from Newport Beach, California. “But with the exception of a little twang, they are the same people that are in California,” he says.

Certainly the employer base is strong, with the city—nicknamed in some circles as the Silicon Prairie—responsible for 47 percent of all tech-related revenue in Texas. That industry alone amounts to 230,000 jobs, with another 20,000 in communications manufacturing, ranking it third in the country for information and communications jobs. Tourism accounts for more than 100,000 jobs in the area, with conventions alone hauling in $4 billion for the local economy coffers. Residents have 300 banks to choose from. When the dust settles, pundits say the city will lead the nation in employment growth through 2010.

So when Bowles wants to describe the city, he uses adjectives like young and energetic. It’s especially conducive to singles, thanks to the diverse corporate scene. Residents can buy tickets to root for the Dallas Cowboys (football), the Dallas Mavericks (basketball), the Texas Rangers (baseball), the Dallas Stars (hockey) or the Dallas Sidekicks (soccer)—not to mention the competitive college sports scene. “I was amazed at how many jogging clubs there are here, and on the weekends, children’s sports activities are just tremendous,” Mosley says. Little League is huge among residents, high school football is king, and softball is the ‘in’ sport for adults.

A plethora of arts organizations reflect the city’s ethnic diversity. Performance groups range from classical music, theater, and dance, to Latino dance and music, to African music and cinema. The arts community’s crown jewel will no doubt be the Dallas Center for the Performing Arts, a four-venue, $275 million complex which began construction in the Dallas Arts District last November. The complex, scheduled for completion in 2009, will include an opera house, a theater, outdoor artists’ square, a performance hall, and a performance park.

Families can send their students to one of the six public four-year colleges and universities or 17 private colleges located in the metroplex. In the k-12 arena, 215 of the 236 total public and private schools rank as exemplary based on results of the Texas Assessment of Academic Skills Test. These schools typically turn in a 90-percent passing rate on the exam, a 94 percent overall attendance rate, and a dropout rate of less than 1 percent, reports Wetfeet.

“Austin, with its political roots, is considered the liberal town, although in any other state it wouldn’t be considered a liberal community,” says Bowles. “San Antonio, with its retired military population is very slow. Houston is still very much tied into the energy loop, so the ability for folks to climb the corporate ladder and exceed earning expectations there are more limited,” he adds. “The diversity of the economy here means, for the most part, Dallas is leading the way in Texas.”

Housing ranks as the most affordable category of all. Of course, the Plano suburb is reaching saturation, but Frisco, McKinney, Duncanville, Southlake, and Addison on the north side are booming. Much of the housing in these areas features multimillion-dollar gated communities. Younger physicians, particularly those without family concerns, are beginning to take advantage of a downtown revitalization, moving into hip lofts and condominiums in the Uptown area along McKinney Avenue. Even the ritzy W Hotel is moving into downtown digs, offering both high-rise residential and hotel facilities.

“Most people come to Dallas on a conference or training and they think we’re all about shopping and eating. But it really does offer the opportunity to build a family, start a career, and be able to get home in time to see your kids. It’s a good quality of life,” Bowles sums up. g

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