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Community profile: Dallas, Texas

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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

Change is the constant in Dallas in 2006 and growth is the operative word. The population rose by 31 percent between 1990 and 2000 and is expected to add another 24 percent by 2010. And as the population swells, so do the hospital systems, where, once again, large is the name of the game. There’s Parkland, perhaps best known as the hospitalwhere President John F. Kennedy was pronounced dead. (The area once occupied by the trauma room is now a waiting area for the X-ray department; a plaque marks the site.) Baylor University Medical Center consists of 19 hospitals, with a heart hospital to open in 2007. The University of Texas-Southwestern Medical Center boasts a faculty including four active Nobel laureates. All three are ranked among the nation’s best by U.S. News and World Report. Texas Health Resources, one of largest faith-based, nonprofit U.S. health-care systems, counts 13 hospitals and 2,600 beds. It was named among nation’s “100 Most Wired” companies for 2006. Altogether, there are 60 hospitals, 13,000 beds, and 5,800 physicians in the Dallas-Fort Worth metro area, according to the latest market report from Wetfeet.com recruiting firm in San Francisco.

“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.

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Julie Sturgeon

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