Physician technology to assist with ultrasound procedures.
Physician technology to assist with ultrasound procedures.

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Finding your niche in Baltimore

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Maryland General Hospital in particular represents this system’s dynamic impact. It has grown steadily in the past five years, exceeding budget in terms of both admissions and volumes across the board for inpatients and outpatients.

“As far as practicing medicine, Baltimore is a very exciting city in terms of education and training because of these two institutions’ continuing education opportunities,” says Tate.

GBMC happily basks in the glow. Dwyer cites this hospital’s strength in ob/gyn services and the fact it performs the most outpatient surgeries in its stateof-the-art ambulatory surgical center. GBMC made U.S. News and World Report’s list in 2001 for gastrointestinal services. Mercy Medical Center received accolades as well when HCIA, Inc. cited this hospital as a benchmark for success in quality care, efficient delivery, and superior financial performance. Self magazine picked it among the top 10 hospitals for women’s care. The city also tapped Mercy in August, 2002 to run its employee health clinic and save taxpayers $2.5 million over five years in operating costs and absenteeism.

“We’re always competing to do something better, newer, bigger,” Dwyer says.

The doctors’ side

Physician practice management experiments bear out the same failure rates in Baltimore as the rest of the country, so most doctors today practice in small, independent groups rather than  multispecialty monsters. “You won’t find a market like California where, if you want to be in practice, you must join a large group,” says UMMC’s Brown. Most doctors shake out into groups of two to four partners.

Dr. Dana Simpler even rates the city an ideal location for solo practices. This general and internal medicine  practitioner took over an existing practice in 1987 and maintained her solo practice for 13 years. In 2000, she teamed up with another woman internist—although not legally partners, the newcomer pitches in with Simpler’s patient flow when necessary.

“The secret to starting a solo practice is to keep overhead low and not accumulate debt quickly. That’s very doable here,” she says.

Fedder, however, doesn’t see the same solo opportunities when it comes to popular specialties like orthopaedic surgery. Marketing costs for name recognition can be high and call coverage at the hospitals comes dearly. “Getting credentialed by insurance companies can take six to nine months, getting hospital privileges if you have no group connections there could take nine months to a year,” he adds. “But that’s not so different from any metropolitan city.”

Most doctors settle in Baltimore because they have East Coast ties rather than choose the city at random. Fedder accepted Orthopaedic Associates’ offer because it placed him within easy reach of both his family and his in-laws in Virginia. Simpler attended the University of Maryland Medical School with no intention of making the city her home. “But you know the old story: I met my husband when he was in law school so I couldn’t leave. Then when it was time for him to start with a law firm, I was still in residency here. We were never in sync to move,” she says. Meanwhile, she found her adopted home to be a “down-to-earth place where patients are generally respectful of what their doctor says. I really love it.”

Recruiters draw most of their candidates from the educational pool—physicians who attended med school, internship, residency, or fellowship at the universities. “Most have a favorable feeling that brings them back, if they ever left in the first place,” says Tate. But, these teaching hospitals boost Maryland’s concentration of doctors per capita higher than other East Coast cities, according to Miles Cole, the senior vice president of government affairs at the Maryland Chamber of Commerce. And that makes strong credentials on the curriculum vitae crucial for a job offer. Yet, in Tate’s experience, physicians only need a Who’s Who listing if they are angling for a faculty position. Brown, too, rates the city as an attractive place to start a successful practice. Dwyer sees a tighter market.

“There’s a glut of extremely well trained physicians in this area. There was a time when we seeded physicians for a year or two to get them started, but we’re not doing much of that,” she reports. “GBMC probably wouldn’t be the best chance of a starting practice.”

Of course, that also depends on where a physician chooses to practice what. In the inner city, Tate assures that opportunities are wide open. She currently needs anesthesiologists and ob/gyns in particular. GBMC shut down its family practice department last July thanks to the success of its hospitalist program, so Dwyer labels family practice “not a hot item.” Meanwhile, Simpler stopped accepting new patients in 1995 and remains busy.

Dwyer gives a thumbs up to orthopaedic surgeons since “it seems like everybody is opening a spine center,” she explains. Fedder, however, believes the growth for this field lies in subspecialties. “There are a handful of general orthopaedic surgeons in the community, but most of the large groups hire younger physicians who are fellowship trained or have significant experience, such as the military,” he notes.

UMMC is hungry for pediatric subspecialties in addition to more internists and board-certified geriatricians. And according to the hospital association’s 2001 “State of the State’s Hospitals” report, it takes between 40 and 50 days to fill an opening for nuclear medicine techs, radiation therapy techs, radiographers, and sonographers.

Third party chimes In

Physicians label Baltimore’s managed care penetration “very high.” Johns Hopkins administrators admit they initially feared the managed care organizations would siphon off patients, but notified donors in 2001 the opposite occurred. Word from the Maryland Health Care Commission confirms HMO market share has fallen to 41.6 percent statewide. It attributes the decline to employers’ trends to shift from fully insured plans to self-insurance arrangements, and consumers’ demand for fewer restrictions. The news gets even better for Baltimore metro area, where Medicare HMOs’ market share fell 11.3 percent from 1999 to 2000, and privately insured HMOs fell 3.4 percent in that same time frame.

The Commission tracks 12 HMOs operating in Maryland. Its 2001 performance report reveals that 71 percent of patients say they haven’t called or written in a complaint against their HMO in the past year, and all but two received scores in the 90th percentile for providing ambulatory or preventive care in the past three years. Furthermore, HMOs report their average drug coverage per patient climbed 16.4 percent since 1998 to $337 per member.

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Julie Sturgeon

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