There exists in this country an idyllic spot, nestled in the mountains with moderate temperatures and sunshine nearly every day - a place so attractive to physicians that recruiters don’t have to sell it: Boulder, Colorado.
"I have only one opening for infectious disease at the moment, and we’ll get six to 10 applicants," says Jim Peters, the vice president of Boulder Community Hospital. "When it comes to family practice, I may get four to five applicants. But I have very little turnover in internal medicine and family practice; I haven’t had to fill one in a while."
Yes, Boulder, Colorado, has it that good. Dale Varner, MD, the chief of surgery at Exempla Good Samaritan Medical Center in Boulder County, will vouch for its popularity. He grew up and attended college in California, but shipped to Colorado for his residency. He and his wife, eager to get away from Los Angeles, liked Denver’s smaller city feel, and stayed. Varner joined a private practice in the suburbs for seven years, then joined the Kaiser Permanente system at the turn of the millennium, working in mid-town Denver. While Varner was on deployment as a flight surgeon in Iraq as part of the Army Reserves in 2003, a senior partner e-mailed him with a question: "Would you like to start a new hospital in Boulder County?"
"I didn’t really want to at first, but I thought about it and decided it would be
a great opportunity to be part of a state-of-the-art facility, with all the new doctors," he says. The Varners made the move, and he couldn’t be more satisfied with the change.
His is a typical tale, says Patty Fahy, an associate medical director of human resources at Kaiser Permanente of Colorado. "A lot of folks travel through Colorado on vacation here and just latch onto it," she says. Fahy herself, a North Dakota native transplanted to San Diego, plotted her future as a
Boulder resident while eating lunch here in 1989.
A bedroom community, Boulder is a straight shot 30 minutes from Denver’s sports and entertainment culture - just far enough to take advantage of the natural beauty of the Rocky Mountain range in their backyard. The entire county offers just four hospitals, but remains a hotbed of medical advancement, thanks to the University of Colorado campus teeming with 28,000 students. Add it all up, and you get the second most highly educated work force, according to a study by Expansion Management in May of 2005. Only Ithaca, New York - home of Columbia University - ranked higher.
Recruiters say they field requests from physicians across the country looking for their slice of heaven, but the vast majority of doctors at Kaiser are already natives of the state, Fahy says. The rest of the roster hails from California, Illinois, Texas, and New York, predominantly. The East and West coast residents seek escape from the metropolitan concrete jungles, Texans want out of the heat, and Illinois enjoys an excellent training program that feeds this industry.
Mark Cole, MD, a hospitalist, joined Kaiser Permanente in 2000 after 25 years in California because his partner developed a long-term association with the University of Colorado Boulder. He likes the university atmosphere for the associated cultural arts, political discourse, liberal attitude, coffee shops, and diverse restaurants it contributes. He compares Boulder to Berkeley, California; Eugene, Oregon; and Cambridge, Massachusetts. (Peters likens it more to a Madison, Wisconsin or Ann Arbor, Michigan.) "It’s not as liberal as Berkeley or Cambridge, but definitely the most liberal, moderate-sized town in the state of Colorado," Cole says. Indeed, Boulder County, which includes Boulder’s more conservative suburbs, is 37 percent Democratic, 27 percent Republican, and 36 percent independent, according to census reports at Wikipedia.
Nor have the outdoor activities escaped his notice. Everywhere he looks, he
says, he sees high-end cycling, mountain activities, and a plethora of runners. One of those could very well be Varner, who likes to take his kids fishing and canoeing on the lake just outside his back door. You’ll also find him skiing or hiking often. "As far as going to concerts and to hot restaurants, there are plenty of those in Boulder, and downtown Denver isn’t far. You can do that on a Friday or Saturday, no sweat. But to be honest, I’m a more outdoor soul, so I don’t really go to Denver except for meetings," he says.
As for the politically active atmosphere, Fahy is seeing its impact spill over into community service involvement. Her system offers an array of volunteer opportunities ranging from speaking opportunities to community board participation; she says a lot of Boulder area physicians lend their services to these efforts.
"The people of Boulder like their reputation as a quirky, artsy community combined with a high-tech, high-end culture," she says.
Demographics in Boulder County skew young, with the medium age at 29 versus 34 for the rest of the state. That translates to a healthier patient base, interested in maintaining their good health. It also means a greater demand for those who can treat sports-related injuries, and at this altitude, dermatology services are in demand. Certainly incidences of skin cancer are much higher in Colorado than in lower altitude states.
But what lifestyle giveth, it also taketh away. In a health conscious town like Boulder, smoking, substance abuse, and obesity are less prevalent than other cities, which lowers the need for physicians.
On the other hand, it’s not a particularly ethnically diverse patient population - Boulder’s census numbers show 88 percent of the people are Caucasian and 49 percent are single compared, to 27 percent single for the rest of the state.
"The patients are pretty cool," Varner says. "As a rule they will come with papers in hand, have already done their Internet search on their conditions, and have a list of questions. It makes it easier for me to engage those patients, I think." Their propensity for physical activity means "I sometimes get in trouble with my nurses for spending too much time chatting about non-medical stuff," he jokes.
The corridor between Boulder and Denver is growing, which is why Kaiser partnered with Exempla to build Good Samaritan Memorial Hospital as well as expand its medical offices in Boulder and nearby Lafayette. Still, the population isn’t a captive audience, as Peters points out - because many individuals commute to Denver for their jobs, they also set their medical appointments with physicians there. And the big city is still the hub for more complicated procedures such as transplants and burn treatments.
That’s not to say Boulder isn’t keeping up with the Joneses. Varner left a building initially built in the 1800s and modified over the years for a facility built from the ground up in 2004. He’ll gladly bend your ear about his cutting edge surgery center, with operating rooms that can be used readily with laparoscopy or any kind of video-assisted surgery.
"The doctor population is interesting, too," he adds. "It seems like the ones who decided to move and come to this new hospital are, on the whole, younger and a lot more willing to jump in and solve problems and change the patterns of the past. That includes adopting new standards to being a little more innovative and fun."
Peters reports many of the job candidates he invites to Boulder Community Hospital for interviews are pleasantly surprised. "They are surprised by the quality of the medical staff here. It’s top-notch in all specialties, and they don’t expect a community of 100,000 people to have the breadth we have," he says.
Thanks to the 578-acre integrated life sciences community rapidly rising at the former Fitzsimons Army Medical Center in neighboring Aurora, Colorado, the technical reputation could be poised for a wonderful explosion. Already, the three metro areas that comprise the Denver Consolidated Metropolitan Statistical Area (which includes Boulder) account for 80 percent of the state’s bioscience employment and have provided hundreds of new medicines and diagnostics, according to the Biotechnology Industry Organization. Already, graduates from the University of Colorado medical school account for roughly half of the family practice and internal medicine physicians in the area.
However, the structure of the medical scene is simple. Physicians either work for one of the four non-profit hospitals in the county or in large multi-specialty groups. Boulder Medical Center, for instance, employs approximately 65 physicians, while a clinic in Longmont has hired 60 doctors. The third choice, independent practice, is also strong, according to Cathy Higgins, the executive director for Boulder Valley IPA. "It’s part of the Western attitude," she says. Her association chips in to help with everything from credentialing to bookkeeping, contracting, centralized referrals, active pharmacies, national purchasing agreements, and a host of consulting services.
But none of that could coax Shannon Pryor, MD, an otolaryngologist, into striking out on her own in this environment. She moved to Boulder in September 1999 when her husband was transferred to the area from Baltimore. "My husband is the primary breadwinner in the family, and we didn’t love Baltimore, so it was an easy decision to go," she says.
However, over the next several years, her career stalled. She received a few offers in Denver and Cheyenne, but the commute was too far for Pryor to take any call. "The only ENT group in town had just added an associate and had no interest in speaking to me," she says.
The Pryors moved back to the East Coast, where she has practiced in Washington, DC since March of 2001. "We loved Boulder, but we’ve put down roots here," she says.
Varner can sympathize. Boulder is great for surgeons with a referral based, primary physician on their side to provide a patient population, he admits. "A solo practice is not really where you would want to go in the Denver metro area because the referral patterns are pretty much locked in. It’s better to join a group," he agrees.
Of course, getting noticed among the competition is the first order of the day. For Fahy, necessary criteria are proven quality and a track record of providing excellent care. After all, she receives three to five applicants for every opening. "The intangibles loom very large," she warns. "It’s incredibly important to have a collegial disposition, and work well with teams." Personally, she wants to talk to physicians who are extremely interested in clinician-patient communication, and have a sense of ownership about their patients.
Rochelle Woods, the president of Mountain Medical Group, a Boulderbased physician recruitment firm, looks for these traits on the résumés that flood into her office for Boulder:
• a stellar training program
• ties to the area
• hobbies that explain why a physician would be happy here long term
Thanks to this precision, on average she needs just 1.5 interviews per placement.
Varner warns new physicians against accepting an association with multiple hospitals, because although they’re in the same county, Western miles can spread out. He learned this the hard way during his private practice days when he covered four hospitals. It didn’t work out well for him or his patients. "At worst, associate with two but not three," he says.
In late 2006, Woods was seeking a hospitalist - one of the most sought-after specialists in the country - to work in Boulder, but she certainly wasn’t doubting her success. She had several CVs on her desk. "It’s a buyer’s market," she says bluntly. "Physicians use me here more to manage the process, not market their practices."
Fahy can’t lay her finger on any difficult- to-recruit niches for Boulder, although Kaiser’s skin cancer center does require special skills in the head and neck department as far as micro laser abilities. "There is such an attraction in coming into Colorado, I don’t so much use the word recruiting as I do selecting," she says.
None of this is lost on Cole, who admits his position has put him in a rather sheltered environment compared to his local colleagues. Even so, fields like sports medicine and alternative/complementary medicine are quite saturated in his experience. Heck, his own niche isn’t a cakewalk. "It has been difficult to maintain a viable adult primary care practice, as many patients go directly to specialists, and reimbursement is difficult," Cole says. "There are enough adult primary care physicians in Boulder and no one is retiring soon, but some have come and gone due to difficulties getting established."
Managed care is tolerable, with Peters describing Boulder Community Hospital as providing a great deal of managed care. Hospital-wide, just over 20 percent of their patients are on Medicare; family practice usually checks in at 10 percent Medicare, while internal medicine practitioners can see as many as 40 to 50 percent Medicare patients. The orthopedists, general surgeons, and other specialists can expect to see numbers anywhere between the two, his records show.
Now the bad news: Salaries aren’t that high. In fact, Peters places them on the lower end thanks to the heavier managed care system. Primary care physicians can expect an average annual salary of $120,000 to $150,000. "The lifestyle is what attracts people here," he says. "But if there’s a stumbling block for primary care, that’s it."
Yet it’s not as if doctors in Denver command higher rates, Fahy adds. Boulder’s rates reflect the entire area. Indeed, Woods finds the West in general tends to offer lower income guarantees than other parts of the country. Boulder’s bugaboo is that the cost of living is off the charts, with residents comparing it to Southern California.
"When people ask questions about Boulder, they want to know if they will ever own a home here," she says. Peters estimates families need to budget $400,000 for the average home; local real estate listings say a three-bedroom, four-bath Tudor home with a two-car garage and amenities like Wedgwood cherry cabinets, Viking gas range, Sub-Zero refrigerator, a fireplace, formal living and dining rooms, hardwood floors, and a Jacuzzi in the master suite has an asking price of $1.2 million. A 1,900-square-foot town home sells for $269,500.
Varner bit the bullet and bought property to avoid commuting the 30 miles from the extreme southern side of Denver. "I tried it for a while until we sold our house and could move. It was pretty nasty," he says.
Keep in mind, however, these prices are for Boulder proper. Slightly more affordable neighborhoods are springing up along the 125 corridor between Denver and Fort Collins, so many physicians are opting to live within 15 miles in Longmont, Louisville, Lafayette, and Erie, according to Peters. Website listings show a four-bedroom, three-bath house in Longmont is priced at $585,000.
"It all seems to work out," Woods assures. "It’s still enough of a small town that things kind of open up for you. It’s just sticker shock.
"I have recruited a lot of people here," Woods says. "It’s a magical place. Coming into town, it looks like Brigadoon, [yet] operates as a large city with a community feel. You’re speaking to someone who loves it here."