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March 1, 2009

South on the border

The U.S. District Courthouse in El Paso rises among the diverse modern and traditional architecture of the city.

The U.S. District Courthouse in El Paso rises among the diverse modern and traditional architecture of the city.

There’s an aura of excitement these days in the halls, offices and classrooms of the Texas Tech University Health Sciences Center at El Paso. To summarize the reason in a few words, German Hernandez, MD, says, "You don’t get to start a new medical school very often."

He’s one of a growing group of teaching/practicing physicians who will be ready for classes when the school opens in July with a class of 40 students.

The new Paul L. Foster School of Medicine is actually an addition to the school that has been accepting third- and fourth-year medical students for about 25 years. "Typically," adds Hernandez, "students have gone first to Texas Tech in Lubbock (the main campus) to get their basic science education. But from there they have split up for their last two years. Some stay in Lubbock, some go to Amarillo and about a third come to El Paso." Now medical students will be able to spend all four years at the El Paso venue.

Kirk Baston, MD, may be even more exuberant about the change. "The school was actually my main reason to come, " he chimes in. "It’s been a very exciting and unique opportunity to be part of a team that’s basically creating a new medical school. The campus is gorgeous, with beautiful buildings and up-to-date resources. If anyone loves to teach, this is one of the best facilities that I’ve ever seen."

As proof, he cites "an exciting and innovative curriculum that puts students in contact with clinical practitioners and clinical studies from the get-go. But aside from the new buildings and the heavy emphasis on teaching by the physicians (at least 70 percent of one’s professional time is allocated to teaching, with up to 30 percent for patient care), is such state-of-the-art equipment as simulation equipment that I didn’t even know existed."

Another plus: The school will be based on the Calgary Model. "Traditionally, first- and second- year students don’t see patients, " says Lisa Ruley, the school spokeswoman. "But here they will be attending actor-patients simulating all different situations." Current plans also cover nine residency programs, with more to come.

Patterned archways give the Texas Tech at El Paso campus a distinctive flair.

Patterned archways give the Texas Tech at El Paso campus a distinctive flair.

Bilingual opportunities in El Paso

Another serendipity different from most if not all other medical schools: "Because we’re on the border, there are a lot of Spanish-speaking patients. The students will have about a four-week Spanish immersion course before they start their actual medical curriculum."

The advantages radiate into the community, Baston points out. "Having a school within the city is hopefully going to increase the number of doctors here. What’s intersting is that since I have been here and talking to the general community, when I tell them I’m working at Paul Foster they seem very excited that the school is here."

They’re excited for good reason. El Paso is the twin city of Ciudad Juarex, Mexico, just across the Rio Grande River. In fact, ’The border is just down the street from City Hall, and some people see the two cities as one," says city spokeswoman Juliet Lozano. As one El Pasoan puts it, "If you make a wrong turn, you end up in Juarez."

Medical needs in El Paso

Medical care needs are great, with a combined El Paso/Juarez population of more than 2 million. Many Juarez citizens seek medical care on the U.S. side of the border, and a surging incidence of diabetes and obesity in both cities has created a greater and greater need for physicians. Hernandez and Baston- and more than a few city leaders- hope that some will opt for a congenial life in an even more congenial climate. Some El Pasoans delight in talking about rare occasions when snow might cover the ground in the morning, then melt in the afternoon when the temperature rises into the 60’s.

El Paso, the

El Paso, the "city on the border," is tucked into the Franklin Mountains. These mountains are the southern-most part of the Rockies, with more than 24,000 acres designated the Franklin Mountains State Park - the second largest urban park in the U.S. The area provides seemingly endless hiking and biking trails.

Warm and welcoming

Climate, in fact, played a key role in attracting Augustine Eleje, MD. Born in Nigeria, Eleje earned bachelor’s degrees in medicine and surgery, interned and practiced there until coming to the U.S. in 1990. New Jersey was his first destination: He completed his residency there in internal medicine and pediatrics, helped run the program until 2003, and was also medical director for a nursing home. But after 16 years in Newark, and more than enough winters in the north, "I started thinking about moving to warmer climates," he recalls. "I figured Texas would be a good place. Not Houston or Dallas; they’re too big." But El Paso was the "average size city that I needed, a nice place to raise a family."

Another consideration: "I needed a place that needed doctors and one where I could get up and running quickly. I like to work, and I like to make money so that the kids can go to college. (Two of his four children are now students at Baylor University.) As a professor, the compensation wasn’t going to cut it."

In a welcoming gesture, Eleje’s sponsor, Las Palmas Medical Center, one of the city’s six major hospitals, eased him into his new practice by helping with startup costs. In five months, his practice was showing a profit, and, he says, "I could pull my own weight."

El Paso, Texas Statistics

El Paso, Texas Statistics

Easy transition to Texas

Authorization numbers for Medicare and Medicaid were another story. Even though he’d had the certification in New Jersey, he had to reapply in Texas. The problem, as every peripatetic practitioner knows, was that he could draw no reimbursement until the paper work was finished, but at that point the payments were retroactive. In eight months, he was in the system. Contrasted with his previous experience, the Texas bureaucracy acted with lightning speed. Today, he’s affiliated with four hospitals - Las Palmas, Del Sol Medical Center (now combined as a regional healthcare system and operated by HCA), Providence Memorial Hospital, and Sierra Medical Center (linked as the Sierra providence Health Network under the aegis of Tenet Healthcare).

Hernandez, a nephrologist, and Baston are employed by Thomason Hospital, which is affiliated with the medical school. Baston, who earned a degree in chemical engineering before going on to medical school, combines both disciplines as a specialist in blood, transfusion medicine, coagulation, clotting, and bleeding disorders.

Thomason is the city’s sole publicly owned and operated facility and is in the midst of a $154 million expansion program. In an unusual arrangement, a new tower will include facilities for women and infants, but its top five floors will be leased, separately licensed and operated by an independent entity as a children’s hospital. However, city leaders have a much grander vision for the future in which the only medical school on the U.S.-Mexico border and the hospital will become the nucleus for a system similar to Houston’s expansive healthcare complex. They plan to call the El Paso counterpart the Medical Center of the Americas.

Eleje, Hernandez, and Baston have all been pleased such physician-friendly Texas regulations as malpractice caps, greatly accelerated license processing times (51 days or less), and an online tracking system allowing prospective licensees to check the progress of their applications 24 hours a day. Not to mention the advantage of practicing in a setting with minimal managed care penetration. According to Hernandez, "Probably Texas has some of the best in terms of laws helping physicians have a friendly practice environment." As a result, he adds, "It seems like every year (the state) is getting more and more physician applications, and I think that is partly why the legislative changes are made."

Statistics bear out his statement. "Texas is a popular place to practice medicine, as evidenced by the dramatic increase over the past few years in the number of doctors who seek to be licensed here," reports Roberta Kalafut, president of the Texas Medical Board. Licenses issued to 3,621 physicians in Fiscal 2008 set a record that surpassed the 2007 record of 3,324, which put 2002 into third place with 2,828.

Texas’s physician shortage

Nevertheless, says Hernandez, as things now stand, "areas like El Paso are (still) truly underserved."

There’s good evidence of the need in his own nephrology practice. "When I first moved here (three years ago), there were only two other nephrologists on staff. Now there are four-and-a-half of us (one is part-time). We’re definitely below the national and state average in terms of incisions per population. There are 1,500 patients on dialysis in this whole town of only 700,000 people." For a physician, there’s a certain serendipity about practicing in an underserved area. "Patients may come in with advanced stages of disease, which means we get to see things that only advanced students would see and some medical students would only read about, including a lot of tropical-type diseases and a lot of cancers that are at more advanced stages."

Lifestyle perks

Renowned architect Henry Trost designed more than 200 homes in the El Paso area, including his own, at 1013 W. Yandell, adapting Frank Lloyd Wright’s Prairie style.

Renowned architect Henry Trost designed more than 200 homes in the El Paso area, including his own, at 1013 W. Yandell, adapting Frank Lloyd Wright’s Prairie style.

Still, as he, Baston and Eleje point out, there’s much more to the city than a new medical school and attractive employment features. As for the city itself, Hernandez calls it "almost like a hidden jewel. A lot of people don’t really know about El Paso," he says. "It’s not really like the rest of Texas, but it’s not like Mexico or New Mexico, either. It is very unique. You almost have to come out and see for yourself what a wonderful city it is."

Although it became Texas’ first settlement when it was formally organized in 1682, the city can chart its history to 1582, when Spanish explorer Juan de Oñate found the pass that enabled him to extend his northward expedition. He called it El Paso del Norte, or "the pass to the north" between mountain peaks rising out of the desert.

Unlike most cities "divided" by rivers, "We’re a city tucked into the Franklin Mountains" (the southernmost "contingent" of the Rockies) says Lisa Ruley in the communications/ marketing department at the medical school. Today this cluster has become a destination for outdoor enthusiasts. In fact, more than 24,000 acres have been designated the Franklin Mountains State Park, the second largest urban park in the U.S. (Chugach Park in Anchorage, Alaska, is first with half a million acres.) Outdoor enthusiasts can find almost endless hiking and biking trails. Every summer, audiences enjoy performances of "Viva El Paso" in an amphitheater in McKelligon Canyon. And sightseers can ride a cable car up 2,300 feet to an observation deck atop Ranger Peak. The view encompasses three states (Texas, New Mexico and Arizona) and two countries.

El Paso recently earned the 2008 Community of the Year award from the American Planning Association. Among the city’s new "green" programs is weatherizing homes.

El Paso recently earned the 2008 Community of the Year award from the American Planning Association. Among the city’s new “green” programs is weatherizing homes.

Not content with the status quo, the city’s Parks and Recreation Department is working on an ambitious 18-project revitalization plan that includes a comprehensive trail system with linkages throughout the city and for extreme sports enthusiasts, an "X games" outdoor recreation facility.

The parks and recreation activities are part of an almost staggering program of revitalization, including infrastructure upgrades and beautification projects. Some of the initiatives are related to enhancing benefits from the North American Free Trade Act (NAFTA), green infrastructure, streamlined zoning/subdivision ordinances, and groundwater management, but there’s a heavy concentration on more visible projects such as the city’s "Downtown 2015 Plan." As part of a citywide public art ordinance, two new works were unveiled in 2008, with 13 more on the docket. The new El Paso Museum of History opened in 2007, and expansion/improvements are going on at the 65-year-old zoo.

"When we first moved here (15 years ago)," says Lori Gaman, a local business owner, "there were just a few things to do. Now the city has really focused on quality of life, with parks, museums and more of a united effort to plan for youth, in sports and in the arts and culture of the city." Besides the history museum, other recently opened attractions include children’s and Holocaust museums.

El Paso, now among the most noted and progressive Texas communities, continues to undergo a wide-ranging revitalization, improving the efficiency of commercial buildings and transportation.

El Paso, now among the most noted and progressive Texas communities, continues to undergo a wide-ranging revitalization, improving the efficiency of commercial buildings and transportation.

Industry expansion

The concentration on "green" programs, including weatherizing homes, making commercial buildings more efficient, and making transportation systems more effective also seems to be sparking new business enterprises, says Kathy Dodson, director of the Regional Economic Development Corporation. "We have all these alternative energy companies starting up," she reports. Among them are firms growing algae and working on developing and refining it into fuel and others involved in wind and solar energy systems. "I think this industry is going to be giant."

Not to be overlooked is the economic contribution of Fort Bliss, the U.S. Army installation dating back to 1848. Today it’s an Air Defense Artillery Center with eight brigades, battalions and a military police company, a large part of whose mission is to provide desert training for troops. In that context, a new contingent of some 20,000 will arrive in the next five years, along with some 30,000 family members. Local leaders are planning for a concomitant economic boost. Says Gaman, the business owner, "We’re expanding our schools and facilities to get ready."

As a contrast to America’s current woes, she adds, "Sometimes we feel that, when the economy does poorly elsewhere, it’s good here."

At least one economist, Richard Florida, seems to agree. "El Paso is now among the most noted and progressive Texas communities," he says. Its accomplishments so far, combined with others in progress, recently earned it the 2008 Community of the Year award from the American Planning Association.

Making El Paso safer

Texas Tech at El Paso’s Medical Science Building is one of three buildings on a brand new campus that house the Paul L. Foster School of Medicine, whose recent expansion will allow medical students to spend all four years of their training in El Paso.

Texas Tech at El Paso’s Medical Science Building is one of three buildings on a brand new campus that house the Paul L. Foster School of Medicine, whose recent expansion will allow medical students to spend all four years of their training in El Paso.

Another accolade might surprise the millions of Americans who can’t help but know of the turbulence and violence that’s been wracking Juarez in the last year or more. While thousands of Mexicans in Juarez have been victims of killings and other violence, El Paso has been named America’s third safest city by the prestigious Morgan Quitno research organization. (San Jose and Honolulu are first and second.)

Javier Sambrano, public affairs officer for the El Paso Police Department, has some explanations for the paradox. For one thing, he says, "The Mexican cartels don’t want to cause any situation in the U.S. because they know that police consequences [here] would hamper their dealings in trying to get drugs across the border." But there’s more. "Something that has kept the community safe has a little bit to do with the department’s solvence rate on homicides. The national average is 67 percent. El Paso’s is about 98 percent.

"A lot of that," he adds, "has to do with our investigative measures. [When there is gang violence] the whole law enforcement gang and/or homicide section goes at it until all leads are exhausted, sometimes for 48 hours. Then a detective is assigned." To contrast then and now, "In 1992 there were about 300 drivebys a year. Now the rate is as low as eight to ten a year, if that." Another nail in the criminal coffin: "We have a very good working relationship with federal agencies and a lot of task forces, such as the Drug Enforcement Administration, U.S. marshals, the FBI, and the border patrol. And locally we share information with the sheriff and other municipalities." With a note of modesty, he does say, "We’re not always perfect, but we have been very fortunate." Probably apropos is that old saying, "The harder I work, the luckier I get."

A lesser but still unlucky circumstance for Juarez itself, says Gaman, is that the violence is hurting the Mexican city’s share of the tourism industry. "According to a recent story in the paper, 20 restaurants have closed, and shops and boutiques are closing, too, although the bridge (across the border) is a busy place both ways, so I’m sure it’s affected our downtown." In another are: "Medically, we’ve received a lot of victims of violent crimes coming over here for treatment."

The famous Sun Bowl Stadium of University of Texas at El Paso.

The famous Sun Bowl Stadium of University of Texas at El Paso.

In the four centuries since Oñate’s excursion, thousands of Hispanic peoples also made their way north. Today their heirs and many newer arrivals comprise a whopping 80 percent of El Paso’s population and, in many ways, have become the backbone of the city’s business and cultural scene. "This is a truly bicultural city," Dodson exults, "and it’s wonderful. [Among other things], I can choose to attend a [European-style] ballet or a ballet Folklorico." And residents revel in celebrating the Hispanic holidays as well as the American.

On the business side, since 2003, the Hispanic Chamber of Commerce has packaged some 200 small business loans and has been involved in more than 600 other start-ups.

El Paso was one of seven American and foreign cities featured last July in a Wall Street Journal article, "Success Stories." Leaders in each locale had pursued a quest for revival and upgrading in a different way. A major spur in El Paso was the energetic work of attorney James Scherr in restoring the historic downtown International Hotel. Commenting on this and the city’s other master plan work, he said, "El Paso is going into the 21st century with our running shoes on." On this, most other city residents seem to agree.

 



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