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Medscape part 2: Mon Health physician roundtable on working in West Virginia

MORGANTOWN – When The Dominion Post contacted Mon Health System about the Medscape medical news site piece ranking West Virginia the third-worst state to practice medicine in the U.S., Mon Health President and CEO David Goldberg put together a physicians roundtable – at 6:30 a.m. on a Wednesday – to let them speak for themselves.

They talked about working in Morgantown, Monongalia County and West Virginia in general. A few spoke during the roundtable and provided additional thoughts via email.

A short summary of their comments would be that the Medscape writer makes some valid points but doesn’t paint the whole picture.

Dr. Brad Warden, executive director, Mon Health Heart & Vascular Center

“All the things they brought up, honestly, are true, because they’re statistics. What you see a lot of is that the people who practice in West Virginia are from West Virginia, and we tend to retain a lot of physicians who train here and live here.” The osteopathic school, in particular, does a good job of retaining trainees.

“It is a tough environment to practice in.” PEIA, for example, pays only half of the cost of the care of a patient. Between government payments and private insurers, it falls to the private insurers to help make up the difference. “And it’s difficult, it’s hard to make ends meet.” All costs are going up, medication, staff and so on.

“I think that people that are from the state stay here because they know what the state’s about.”

Goldberg, on malpractice: Tort reform in recent years put caps on lawsuit payouts. The state is losing population and the older population that is staying uses healthcare more. “So, you’re going to see an expense a little higher than the norm. But that being said, our outcomes are improving. … The good thing is there’s some caps so we don’t overly charge the system or those who would reimburse for malpractice.”

Goldberg, on the challenges of rural healthcare: Many Mon Health physicians do outreach to rural areas and visit multiple sites or do telemedicine. But it is harder to recruit doctors to certain rural areas. “We’ve seen an uptick in our ability to recruit. … They advance their career by staying here.”

Dr. William McBee, gynocologic oncologist

He returned to Morgantown because he wanted to live, practice and raise his family here. “If I didn’t come back and practice here, probably nobody would. … For my particular specialty, the downside of being here is I’m here by myself (compared to nine gyno-oncologists at UPMC). “I enjoy practicing here because I do get to see patients from all over the state and I think I fill a need that otherwise wouldn’t be met.”

Dr. Joseph Blatt, hospitalist

“I’m here to work for the community. Mon, specifically, gives me to opportunity to do that. I feel like the care is very personal here … there’s a familiarity with the patient that’s drawn me back to the state.” At Mon Health Medical Center, he has the resources to draw on, including a wide array of physicians, so he doesn’t have to send patients to UPMC or Hopkins or Duke.

Kristen Statler, general surgeon

She’s the only female general surgeon but has seen no evidence of complaints aired online about women being treated differently. “I feel like I have the exact same respect men in the profession get. I have a great place to practice.” Her dad, she and her son were all born at Mon and get their care there. People get the small-town feel there but get all the care they need.

Dr. Ihtishaam Qazi, medical director for oncology

He was born and raised in Nitro. He went out of state for undergraduate but did his medical training here. “You won’t find more grateful patients than in West Virginia.” They bring gifts – maple sugar, venison, baked goods. “It really is a great place to practice.” Much of his family works for CAMC and they like working there, too. Mon is “a community-forward place that does not commoditize medicine.”

He said in his email, “Compared to places in Ohio, where I did my early training, it was a very stark difference. There are some issues with practicing in this state, from poor healthcare resources, poor access to sites, low health literacy, poor malpractice environment etc. But that is why I love working at Mon, I feel that I am empowered to improve my patients’ access to care and given the respect and latitude to do my job to the best of my ability. … I may be a little busy in my current role, but it is satisfying, and I could not imagine being anywhere else.”

Dr. Bonnie Forman, primary care, Kingwood

She grew up in Preston and returned there after training. “Almost every single provider [in Preston] is either from the area or was brought in by some type of governmental grant.” Regarding the grants, “I guess you can look at that as a benefit or a sadness, that it frequently takes that to get someone to come back. But it is a great place. … If you had told me 20 years ago or 30 years ago that we were going to be giving chemo or have a urologist in Preston County, that was just unheard of. … There’s nothing better than being able to give back to a community.”

Dr. Christopher Edwards, chief administrative officer, Mon Marion Neighborhood Hospital, Mon Health Systems Emergency Services director

“The large majority of us basically came home to work in a state we grew up in. … In terms of retaining doctors, there is some pressure put on the facilities that run the residency programs throughout the state.”

Many residents are from out of state and want to go back to their homes, which makes retention a little more challenging. And puts a little more pressure on natives who want to be here and stay here. Emergency departments across the state find challenges recruiting. “I would be shocked if there’s any emergency room in the state that doesn’t have openings.” That affects pay, too. They have to offer a bit more than market scale.

“I do find that when we recruit folks that aren’t from West Virginia, when they get here they love it.”

Mary Edwards, emergency medicine

A Bluefield native, she moved here with her husband, Christopher. “I don’t know that there’s anywhere else, with the quality of care and the physicians that we work with, that you’ll find a better place.” They trained in Ohio. “It was wonderful there, but this is home. … It’s just unparalleled, in my mind.”

Goldberg, on physician pay: “In some respects, I think our salaries are competitive. Our salaries are comparable, not significantly less, not significantly more.” Expenses: school loans, office expenses, malpractice premiums, all have to weigh in. “It’s not inexpensive to run a medical practice,” including the office specialists who fight the insurance companies every day. There are federally guided standards for fair market value. “I don’t think the money motivates them.”

Dr. David Hall, urology

He’s a Morgantown native, his father practiced here and he wanted to practice here. His wife is also a physician who lived in Pennsylvania, Maryland and Florida. “She came here for me, but I think the reason she stayed was more because of the state, the town and her appreciative patients. And it’s a great place to raise our kids.”

Dr. Shane Prettyman, obstetrics-gynecology

Regarding the Medscape article: “It’s not surprising to us. … All these things are very stereotypical. … The big money, the metropolitan places are going to be the great places. … And the more rural places will be the lower places.” But as others have said, doctors will either want to go back home or go to the destination places. “The grass is not always greener on the other side.”

His family wants him to move to Charlotte, N.C., but he doesn’t want to. “I’m going to a place where I have no connections to, and then it’s just a job.” When the providers want to be there, “the patients feel that because you have people that want to be there.”

Dr. Susan Capelle, gynecology

“I think that West Virginia has the same problems that any rural community or state has in recruiting physicians. … But I don’t think people who don’t know West Virginia understand what a great place it is.”

She trained in Pittsburgh and was there for nine years. “I now that we give as good or better healthcare here than we do there. … There are prejudices, it’s just the way it is. … I can’t imagine being anywhere else.”

In her email, she noted Medscape’s reference to West Virginia’s relatively poor health. “As physicians, that is what we have trained to do – take care of these patients; and in so doing, hopefully, improve their lives. So that should not be listed as a negative reason for wanting to practice medicine in this state. Shame on Medscape.”

Dr. Todd Tallman, general surgery

He echoed Prettyman’s point about two kinds of physicians. “There’s the kind that do feel a sense of responsibility to the people they grew up with. And there’s the kind that’s more mobile.” Doctors from other states who feel a responsibility to their homes stay in their own states. “That naturally eliminates them from the recruiting process.”

His daughter just completed medical school and will do her residency here. “I’m cautiously optimistic she’s going to be staying here. … I think the medical schools are doing a pretty good job of educating our students and retaining a significant portion of them. Our students are a tremendously valuable commodity for our state, because that’s the most likely way we’ll take care of our people.”

Many doctors like serving in small, rural areas. “If you’re a doctor in D.C. or Baltimore or New York City, I can understand why you wouldn’t understand that – it’s a totally foreign concept.”

Dr. Wissam Gharib, cardiology

“I do think the article has merits. I don’t know that it has merit in Morgantown specifically. West Virginia does carry a negative connotation. When we’re trying to recruit the higher-level type [heart] care … it is quite difficult to recruit to West Virginia … where people think we’re something that we’re not. They think we’re really rural, they think we don’t have the advanced technologies, etc. Here specifically at Mon, we’ve created a really nice niche, where we’re offering next-level care in a very family-friendly, very direct patient approach.”

One challenge is that the feds [Medicare, Medicaid] see the rest of West Virginia’s lower cost of living and assume they can reimburse less in Morgantown. “We get paid a lot less here for a valve replacement than you would in Maine or Boston. We get paid almost half as much in certain cases, which is really a challenge because the cost for that valve is the same. … It’s a juggling act; it’s very difficult for us to make that work, where we’re able to offer our patients those types of services but still be able to keep the place afloat. … We’re working through those challenges.”

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