Eastern Idaho faces doctor shortage

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Eastern Idaho native Lucas Webb doesn’t like subzero temperatures unless he’s on a snowboard, but the pediatric anesthesiologist still decided to start his career in Idaho Falls.

After finishing a medical fellowship in California, Webb considered staying in the Golden State for the foreseeable future, or moving to Colorado or Nevada. Ultimately, Idaho won out.

Family roots and the region’s wealth of recreational resources drew the young physician. To Webb, Idaho Falls is much different from the place where he grew up just 10 years. It also seemed like a good place to raise kids.

Then there was the recruiting process conducted by Eastern Idaho Regional Medical Center and Intermountain Anesthesia. Webb, a Hillcrest High School graduate, got job offers elsewhere, but none with as many incentives as the one he took here.

“If felt like EIRMC really went out of their way to do whatever they could to get me here,” Webb said.

‘The long and short of it is we need doctors’

Webb’s story is common among the network of physicians who choose to practice in eastern Idaho, but it’s not common enough.

Idaho’s physicians are the most overworked in the country, according to an August report by Medicare Health Plans. There are only 1.7 doctors for every 1,000 residents, and Idaho Falls, only behind Boise, has the second most difficulty hiring among Idaho’s cities.

The shortage leads to long hours for professionals and intermittent drives to Salt Lake City for patients. It also means medical organizations — reliant on thoughtfully recruiting the type of people who take to eastern Idaho — are desperate for physicians.

“The long and short of it is we need doctors,” EIRMC CEO Doug Crabtree said. “If any doctor walked through that door today that is highly qualified, has a great reputation and wanted a job, regardless of the specialty, we need them. And that’s with few exceptions.”

EIRMC, like many hospitals, doesn’t actually employ the majority of physicians associated with it. They are, in most cases, credentialed to work there. Many have their own solo practices.

The hospital’s geographic service area — determined by the majority of its patients ZIP codes — extends northwest to Challis, northeast to Yellowstone National Park, east to the Teton Range and south to Blackfoot.

According to EIRMC data based off the ideal number of physicians per population size, the majority of specialties within the region are understaffed.

There are 24 internal medicine physicians credentialed at all hospitals within the service area — not just EIRMC — though ideally there would be 66, according to the data. There are 16 pediatricians in the area, leaving the region short 26 doctors, and there are only 10 psychiatrists — far lower than the ideal 26.

Sometimes the shortage means physicians spend more time serving patients. Sometimes it means patients are turned away as to not dilute the quality of care, as is the case with psychiatric services. EIRMC credentials only four psychiatrists.

“They do a great job for us, but there’s only four of them. We end up sending patients to other areas of the state, and sometimes Utah to find an open psychiatric bed.” Crabtree said. “And that’s clearly a function of the physician supply we have leading to an inability to provide care to those patients.”

Barriers include lack of med school, amenities

Hiring woes may be due to a handful of reasons. There are no medical schools in the Gem State — though one is scheduled to open next year — and there aren’t many residencies. Locally, there is extreme weather, and for some a lack of luxuries.

“If you’re coming to Idaho Falls for certain amenities like a crazy night life, those aren’t things we offer,” Crabtree said. “The winters also are rough. You have to get used to the way of life here, and those of us who love it, love it. But there are those … who don’t want to live in this small a town and be far away from a Nordstrom. We still find that to be a barrier.”

According to Idaho Department of Labor data, Idaho had 7.5 percent physician turnover between 2016 and 2017, roughly 2 percent more than Wyoming, Montana, Oregon and Washington state.

For many, Idaho could be the initial stopping point in a career, Idaho Department of Labor regional economist Hope Morrow said.

“I sometimes look at it as a career opportunity state: a good place to come get experience under your belt. Some of those higher-wage states would most likely look at you if you already have a few years experience,” Morrow said.

Idaho’s average physician earnings, $100.73 per hour, are lower than Washington, Montana and Wyoming, which average $106.75, $111.26 and $112.73 per hour, respectively. Oregon, meanwhile, actually has the Northwest’s lowest average earnings, at $91.18 per hour.

Morrow said long work hours also could encourage high turnover, and even cause physicians to switch careers. The same factors that can push potential physicians away may attract others, Crabtree said.

“Sometimes the amount of hours is really enticing to a new physician,” he said. “Our physicians are in such demand, if they’ll come in and be good physicians, they’ll be as busy as they want to be.”

The increased demand likely leads to higher wages, Crabtree said. According to state data, the average Idaho Falls physician makes $118.40 per hour, which is highest in the state. Crabtree said there’s minimal turnover at EIRMC.

Job fairs, referrals among recruitment tactics

The hospital recruits formally and informally. The center’s parent company, Hospital Corporation of America, locates recruits through open houses, listings, job fairs and other conventional methods.

Yet some of the greatest success comes from the hospital’s existing employees, Crabtree said. Recently, an EIRMC nurse recommended Crabtree contact a pulmonologist she knew who was finishing his training in Las Vegas. Soon after, he visited Idaho Falls.

“We would not have known about that candidate if it hadn’t been for our nurse stepping forward and saying ‘Hey, you should call this guy,’” Crabtree said. “The job fairs work, but we also really love the informal stuff. We can’t rely on either one.”

Webb also contacted a friend of a friend regarding an opening for Intermountain Anesthesia, a group certified to work in EIRMC. Webb eventually contacted Crabtree, who paid for Webb’s family to visit Idaho Falls.

After several meetings Webb accepted the job, which came with paid relocation expenses and an “educational stipend” to help with some of Webb’s college debt.

The hospital can offer additional debt compensation in exchange for a multiyear commitment from the physician, Crabtree said. Revenue guarantees also can be arranged; EIRMC can pay the difference in a doctor’s projected monthly revenue quota if they fall short while starting a new practice.

The incentives offered to a physician depend upon the regional scarcity of their position. Webb was only offered relocation expenses to work for a different hospital that didn’t need as many anesthesiologists.

“They were willing to do more for me here,” he said.

Webb previously considered moving back to Idaho Falls, but thought it would be a tough sell to his California-born wife. She had attended Brigham Young University-Idaho and wanted to live somewhere larger than Rexburg.

“But things are different the 10 years I’ve been away,” Webb said. “The city has grown a lot. There’s big chain stores like Hobby Lobby and Cabela’s; it definitely has a bigger town feel. There’s a lot more activities in the area, like the (Idaho Falls Symphony) and River Walk. A lot of those things are really fun.”

Mountain resorts are near, and Webb, an avid golfer, can get a municipal season course pass for “the price of five rounds in California.” The tax burden is lower, as is the cost of living, while the city is relatively safe.

And ultimately, Webb saw he would be valued in Idaho Falls.

“There’s a strong need for pediatrics here. I think it’s going to be a good thing for our community, and that went into the decision to move back,” he said. “So far, no regrets. I look forward to being here for the long haul.”

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