Startup costs for a private medical practice vary between $100,000 and $200,000 for rent, business insurance, malpractice insurance, equipment, supplies, information systems, computers, and simple office decorations. Most of the healthcare providers in the Gulf Coast region lost well-established practices, and if they were insured at all, they used the funds from those insurance payments to begin again in their new communities. Unfortunately, healthcare practices in 2007 have little resale value, particularly when only one or two years old. Even if these professionals were inclined to move back to the Gulf Coast region, they would face significant financial hardships in accomplishing that feat.
Add to this the lack of meaningful business recovery and a decline in the number of insured patients in many of these regions. The sad facts are that employment statistics and new business starts in the areas most affected by Hurricane Katrina are well below national averages. Healthcare providers, now comfortable in their new homes, find little inducement to assume the responsibilities, liabilities, and hardships of returning to their former practices, and even when they do, they often find that their former patients have yet to return as well.
Physicians are not the only individuals affected in this fashion. Hospitals that have already reopened in the Gulf Coast region are finding it more difficult to recruit nurses in a nation where there are already nursing shortages. Even when temporary staffing agencies provide nurses, known as travelers in the industry, to the Gulf Coast region to fulfill short-term contracts, most of these nurses decline the opportunity to extend their stays, take full-time positions, or return at a future date.
Much of the problem is that as healthcare has moved from the individual private doctor and the small community hospital to large corporate enterprises, it has severed its relationships with its healthcare professionals, seeing them more as expendable drones and less as necessary and valued parts of the healthcare-delivery system.
Healthcare professionals regularly find themselves mandated to choose between maximizing patient flow and maximizing patient safety. They are often forced to forego important family events under threat of suspension, retaliation, or termination. When healthcare professionals find homes where they can achieve levels of work/life balance, it is difficult, if not impossible, to dislodge them again. It took a hurricane to dislodge these professionals from the Gulf Coast, and nothing short of another force of nature, perhaps this one favorable, will move them back.
About the Author
Dr. Maurice A. Ramirez is co-founder of Disaster Life Support of North America, Inc., a national provider of disaster preparation, planning, response, and recovery education. Through his consulting firm, High Alert, LLC, he serves on expert panels for pandemic preparedness and healthcare-surge planning with congressional and cabinet members. Board certified in multiple medical specialties, Dr. Ramirez is founding chairperson of the American Board of Disaster Medicine and a senior physician and federal medical officer for the Department of Homeland Security. Cited in 24 textbooks and with numerous published articles, he is co-creator of C5RITICAL and author of Mastery Against Adversity. Dr. Ramirez invites comments at www.disaster-blog.com. For more information, please visit www.mauricearamirez.com, www.disaster-ready.com, or www.high-alert.com.
