Dr. Michael Kaiser, acting chief medical officer of the LSU Health Care Services Division, said at the field hearing thatbefore Katrinathe VA bought at least $3 million in services from LSU annually. Before Katrina, 75 Tulane physicians had joint VA-Tulane appointments, and 120 Tulane residents received training at the VA, said Dr. Alan Miller, interim senior vice president for health sciences at Tulane, at the hearing. Currently, 40 Tulane doctors provide services and training at VA outpatient clinics, which represents $2.2 million in physician compensation, he said.
The private Ochsner Health System is vying to have the new VA hospital built across the street from its campus in Jefferson Parish. At the field hearing, Dr. Patrick J. Quinlan, Ochsner's CEO, noted that the site "is above sea level and not located in a floodplain."
Because the federal government has not agreed to fund a new campus, Gov. Kathleen Blanco signed an executive order allocating an immediate $74.5 million for land acquisition and planning. To come up with the additional $1.2 billion needed, the state will float a series of bonds.
Mayor C. Ray Nagin is supporting a plan for a new medical center on a 37-acre parcel a few blocks from Charity Hospital. Jay Westcott/Elsevier Global Medical News
Federal Incentive Grants Offered to Draw Physicians to Louisiana
The state of Louisiana and city of New Orleans are struggling to lure physicians, dentists, mental health professionals, and nurses back to the city, or at least to convince those who did return to stay in the face of an onslaught of uninsured patients and a patchwork system of care.
After Katrina, thousands of residents, many of them doctors and nurses, evacuated. A recent study, citing Louisiana State Board of Medical Examiners data, reported that the number of board-certified primary care physicians in New Orleans dropped from 2,645 in August 2005 to 1,913 in July 2006 (Disaster Med. Public Health Preparedness 2007;1:21-6).
In April 2006, the federal government declared the greater New Orleans area a health professional shortage area, eligible for federal grants to retain or recruit health professionals. This gave rise to the Greater New Orleans Health Service Corps.
The Louisiana Department of Health and Hospitals, which is overseeing the Corps, has received $50 million to spend on recruitment and retention; the money was originally earmarked at 70% for recruitment and 30% for retention.
Realizing how difficult it is keep physicians in the city, the state received permission to adjust the split, said Gayla Strahan, a program administrator for the DHH's Bureau of Primary Care and Rural Health and manager of the Service Corps effort. Now, half goes for recruitment and half for retention.
When the state applied for federal health shortage funds in mid-2006, there were 405 primary care physicians and 30 psychiatrists in the region, but just 76 primary care doctors and 6 psychiatrists at that time took Medicaid or uninsured patients. The DHH determined thatbased on the region's population at that time (about 700,000) and the Medicaid enrollment (about 135,000)there was a need for 48 more primary care physicians, 38 more dentists, 10 more psychiatrists, and 33 other mental health professionals, such as psychologists, licensed clinical social workers, and marriage and family therapists.
The department also will seek to retain and recruit faculty at the area's medical, nursing and allied health schools, said Ms. Strahan. The goal is to retain 50 primary care physicians and recruit 48 new ones by September 2009 when the grant cycle ends. For mental health, the goal is 24 retentions and 43 recruits; for dentists, it is 10 and 30, and for faculty, the aim is to keep 48 current positions and bring in 46 new appointments, including 24 at the medical schools.
The Service Corps also has earmarked a little over $2 million to retain 5 specialists and bring in 15 new ones. The bar is a little higher for a specialistthe applicant has to show there is a dire need. For instance, if there's only one cardiologist who agrees to accept Medicaid patients, "that's a dire need," said Ms. Strahan. Applicantsand there had been 300 as of press timehave to accept Medicare, Medicaid, and the uninsured; must work at least 32 hours a week in clinical practice; and have to be licensed in Louisiana or at least agree to become licensed before starting work. Once accepted, participants have a 3-year obligation.
Physicians, psychiatrists, and dentists can tailor their packages of incentives up to $110,000, which is paid in one lump sum at the beginning of the 3 years. They can use it toward salary, to repay loans, for malpractice premiums, and/or to buy health information technology. Mid-level providers are eligible up to $55,000, registered nurses and nurse faculty up to $40,000, and allied health professionals can receive $10,000 to $40,000, depending on the discipline.