The ability to earn more elsewhere often outweighs quality of life, family ties and the draw of Brown Medical School.

01:00 AM EST on Thursday, April 1, 2004

BY FELICE J. FREYER
Journal Medical Writer

So many people are seeking cancer care at Rhode Island Hospital these days that the program needs to hire three additional doctors who treat cancer with radiation. But none will go work there.

The reason? Dr. David E. Wazer says it's money.

For three years, Wazer, chairman of radiation oncology at Rhode Island Hospital and Brown Medical School, has had no luck recruiting because he can't pay enough to attract doctors in his highly competitive specialty.

Doctors have long complained that insurance companies in Rhode Island pay lower rates than in many other states, including Massachusetts. But the high quality of life, family ties, the Brown Medical School and other lures were usually strong enough to attract them and keep them despite the comparatively low pay.

Not anymore, some doctors say. Expenses, such as malpractice insurance and health insurance for employees, are soaring, while the pay is staying low.

Wazer says that Blue Cross & Blue Shield of Rhode Island reimburses at less than half the rates paid in Massachusetts. Blue Cross declined to comment. "We can't even come close to being competitive to recruit high-quality physicians," Wazer says.

Wazer even trains doctors in his specialty, which is experiencing a shortage. He graduates two or three residents each year -- and for each of the past five years, all have found work elsewhere.

Rhode Island Hospital can offer a radiation oncologist $200,000 a year. Wazer says the national average is $275,000, and "my graduating residents are getting jobs elsewhere in the country over $300,000."

In primary care -- where pay tends to be one-half to one-third that amount -- the situation is no better, other doctors say.

Dr. David P. Carter, a family physician, tried to recruit a third doctor to his Pawtucket practice earlier this year. One top-notch candidate, a Brown Medical School graduate who wanted to work in Rhode Island, was interested in the job until they started talking about money, according to Carter.

The young doctor eventually decided to accept a position in Fall River -- where he could make $25,000 more than Carter could offer, and more than Carter himself makes after 25 years in practice.

Carter says the doctor lives on the East Side of Providence and commutes to Fall River. "Isn't that absurd?" he says. "It's scandalous. A well-trained physician that would be a benefit to the community can't stay here."

Although pay has always been lower here, Carter says the financial crunch is worse now. Every week, he says, the first question he asks his office staff is: "Can we meet payroll?" That's why Carter himself is thinking of leaving after a lifetime of service here. He's looking at a possibility in Vermont -- or he may simply move his practice across the border to Seekonk.

Dr. Michele G. Cyr, who oversees Brown's residency training programs for doctors, says that this year, for the first time, graduates are not filling all the openings in primary-care practices.

"Usually, if I have a phone call from one of the group practices and they have an opening, I have a number of graduating residents I'd like to send," Cyr says. "This year everybody is going elsewhere."

Cyr says she doesn't have data spanning the years, but she senses that this year is different. "I don't know if it's going to be a trend or not," she says.

Dr. Donald R. Coustan, chief of obstetrics and gynecology at Women & Infants Hospital, graduates seven OB-GYN residents each year. This year, only one plans to stay in Rhode Island, he says. Five years ago, typically five out of seven would stay.

But Coustan says the state does not have a shortage of obstetrician-gynecologists.

Dr. John B. Murphy, the director of graduate medical education at Rhode Island Hospital, says his trainees are finding it hard to stay here because the cost of living has gone up while salaries have gone down. In 1996 and 1997, graduating family-practice residents were being offered annual salaries of $120,000 or $125,000 to start. Today, Murphy says, the offers in Rhode Island average $105,000 to $115,000.

"There are doctors who want to practice in Rhode Island who don't come," Murphy says. "For a number of them, the primary reason is the reimbursement rates."

Asked whether this is a new phenomenon, Murphy said: "It was very bad in the early '90s. Then it got better for primary care. It's gotten worse again. . . . You can draw a reciprocal curve to Blue Cross profits and the viability of primary-care practices. When Blue Cross is doing well, they're doing poorly, and vice versa."

Asked yesterday about Murphy's comment and doctors' complaints about reimbursement, Blue Cross spokesman Scott Fraser said: "We're going to be embargoing any further communication with The Providence Journal on a short-term basis. We're going to seek a meeting with the editorial board. We don't believe we've been treated fairly."

Responding to Fraser's comments, Joel P. Rawson, executive editor of The Journal, said he has not heard anything from Blue Cross.

"We believe our reporting on Blue Cross, while aggressive, has been fair," Rawson said. "We are willing to meet or speak with anyone.

"However, our readers should understand that the editorial board writes opinion and that work is confined to the two commentary pages of The Journal. The news reporters are separate from the editorial board. They work for a different editor and we will continue to cover Blue Cross whether or not the company chooses to speak with us."