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A healthy practice: urban doctors flourish in central Arkansas with some pulling down salaries of over $1 million.

A Healthy Practice

Urban Doctors Flourish In Central Arkansas With Some Pulling Down Salaries Of Over $1 Million

A smell of newness permeates the air of the office of Little Rock plastic surgeon Jim English. The waiting room resembles the lobbies of finer hotels with greenery and mirrored walls. Even the treatment rooms feature glass tables supported by faux Roman columns.

It's a far cry from Norman Rockwell's classic interpretation of the doctor's office. But then some of the only similarities between today's doctors and general practitioners of the 1940s and 1950s are the diplomas on the walls.

Medical practices are now full-fledged businesses with plastic surgeons like Dr. English employing marketing representatives to handle the politics of their businesses.

"Doctors don't have time to handle all of the extras," says Helen Kay Spears, Dr. English's public relations specialist.

With average urban doctors' salaries pushing well past $150,000 per year, the practice of medicine is not only physically healing, but financially healthy, unlike earlier eras.

Fifty years ago, the doctor's adage was "If you want to be a doctor, you need to marry a rich wife." But today with 11.5 percent of the United State's gross national product going toward health care, doctors are loaded.

Specialized surgeons in cardiology and neurology can make millions annually, and even general practitioners -- lowest on the physician pay scale -- make a healthy average of $86,860 a year.

It all started during World War II.

Getting On The Gravy Train

During World War II, significant advances in medicine were made with the discoveries of penicillin and other bacteria-fighting agents. Rapid changes in medical technology followed.

It wasn't until the advent of Medicare and Medicaid in the 1960s and 1970s that physicians' salaries began to take off. Suddenly fed by a continuous stream of federal funds, doctors' incomes rose steadily.

Doctors began to specialize, separate clinics sprang up, and the business of medicine grew. For example, Dr. Robert Watson started Neurological Surgery Associates PA in 1974 with one other partner, and now the practice has grown to include eight physicians.

In an attempt to control rapidly inflating health costs, the federal government instituted in 1983 the controversial -- if not dreaded -- DRG's: diagnosis related groups.

DRG's pay flat fees for a patient's optimal treatment plan with Medicare and Medicaid footing the bill. Controversy arises because physicians say the amount of time and resources a patient needs varies so greatly.

Doctors say they are penalized if their costs exceed reimbursements, and they must charge higher fees to private patients to make up the difference.

For example, DRG's might allocate $8,000 for hip replacement operations. But if complications occur and the total bill runs higher, Medicare and Medicaid won't pay the difference. The extra funds must come either from privately insured patients or out of the doctor's pocket.

Bypassing Surgery

To help balance the books, doctors are trimming costs by increasing outpatient services and only admitting the seriously ill for overnight hospital stays.

A prime example is the expedient service of carpal tunnel surgery. The wrist surgery formerly required an average one-week stay in the hospital, but now the procedure is completed in 45 minutes, and a patient can recuperate at the hospital in under four hours.

Bypass surgery that used to rack up several weeks worth of hospital bills can now be taken care of in roughly a week or two. While expenses and time constraints are greatly reduced, the DRG's have a negative effect in this area as well.

Some critics say elderly or indigent patients are often released too soon because the DRG's stipulate they should only stay in the hospital for a set period of time.

Rural Exodus

Of Arkansas doctors struggling to make their peace with DRG's, rural doctors in Arkansas are in particular trouble.

Rural doctors receive less reimbursement money, sometimes as much as 40 percent less, though costs are often the same or even higher than urban areas.

In 1989, the national average net profit for incorporated doctors in rural areas was $131,000 compared to $163,320 for urban doctors. In search of more lucrative practices, rural doctors often move to the city, leaving rural hospitals with inadequate staffs.

In the 1980s, Lafayette County Hospital was caught in a vicious circle of not enough patients to attract doctors and not enough doctors to attract patients and was forced to close. A final blow was dealt the hospital when it gathered enough money to reopen, but found the building had become contaminated with asbestos during the vacancy.

Practice Alone Doesn't Make Perfect

The effects of DRG's are evidenced in different ways in Little Rock. As doctors began cutting hospital stays, they needed to generate more patients to compensate for the loss of money.

Advertising has become an important weapon in the competitive market. Instead of television commercials projecting sterile hospitals with white uniformed staffs, Cantrell and Rodney Parham Roads have become homes to billboards featuring people and programs at hospitals such as the Women's Clinic at Baptist Hospital.

Doctors Hospital billboards have been particularly creative with large pictures and catchy phrases such as one featuring a person looking like a mummy completely wrapped in bandages.

Some speculate that physicians' salaries have peaked and will begin a downward trend. But those with business savvy will continue to thrive.

PHOTO : ROYAL TREATMENT: What seem like special perks are actually normal offerings in modern day practices such as Dr. Jim English's facial surgery center.

PHOTO : WHOSE OFFICE?: Norman Rockwell's work At The Doctor's Office represents a bygone era in medicine but doesn't come close to painting the picture of doctors' practices today.
COPYRIGHT 1990 Journal Publishing, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1990 Gale, Cengage Learning. All rights reserved.

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Title Annotation:includes related article on McFarland Eye Surgery Center
Author:Rengers, Carrie
Publication:Arkansas Business
Date:Oct 15, 1990
Previous Article:Looking at Whitehead.
Next Article:How do I look?

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