What do you like/dislike about practicing in your state?

August 28, 2018
Karen Nash

Karen Nash is a medical reporter and media consultant based in Monroeville, PA.

“Florida, specifically South Florida, is a very tough place to practice. There’s a fairly prominent infiltration of Medicare HMOs with a lot of obstruction to doing anything for the patient that’s necessary," says one urologist.

Urology Times reached out to three urologists (selected randomly) and asked them each the following question: What do you like/dislike about practicing in your state?

“Honestly, what I like best about practicing in North Carolina is living in North Carolina. It’s an excellent way to live, particularly in Charlotte. We have a wonderful city and access to a lot of activities. I’m mainly here for family. I prefer to be close to my family, which is in this area.

As far as actually practicing medicine, it is excellent here.

We do have issues in my specialty, but that’s true most everywhere you would choose to practice. I’m in pediatrics and Medicaid is a big part of our payer base. I practiced for a long time in Tennessee, and dealing with the managed care of Medicaid is probably our biggest constraint.

Also see: What traits are important to be a good urologist?

What I like least is Medicaid. There’s always pressure on our practice to provide circumcisions because North Carolina Medicaid doesn’t cover that. That’s not what I became a pediatric urologist to do. It’s not covered by Medicaid, and it becomes a real frustrating point.

I practiced as a hospital-employee physician with residency programs in Memphis at the University of Tennessee, and now in Charlotte at Atrium Health. My bias is toward the hospital-employed model in a teaching practice. In that context, it’s really been the same between Memphis and here.”

Mark Williams, MD

Charlotte, NC

Next: “Florida, specifically South Florida, is a very tough place to practice."“Florida, specifically South Florida, is a very tough place to practice. There’s a fairly prominent infiltration of Medicare HMOs with a lot of obstruction to doing anything for the patient that’s necessary. It’s very obstructive in the sense that everything needs a referral or precertification, and patients get upset very easily because basically we’re not able to do anything on our own. It’s like trying to practice medicine with our hands tied behind our back.

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I’m here because of my family. That’s the only reason.

It’s a beautiful place to live, don’t get me wrong. But problems came about because of the infiltration of Medicare HMOs. Our population is a little bit older where I practice. Many patients sell their Medicare to HMOs and think they’re getting a great deal. But then HMOs take over and limit what you can do, how you can do it, and when you can do it. It’s just a shame.

Unfortunately, you have to jump through hoops. Significantly fewer people have just Medicare, because they cannot afford it because they’re liable for 20%.

Also see: How do you manage noncompliant OAB patients?

My wife, kids, my parents, and other family were already established here. Other than family, I do enjoy the patients in Florida. They’re super sweet, super nice, and for the most part the majority appreciates what you do. Also, the hospital systems, for the most part, are excellent. It’s just frustrating dealing with the insurance companies.”

Boris Klopukh, MD

Miami/North Miami Beach, FL

Next:"Oregon is a really beautiful place"

“The culture and leadership of our department are great and very supportive. There’s an opportunity for me to do reconstructive urology here in a beautiful area that has a lot to do outside of work. Oregon is a really beautiful place-the year-round climate is pretty moderate. You have mountains, the ocean, rivers. There’s skiing nearby, lots of hiking. The food is great. Portland is kind of a small city but has a lot of things you like in a city-museums, performing arts, and fabulous restaurants-without big-city hassles. There’s a big creative culture, as opposed to a corporate vibe you get with Microsoft and Amazon in Seattle. It’s a quirky place for sure. One of the things that attracted me to Oregon in the first place was the liberal and progressive political climate.

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Medically, I basically do 100% transgender surgery, and it’s supported by medical insurance of Oregon. There are a growing number of states where insurance coverage for transgender surgery is mandated, but Oregon was one of the first. We now have one of the largest academic programs for transgender genital surgery in the country, and the supportive environment for the transgender community and for medical resources make that possible. That’s a big deal for my practice. It’s not why I came here, but my surgery grew into that.

The biggest drawback to practicing in Oregon is that Portland is the medical center, but the state has a lot of rural areas and people have to come from a long way away. That makes follow-up difficult to do with people who have to travel long distances.”

Daniel Dugi, III, MD

 

Portland, OR