Katrina displaces 6,000 doctors

Hurricane Katrina can add another victim to its list of destruction: The practice of Scott Needle, MD.

"Almost everything was ruined," Dr. Needle said of his solo pediatric practice in Bay St. Louis, Miss.

His office was waist-deep in water and muck. Ceiling tiles were torn down. Computer equipment and vaccines were destroyed.

Katrina displaced Dr. Needle and scores of other physicians from their practices and homes in Louisiana and Mississippi. A new study by a University of North Carolina at Chapel Hill researcher estimates that nearly 6,000 practicing physicians were uprooted -- the largest doctor displacement in U.S. history.

"Other than people being sent off to war, I can't think of any other similar migration," said Thomas C. Ricketts, PhD, MPH, a professor of health policy and administration at the University of North Carolina School of Public Health, who estimated the number of displaced doctors.

To reach his estimate, Dr. Ricketts examined the number of practices in the 10 Mississippi counties and Louisiana parishes directly affected by Katrina's flooding. He used data from the American Medical Association, Federal Emergency Management Agency and other sources.

About two-thirds of the dislocated doctors practiced in three New Orleans-area parishes that were evacuated: Jefferson, Orleans and St. Bernard.

Many physicians scattered across the nation and took refuge with family and friends. Some will never come back and have taken jobs in places out of the path of hurricanes. Some are still deciding what to do, weighing job prospects against the cost of starting over amid Katrina's rubble.

Others, such as Dr. Needle, plan to stay and rebuild. They love the area and have ties. What Katrina took from them, they hope to get back.

"The hardest part is going to be finding a place that is sound, doesn't have mold and that's available," Dr. Needle said.

The doctor, his wife and three children fled before Katrina struck on Aug. 29. He transferred patients' electronic medical records to his laptop before he left.

The Needles stayed in Birmingham, Ala., for a month before heading back to Mississippi. Hancock Medical Center, the Bay St. Louis hospital Dr. Needle has a contract with, arranged for physicians to use trailers as offices on hospital property. At press time, Dr. Needle was planning to move into one.

"We'll just have to make do. At least the trailer will have power," he said.

Relocation and retirement

Unlike Dr. Needle, some physicians likely will retire, and a large number will move, Dr. Ricketts said.

Mississippi hospitalist Denis Schexnayder, MD, and his wife, internist Pandora Lee, MD, are leaving after Katrina destroyed their Long Beach, Miss., home. They're moving to a house they own in Hot Springs, Ark., and have accepted jobs there. "She always said, 'If a hurricane hits us, I'm never coming back,' " Dr. Schexnayder said of his wife.

In Louisiana, New Orleans likely will take the biggest hit of exiting doctors. "They've taken jobs elsewhere and they're not coming back," said Donald J. Palmisano, MD, a past president of the AMA and a general and vascular surgeon in New Orleans who runs Intrepid Resources, a medical risk management and claims review firm.

Katrina ousted otolaryngologist Michael S. Ellis, MD, from his home and practice. He stayed with cousins in Houston, then returned to find his St. Bernard Parish office destroyed.

"The entire interior of my office looked like it was in an agitator of a washing machine, totally flipped upside down," said Dr. Ellis, whose flood insurance won't cover everything.

Staff members fled to several states, and many patients are gone. He has looked at taking a job elsewhere. Early this month, he also was considering merging his practice with other otolaryngologists.

"People are not going to be where my practice was for probably a year," said Dr. Ellis, who was still weighing his options at press time.

Efforts to rebuild

Groups are taking steps to aid displaced doctors. The AMA made its online service ePhysician Profiles available free to licensing officials to help uprooted doctors get licensed and credentialed more quickly in neighboring states. The Louisiana State Medical Society and the Mississippi State Medical Assn. set up funds to assist doctors rebuild practices. Medical societies in states such as Texas and Massachusetts launched fund-raising campaigns.

But rebuilding won't be easy. "You're at the mercy of the location. If the building itself is shut down, what are you going to do?" said Reed Tinsley, a health care consultant in Houston. Some physicians may find rebuilding too costly, he said. A new solo practice costs $300,000 to $400,000.

New Orleans internist Theodore Borgman, MD, said his group practice expected to reopen this month. He will stay for six months and see if he can re-establish the practice. If it fails, he may move.

"People are scared about making a living here. We have to have patients to make a living and they're not here right now," he said.

IMG Healthcare, a multispecialty practice in New Orleans, ran newspaper ads to tell patients how to find its doctors, who were seeing patients in satellite offices. Internist and infectious disease specialist Michael Hill, MD, board chair of the practice, said some doctors have relocated. He expects only half of the group's 26 doctors to stay in the New Orleans area.

The practice has met with consultants and is looking at downsizing. Dr. Hill said IMG is talking to patients to see where they plan to rebuild -- an indication the practice likely will follow them.

"We're going to shift our resources to where the population has shifted," he said. "It's an unscientific way to figure out where your business is going, but that's the best we can do right now."