Friday, March 16, 2007

By Kate Moran

Staff writer

 

Geoffrey Peters will complete his training as an ear, nose and throat doctor in his home state of Louisiana, but it won't be without hardship.

 

When Peters graduates from medical school this spring, he will start a residency at Louisiana State University. The university's ear, nose and throat program used to be based in New Orleans. But since Hurricane Katrina, the program has been split among the city, Lafayette and its new home base in Baton Rouge. Peters expects to spend a lot of time in a car.

 

Among the many wounds the hurricane inflicted on the state's health care system, Katrina played Boggle with its programs for training young physicians. The storm closed Charity Hospital in New Orleans, scattered medical instructors around the country and forced the next generation of doctors into unorthodox arrangements for completing their education.

 

Peters, for one, is undaunted.

 

'As bad as things are, I still think I will get good training,' he said. 'My only issue is having to move around.'

 

Peters was among thousands of medical students around the country who learned on Thursday, at exactly 11 a.m., where they would conduct their residency training. Match Day was an emotional rite of passage for the students, but it was also a bellwether for how many budding doctors might set up a practice in the New Orleans area.

 

Because doctors tend to settle in the state where they complete their training, policymakers always watch how many medical students remain in Louisiana for their residency. This year, 45 percent of the 154 students graduating from the LSU School of Medicine in New Orleans will stay in the state, while 53 percent from the Shreveport campus will stay.

 

Staying or going?

 

Before Katrina, about half of the students graduating from the New Orleans campus would elect to continue their training somewhere in the state. While this year's retention rate fell below that average, it crept just above last year's rate of 44 percent -- the first year to show the aftershocks of Hurricane Katrina.

 

'I think it is a concern,' said Dr. Larry Hollier, dean of the medical school in New Orleans. 'It is something we will see improve as the infrastructure of the city improves and as we get firm commitments to build a university teaching hospital. Those will have positive impacts.'

 

At Tulane University, which draws medical students from all over the country, graduating seniors were placed in residency programs in 32 states, said Karen Joia, assistant director of admissions. Louisiana captured 27 students from a class of 148 -- more than double any other state.

 

That marks an in-state retention rate of 18 percent for Tulane, up from 16 percent last year but down from 23 percent in 2005.

 

On Thursday morning, the LSU medical students milled around a gym at the lakefront campus of the University of New Orleans as they waited for the decisive moment when they would learn about their residency assignments.

 

The mood was festive, buoyed by mimosas, balloons and crowds of beaming parents. It was also unmistakably taut. Match Day marks the culmination of months of grueling interviews, and some students would emerge from it elated, others at least mildly disappointed.

 

'Not holding the cards'

 

Starting in July and August every year, medical students around the country send resumes and personal statements to the residency programs that most interest them. In November, they begin rounds of interviews that absorb their lives for two or three months. Sometimes, they can rotate through their program of choice for several weeks so the doctors there can see how they work.

 

The process helps the students cross residency programs off their wish list, and it does the same for the program directors busy recruiting students. At the end of the process, the students and the residency programs send their top choices to a computer, which makes a match.

 

For Jeaneen Chappell, a native of New Orleans who plans to specialize in dermatology, the uncertainty of it all was hard to endure. She said doctors are not the sort of people who make a habit of giving themselves over to chance. But that was precisely what she was doing as she waited to hear which program the computer had selected for her from eight she wanted, from New Orleans to Washington, D.C.

 

'It is more stressful than I can tell,' Chappell said. 'We're not in control anymore. We're not holding the cards.'

 

Starting at 11 a.m., an emcee called the students one by one to the front of the gym and handed them an envelope holding their fate. As the students ripped them open, some evinced nothing more than a slow smile. Others broke into Joe Horn-style whoops and pirouettes. Some cried, out of joy or some darker feeling.

 

Shari Rodgers, a friend of Chappell who plans to work in family medicine, tore open her envelope as she made her way back to her family in the bleachers. 'Daddy, I'm coming home,' she said, holding a sheet of paper that showed she would be training at East Jefferson General Hospital.

 

'I'm so glad to be around my family,' Rodgers said. 'I had East Jefferson as my first choice, and I'm going where I wanted to be.'

 

Others among her peers were glad to go. Kelley and Tommy Morel, a married couple who applied to residency programs as a pair, did not intend to complete their training in Louisiana even before Katrina. The storm erased any qualms they might have had about leaving.

 

'I get the sense that most people are pretty frustrated and want to leave,' said Kelley Morel, who will train with her husband at Virginia Commonwealth University in Richmond. 'It is partly the situation with the hospitals. It does not look like they will have a new one open within our training years.'

 

New teaching hospital

 

LSU groomed its residents for years at Charity Hospital, the downtown institution that succumbed to flooding during Katrina. While some doctors have argued that Charity could be reopened, LSU has mothballed it and opened a limited number of beds at its sister facility, University Hospital.

 

LSU is now developing plans to build a new teaching hospital in conjunction with the Department of Veterans Affairs. That plan faces a bruising political fight in Baton Rouge, and the university has strengthened relationships with community hospitals such as East Jefferson and West Jefferson Medical Center until a new facility can be built.

 

Hollier said Thursday that the apprehension voiced by students like Morel is argument enough for building the new facility, which is expected to cost the state nearly $1 billion.

 

'The real importance of having a teaching hospital here in New Orleans is you cannot expect to attract residents when they do not have an academic home,' Hollier said. 'You can't just put them in a bunch of private hospitals and expect that to be an attractive magnet.'

 

Hollier said LSU filled 93 percent of the slots in its residency program through the computer-generated match. The remainder were filled during the 'scramble,' when students who are not paired with a university rush to find a placement.

 

Tulane also filled its residency program this year, as did Ochsner Health System, which accepts a class of 50 residents each year.

 

Hoping to return

 

Dr. William Pinsky, Ochsner's chief academic officer, said nine of Ochsner's residents were from the LSU medical school in New Orleans, eight were from the LSU school in Shreveport and six were from Tulane.

 

Pinsky said he was concerned about luring residents to New Orleans last year so soon after Hurricane Katrina, so he sent a personal letter to applicants to let them know that Ochsner Medical Center on Jefferson Highway survived the storm unscathed. This year, he sent a similar letter to assuage fears about crime.

 

'We did very well this year,' Pinsky said.

 

While Pinsky and others said doctors tend to put down stakes where they complete their training -- whether that be a residency or a fellowship -- some of the students who were leaving the state said Thursday that they hope to come back to Louisiana.

 

'A lot of people have lived here their whole lives and see their residency as a chance to go out of state,' said Tim Haman, a Lake Charles native who will do his residency at the University of Texas at San Antonio. 'It is my intention to come back.'

 

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Kate Moran can be reached at kmoran@timespicayune.com or (504) 826-3491.