Hire and Higher

Okay, so Mount Sinai Medical Center’s star urologist, Stephen Savage (his beat: minimally invasive surgery) recently decamped for Memorial Sloan-Kettering. Sloan-Kettering lost surgeon Warren Enker and oncologist Louis Harrison to Continuum Health Partners, which lost orthopedist Eli Bryk and breast surgeon Deborah Axelrod to Saint Vincent’s. Meanwhile, interventionalist Alejandro Berenstein departed NYU Medical Center for Beth Israel; laparoscopic surgeon Michel Gagner from Mount Sinai to New York-Presbyterian; and orthopedist Evan Flatow from Presbyterian to Sinai.

Physician recruitment is hardly new. The offer of a promotion, perhaps a department chairmanship, by the hospital downtown or down the street, or the promise of more lab space, more operating-room slots, and more support staff have always been potent temptations. “But there’s a lot more poaching now than there used to be,” believes Stanley Brezenoff, president and CEO of Continuum—himself a recruit from Brooklyn’s Maimonides Medical Center.

“The stakes are higher now at hospitals,” agrees Herbert Pardes, president and CEO of New York-Presbyterian Hospital. “There’s more competition. When you’re trying to maintain a broad program, it’s harder to match the bid if another institution is marshaling resources to steal someone away.”

Those resources are being marshaled to good purpose. With budgets in medicine tourniquet-tight, hospital administrators are increasingly intent on goosing patient numbers and increasing revenue. Luring a star—or rising star—from competitors can be an effective way for a hospital to bolster its bottom line. “I was at a conference and someone said, ‘All our volume strategies are about stealing patients from other hospitals,’ ” says Brezenoff. “You steal a doctor and you get his patients, too.”

Many factors can make a doctor listen attentively to an offer from another institution. A heart surgeon may not feel that the cardiac program at his current address is sufficiently strong. Operating-room time may be too much at a premium; the department chairman too lacking in diplomacy; a doctor may simply feel too marginalized. “Economics now force institutions to prioritize which programs are key to their future. If you’re not in that program, you’re vulnerable to being recruited by an institution that does prioritize your area,” says Louis Harrison, whose own move from Memorial Sloan-Kettering to Continuum—as clinical director of its cancer center—fell under the heading “an offer you can’t refuse.”

“I had been at Memorial for twelve years, was very happy, and I wasn’t looking to move,” he says. “But Continuum offered me an opportunity to put a program together for their entire system, to create something with my imprimatur,” Harrison adds. “That’s a bump up.”

Joanne Conroy, chief medical officer of New Jersey’s Atlantic Health System, says that staff doctors “are looking for three things: a chance to develop their clinical practice, a learning environment, and the ability to do research.” Attending physicians (docs with admitting privileges at a hospital) are looking for high-quality colleagues, and a well-run hospital that lets them get in and out quickly and back to their office patients.

A perceived deterioration in the quality of care combined with significant procedural changes might be reasons to move. For example, says Conroy, “if a hospital decides not to accept the terms of a major insurance carrier that many physicians take, it might be time for the doctor to look at a medical center that does take the plan.”

Turmoil or instability at an institution also makes physicians ripe for the picking. Sinai, with its problematic merger and well-publicized travails in the liver-transplant unit, is a case in point. “It was hard scheduling surgery,” notes one Sinai doc who recently moved to New York-Presbyterian. “The operating room was inefficient—a lot of delays. Because of its financial difficulties, the hospital couldn’t offer raises and couldn’t make capital expenditures to improve things. Several of my colleagues left and the department fell apart.”

For a hospital, a high-profile recruit, in addition to helping the bottom line, may also be a magnet for research grants. Further, star acquisitions can produce a halo effect, and not just in the new doctor’s own department. “A person with a great enough reputation helps the whole institution,” says Pardes. If, for example, a patient goes to that big-cheese neurosurgeon and is pleased with the result, and later a friend or family member has diabetes or heart problems, “that patient will say, ‘Oh, you should go where I went,’ ” observes Conroy. Also, adds Continuum’s Brezenoff, “when you get one star, it helps you to recruit other stars.”

Of course, there is no guarantee that the doctor, once recruited, will stay recruited. Consider Irwin Redlener, the former head of outpatient pediatrics at New York Hospital who was successfully courted by Montefiore Medical Center to run its community pediatrics program, head up the creation of its children’s hospital, and, subsequently, become its president. But the ink was barely dry on Redlener’s business cards before he accepted an offer to become associate dean of the Mailman School of Public Health at Columbia University.  

“People assume if you get to a certain position at an institution, you’re in it for the long haul, and for some people it’s true, and it’s good that it’s true,” he says. “But for a small number, the excitement comes from building something new”—in Redlener’s case, establishing a national center of disaster preparedness. “You don’t start trying to keep people the day they look somewhere else,” says Pardes. “You start trying to keep them from the first day.”

Redlener, who did his share of recruiting during his stint at Montefiore, takes the Zen view. “Maybe you’ll be able to replace the doctor you lost with someone who’ll take your program in a new direction,” he says. “Maybe the person who left was such an egomaniac he kept competent junior faculty from rising in the ranks.”

Others, meanwhile, think more in terms of Adam Smith. “The system is a market-driven way of distributing talent,” says Eli Bryk, chairman of orthopedic surgery at Saint Vincent’s Hospital, and an émigré from Beth Israel. “It’s good for the general patient population that the physician talent be scattered around the city. It’s not like the pennant race, where just one team wins.”

Hire and Higher