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FOR NEW ORLEANS NEUROLOGISTS, LIVING IN THE ‘BIG EASY’ TAKES ITS TOLL; THOSE WHO LEFT STRUGGLE TO START ANEW

Avitzur, Orly, MD, MBA

ORIGINAL ARTICLE

Six months after Hurricane Katrina, where are New Orleans's neurologists? While figures are not yet available, it seems that many practitioners have left town, some for good. And although starting anew is always hard, it seems that leaving New Orleans – often affectionately dubbed “The Big Easy” – is particularly difficult. Several neurologists whose lives were shattered by the storm told Neurology Today that moving was a tough decision – and one they didn't make easily.

In the aftermath of Katrina, neurologist A. J. Friedman, MD, lost his entire first floor office – all of its medical records, computers, accounts receivables, equipment, and financial records. More important, he pointed out, his patients have left town.

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PATIENTS GONE, POWER OUTAGES

In the heavily struck mid-city area of New Orleans where he practiced, there still is a long way to go before life will be normal again. So after taking stock of his options, Dr. Friedman decided to take a new job in Waycross, GA. At the age of 59, he is starting all over again, in a town where he knows no one.

“This may be one of the hardest decisions I have ever made,” said Dr. Friedman, “but I did not feel that I was in a financial position to weather the rebuilding.” He estimates that 90 percent of his patients are gone, and said that even his referring physicians have advised him to go, since they too, are seeing far fewer patients. “It's not what I would have chosen,” he admitted, “but what were my alternatives?”

Michael T. Happel, MD, considers himself one of the fortunate ones. His main neurology practice office in New Orleans East was destroyed, but his home made it through. Another neurologist who did lose her house, but not her practice, offered to share her office in Metairie so he can finally see patients again. That's not to say that the going was easy.

“We lost our entire referral network and about 70 percent of our patients,” said Dr. Happel, who was unable to get into his office until five weeks after the building was flooded. There is still no power or elevator service; to reach salvageable supplies and the patient charts, he has to walk up ten flights of stairs. He can't get help due to the skyrocketing cost of labor, and has still not seen a penny from his property or business interruption insurance despite enormous losses including $10,000 worth of botulinum toxin-1A (Botox).

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Costs have gone up too – supplies, hiring new employees, and even ordering lunch for the office. Just driving to work has been challenging due to tremendous traffic, long lines for gas, and dangerous construction debris. In a span of a few weeks, he had to have three tires patched and two replaced.

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STRESS-RELATED CONDITIONS

Dr. Happel and his partners have had substantial delays in payments, even from pre-Katrina services, and he suspects that insurance companies are stalling. Financial worries and the pressures of living under trying conditions have been taking a toll on everyone. A dermatologist and a pediatrician committed suicide, as did an alarmingly large number of other professionals, according to a coroner's report of non-Katrina deaths as of Jan. 26. Statisticians have estimated that the rate is twice as great as national or local averages and is likely to increase.

“In addition to the enormous stresses of living under these conditions, there is the daily angst of seeing New Orleans, once so beautiful, ruined,” said Dr. Happel.

It was not only practicing neurologists who struggled with the issue of starting over, but residents and fellows as well. Alicia Cabrera, MD, was so delighted to be training in New Orleans at Louisiana State University (LSU) that she had bought a new home a few months before Katrina hit. But when the levees broke, her house sustained such severe flood damage that it was uninhabitable. There were no rentals in New Orleans and at one point, Dr. Cabrera and her family were forced to sleep in their car. Her mortgage forgiveness was reaching its time limit too and insurance relief did not appear to be coming any time soon.

In the first few weeks, LSU was unable to inform its residents of where they would be training, assure its faculty of job security, or anyone of housing. Facing so much uncertainty while responsible for two elderly parents and a three year-old child, Dr. Cabrera made the painful decision to move. Her cousin, a surgical resident at Duke, initiated inquiries on her behalf and when she was accepted, she and her family moved to Durham, NC.

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RELOCATING IS TOUGH

But relocating has been rough, said Dr. Cabrera, who had completed a neurology residency in Cuba and has moved three times since then in order to re-credential in the United States.

“People are really nice, but it is hard to start all over again from scratch,” she admitted. In fact, although she was a PGY-3 resident at LSU, she spent the first three months at Duke on basic floor rotations along with first year residents in order to become familiar with the hospital's routines.

“I knew that I needed to learn my way around a new place, but it was tough going back to square one after all this time.” Although everyone has been welcoming and neurology faculty member Donald B. Sanders, MD, even extended the hospitality of his own home when the family arrived, Dr. Cabrera is nostalgic for New Orleans. “Although I would like to return to New Orleans to do a neuromuscular fellowship,” she said, “what my family really needs now is stability.”

Some neurologists had to factor in their spouses' circumstances, making the decision to leave doubly difficult. Diana M. Barratt, MD, MPH, previously featured in Neurology Today (Oct. 2005, page 1) could not wait to return to New Orleans after the curfew had lifted. Even though her home had sustained roof damage, the tap water was contaminated, and the stench from the maggot-infested refrigerator was unbearable, she and her husband celebrated their return with wine and chips.

But soon her husband, whose Tulane residency program could no longer provide training, found a cardiothoracic surgery fellowship in Miami. So after looking around, Dr. Barratt joined a seven-person private practice. Although she enjoys the change, it has required a huge adjustment.

“I spent a great deal of time at Charity Hospital, which so sorely lacked resources, and now I work at a hospital that looks more like a tropical resort,” she said. “The patients here live longer and are in much better shape,” she added, noting that obesity, uncontrolled hypertension, and diabetes were common in her Charity patients. But she misses those very patients as well as her friends, colleagues, and the residents she taught at LSU. “I had lectures planned for the residents, and I really wanted see how they would do on the next in-service exam.”

One of those residents, Renu K. Pokharna, MD, also featured in Neurology Today last December (page 4), said she has adjusted well to her final year of training at the University of Pittsburgh Medical Center (UPMC). She was forced to leave when her husband, Kishor, went into renal failure and sought treatment in Pittsburgh. She praised Mark L. Scheuer, MD, the Neurology Program Director at UPMC, for reviewing her remaining Residency Review Committee requirements and tailoring a schedule of rotations accordingly. Dr. Pokharna added, “Sadly, Kishor has had a setback which has delayed his renal transplant, but we are hopeful that he will recover and find a suitable donor soon.”

All those who left spoke of missing friends and family, the unique culture of New Orleans and, of course, the food. Dr. Friedman recalls, “We never expected to leave and we used to joke: If we move from New Orleans, where are we going to eat?”

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SEEKING A FULL HEAD-COUNT OF NEW ORLEANS PHYSICIANS

No one yet knows exactly how many physicians have been displaced by the hurricanes that struck the Gulf. Cathy Thompson, Membership Development Manager of the Louisiana State Medical Society, said that the organization has sent e-mails to all members in its electronic database, and has contacted various state and private healthcare organizations in order to try to gather information on members who may have left the region.

“There is no way to know the full scope of the problem yet, but I have heard countless personal stories,” she said. “So many physicians had young children that they needed to enroll in schools, or had lost their homes and were unable to find housing, the circumstances made it very difficult to stay in some areas. We are doing everything we can to help our physicians relocate within the state. Only time will tell how many of them will actually stay,” she added.

©2006 American Academy of Neurology