Discouraged doctors leaving Las Vegas for healthy deals

It was a stroke of luck that when Catherine Cohen had a brain aneurysm in April in Las Vegas, one of the top surgeons in the country was still practicing here.

If the blood vessel had ruptured in August, she might not have been so lucky.

That's when Andrew Gyorke, an intervention neuroradiologist, will be leaving to join the staff of the University of Arizona Health Sciences Center.

Also recruited recently by the Arizona college was Las Vegan Dr. Jose Zamora, the only surgeon in the state who performs a kidney-pancreas transplant. Zamora, 39, begins his job in July.

The two men are leaving for different reasons. Gyorke, 42, says he wants more personal time, and Zamora says he is discouraged by the lack of support from the University of Nevada School of Medicine.

But whatever their reasons, the loss of good doctors from Las Vegas is a trend Cohen hates to see.

The community, she says, needs to "sit up and take notice."

"I have friends with serious illnesses who go out of state for treatment," she said. "I even know doctors who take their family out of town.

"People need to start thinking about that when they vote."

She is especially concerned about Gyorke's impending departure because she feels she owes her life to him and she wishes more had been done to entice him to stay.

Gyorke is one of about 50 surgeons around the country who routinely perform an operation on aneurysms that involves the insertion of a coil into the affected blood vessel rather than the more traumatic method of opening up the skull.

Cohen's mother had a similar aneurysm 28 years ago and survived, but the recovery was longer and more difficult.

"It was in the same location, only mine was in a more critical location," Cohen, a trade show spokeswoman, said. "She had a lot of recuperation time -- six weeks in the hospital and four months at home before she was back to her old self again."

On the other hand Cohen's aneurysm occurred April 10, her surgery was April 11 and she was out of the hospital in about a week.

She had no problems with mental functions, speech patterns or other side effects.

"I went in talking and came out talking," she said.

Remarkable, Gyorke said, since there's a 50 percent chance of dying from an aneurysm before getting to the hospital.

The coil technique Gyorke used was first tried in 1991 and has been in general use for two and a half years. It involves repairing the blood vessels from the inside with the coil rather than from the outside using clips, which requires opening the skull. And it is probably what made Cohen able to recover as well as she has.

One doctor told Cohen that because of the aneurysm's location, an operation that required opening her skull would have robbed her of some of her faculties -- perhaps left her a vegetable if she survived, she said.

About 300 centers around the world perform the delicate coil operation.

"I am training one of my partners, Dr. Lindsey Blake, since I am leaving town," said Gyorke, who performs more than 100 such operations a year. "We've been doing cases together for awhile now. There are not that many cases in town.

"This type of stuff is technically challenging," he said. "Each case is different. You really need to have a fair amount of experience to competently and confidently go after the lesions."

Cohen, understandably, can't praise the doctor enough.

"It's a tremendous thing he brings to this city in terms of technology," she said. "It's a shame that we're losing him. He's not just a doctor, but a human being who cares. I can't hardly talk to him without crying. He gave me another chance to live."

Zamora, was head of University Medical Center's transplant center until it closed last month after he submitted his resignation.

"I was approached in February by the University of Arizona," Zamora said. "(The University of Nevada) medical school and I had made our decision to part ways in January."

Zamora will be part of a three-person transplant team that will allow every kind of internal transplant to be conducted at the Arizona medical center.

"I am excited about the change but sad that things didn't work out here," he said.

Zamora is critical of the lack of commitment on the part of the University of Nevada School of Medicine to keep doctors.

"The major problem with this university is it has no business acumen to speak of," he said. "The business side is run by the chair of the department and the dean. Most other universities have some components of a business structure outside the practice of medicine.

"Given the financial woes of the university, you can see where they really need that business side. But with them it's mostly trial and error. They're not getting the expertise they need."

He said the expertise is missing because of politics.

"It's the politics and the University of Nevada at Reno not wanting to support us and their lack of understanding that we in Southern Nevada are bigger than Reno from a clinical point of view and also from the amount billed," he said. "That's kind of the history of Nevada as a whole."

"The powers that be are having a difficult time adjusting" to the movement of the political clout to Southern Nevada, he said.

Zamora said that when he came to Nevada two years ago he was assured he would get help, which would include another surgeon to relieve some of the workload and access to a database for information important to him professionally.

"They never provided that," he said.

Zamora said he was recruited to run the transplant center, but the school then did not utilize his expertise.

"They led me to believe they were going to go ahead with what needed to be done," he said.

If they had followed through, he said, he probably would have stayed.

"But there would have to have been massive changes," he said. "The financial structure of the school is terribly backward. They have cut salaries of numerous people and frozen hiring. They have taken drastic steps, including asking money from alumni just to get them out of debt."

"Arizona has everything in place -- infrastructure, clinics, surgeons, database. They don't have a lot of needs, and they've given me everything I wanted."

Zamora said Arizona has a health science center, a centrally located teaching hospital with several adjacent clinics.

"Arizona has always been aggressive, but now over the last year and a half it has aggressively started recruiting," he said. "It will be a major force in next the few years."

David Schapira, senior associate dean for the University of Nevada School of Medicine, strongly disagreed with Zamora's assessment of the system -- except for the funding issue.

The school could use some help from the Legislature, he admitted, but Schapira doesn't see a lot of doctors leaving the state because of that.

What the state suffers from is unprecedented growth, which outstrips the available number of physicians.

He noted that nationally the rate of physicians per 100,000 population is about 250. Clark County has about 145 per 100,000, he said.

"We are almost half under-doctored," he said.

But those who are here are talented and the state continues to attract high quality doctors, Schapira said.

"As a school, we also have attracted excellent people from around the country," he said.

He added that movement of doctors among medical schools is nothing new. It's been a growing trend for the past 15 or 20 years, Schapira said, partly because doctors affiliated with medical schools don't have to build a practice that may be difficult to move.

Las Vegas gets its fair share of top-flight doctors, he said.

"There is always a tendency to believe the grass is greener as far as a medical career, but is there any realistic bearing on services afforded? Absolutely not," Schapira said.

He said the most sophisticated treatment and some of the best doctors are in Southern Nevada.

"There might be an instance where someone with a rare disease might want a second opinion, but when you look at the most sophisticated treatments, there are people here to perform them," Schapira said.

As to Zamora's complaint about the business end of medical school, Schapira said problems were created by a sophisticated new computer system installed a couple of years ago.

The system was unforgiving and there was no one who could properly enter information, which created a lot of billing problems.

"We scrapped that quickly," he said.

Now the school is again in the black, he said, though it still could use help from the Legislature.

As for Zamora's decision to leave, "Sometimes you have these differences in approach," Schapira said. "It happens."

Zamora's departure to Arizona helps that school work toward its goal to become one of the best in the country as well as providing the best of care for residents of the state and region, said George Humphry, spokesman for the University of Arizona Health Sciences Center.

"There is a strong development effort here," he said.

Humphry said there is support for the medical school from both public and private sources.

Eight clinics, which they call Centers of Excellence, were constructed and funded with private dollars.

More than 5,000 people work at the Health Sciences Center, which includes the medical school, the teaching hospital, the clinics and colleges of pharmacy, nursing and health professions. It has an annual budget of about $500 million.

In addition to the transplant center, the university recently announced a new director for its cancer center.

"Our cancer center is world renowned," he said.

He said the medical school has a children's diseases research center that also is world renowned.

"And now that we will have a full range of transplant services, that will set us apart," Humphry said.

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