There is a need for a new OB/GYN at the Memorial Campus (MC) due to the loss of two previous physicians. While there is not much competition from other providers, specifically at the Transmountain Campus due to its geographical location, the main competitors for OB/GYN services in the area are HCA and the county hospital (UMC). Currently, approximately five OB/GYNs are serving the MC area, with no family physicians performing OB/C-sections or midwives
The working environment at MC is described as very collegial, with the hospital maintaining good relationships with other providers in the community. The primary challenges for a new physician in building a practice would be establishing a good rapport with patients and collaborating effectively with other healthcare providers.
In terms of patient volume, about 70% of the practice consists of OB cases, while the remaining 30% focuses on GYN cases. The clinic utilizes general OB equipment to facilitate patient care. The hospital performs around 45-50 deliveries per month, and the new physician can expect to handle approximately 20 deliveries per month within the first year.
Referrals for certain cases, such as high-risk pregnancies or multiples, are typically directed to The Hospitals of Providence Children's Hospital, which has a level 4+ NICU. El Paso Children's, located at the county hospital, also provides pediatric care.
The wait time for an OB consult can range up to two months, but pregnant patients requiring emergency care can be accommodated more quickly. The C-section rate is at 29%, and the facility utilizes the Cerner EMR system.
The main referrals come from the emergency room/urgent care departments and other OB/GYNs who are not accepting new patients. The payer mix for OB services consists of 60% Medicaid, 35% Managed Care, and 5% other, while for GYN services, it includes 40% managed care, 20% Medicaid, 20% Medicare, and 10% other.
There are no ongoing clinical trials or research initiatives now. However, if the physician is interested in teaching, there is an opportunity for affiliation with the local Texas Tech 4-year medical school, and OBGYN residency. Residency Program (ttuhsc.edu)
A typical work week for the physician includes four days in the clinic and one day in the operating room (OR), which is likely to be located near the hospital for easy access in case of deliveries. The number of OR days allotted is typically 1-2 days per week.
In the clinic, the physician sees an average of 20-25 patients per day, which is considered a good volume for them. The time spent on initial consultations and follow-up appointments is described as standard.
Referrals are made to MFM specialists, Dr. Velazquez and Dr. Giles, anything oncological in nature is referred out. Pediatric cases are referred out once the baby is born, typically around 32-34 weeks of gestation. The percentage of cases referred out for oncology and 1st-trimester cases is less than 1%.
There is a children's hospital in the area, as mentioned earlier. The closest MFM, Dr. Velazquez, is available across the street. However, Dr. Giles is available onsite two times per week.
The practice accommodates VBACs. Pediatric coverage is reported to be sufficient, although pediatricians do not attend deliveries but round on the patients post-delivery.
Gynecological oncology services are provided by Dr. Salvador Saldivar, while breast-related cases are handled by Dr. Mark Landeros.
1:4 for Private Call | ED Call – OB Hospitalists Take 1st Call (1:7)
The call schedule for the new physician involves taking 5-6 ER calls per month. On weekdays, private calls will be shared with other MC providers in the area, totaling around 10-12 days a month. On weekends, the new physician can expect to have call duty approximately 1 weekend per month.
The patient volume for call duty is not very high, with an average of about 1 patient per day. Regarding phone calls, there are typically 3-4 calls, and a triage nurse is available to screen the calls before they are forwarded to the physician.
If a patient is present in the emergency room, there is no specific OB or General Hospitalist team available. However, there is a General Medicine team on call to provide care. In cases of false labor, the L&D nurses will go down to the ED to attend to the patients. Additionally, there are no laborists available within the system.
In terms of labor and delivery, the NICU at the Transmountain Campus is at level 3, while The Hospitals of Providence (THOP) Children's Hospital has a level 4+ NICU. MC has six L&D beds, while THOP Children's Hospital offers 34 beds. The hospital has a dedicated OB floor, and the Anesthesia/CRNA coverage is assigned to the L&D unit and shared with the OR. In the case of multiples or multiple deliveries or C-sections, coverage is provided by the appropriate medical team.
Regarding pain management during labor, all mothers have the option to receive epidurals if desired. The hospital is equipped with an OR for C-sections and other procedures, with a C-section team comprising an OB/GYN, CRNA, Certified Surgical Tech, and RN. During a procedure or delivery, there are typically five experienced nurses and ancillary support staff present in the OR/LDRP.
VBACs are performed at the hospital, and pediatric coverage is available through on-call services. Pediatricians do not have to attend deliveries but are involved in post-delivery care, while babies are taken to the nursery following a delivery. In terms of the operating room, the hospital has six ORs that operate 24/7 for emergencies. Elective procedures typically take place from 7:00 AM to 1:00 PM, with flexibility based on need. OR time is determined through block time scheduling, accommodating both planned procedures and add-ons as needed.
The average number of OR procedures performed per day is 17. While there is no Ambulatory Surgery Center at the hospital, there are three ASCs in the area: El Paso Day Surgery, Paso Del Norte, and The Hospitals of Providence Specialty Campus.
The top five most common procedures in the OR include Orthopedics, Urology, Uro-Gynecology, and General Surgery. Block time scheduling is frequently reviewed to ensure efficient use of resources. The required staffing in the OR includes OB/GYN, RN, Anesthesia, and Neonatology as necessary. Surgical first assistants are available, and the hospital utilizes three DaVinci Xi robotic surgical systems.
The robots are used by qualified and trained providers. The turnaround time in the OR is approximately 20 minutes. Anesthesia is administered by both MDs and CRNAs. In the event of a patient presenting in the emergency room, elective procedures may be rescheduled to accommodate emergent cases. Overnight epidural coverage is available, and the hospital is equipped with CT, X-ray, and MRI imaging equipment.
The primary service area covered by THOP extends throughout El Paso and also draws patients from West Texas and Southern New Mexico. With regards to market share, THOP holds approximately 51% of the overall market, while their OB market share stands at 50%. However, the goal for THOP is to increase their market share to 60% in the future. The major competition for THOP includes HCA (Hospital Corporation of America) and the county hospital.
In terms of outpatient migration, there is a need to address this issue, and bringing on a new physician is expected to significantly mitigate it. THOP has upcoming initiatives and investments in expanding the hospital's capacity as needed. However, adding new service lines in the next 3-5 years is not currently a likely plan for THOP.
The overall financial situation of the facility is healthy, and THOP operates in the black, indicating that they are financially sustainable. However, the specific number of days of cash on hand is not applicable to this recruitment process.
Overall, THOP has a significant presence in its primary service area, a strong market share, and a favorable financial situation. The focus is on expanding and enhancing services, addressing outpatient migration, and attracting new physicians to further strengthen their position in the market.