The Finger Lakes region is doing better than other areas. But when it comes to being a desirable state for doctors, New York ranks at the bottom of the heap.

Doctors are among the highest paid and most educated professionals in the nation, but what’s the trade-off?

In 2006, the average medical-school graduate left campus with more than $189,000 of debt, according to the Association of American Medical Colleges.

And that’s just the tip of the iceberg. Health-care reform, insurance costs, the rise of branded hospital networks and retirement of baby boomers all are complicating the lives of doctors, according to the finance website WalletHub.

While physicians are feeling the heat nationwide, those in New York have the worst of it. Based on key factors such as starting salary and annual wages, malpractice liability insurance rates and hospitals per capita, the overall environment for doctors in the state ranks dead last among all 50 states and the District of Columbia.

According to a few local experts, however — including two doctors in Rochester and the Finger Lakes region — there are bright spots despite struggles revealed in the WalletHub report “2017’s Best & Worst States for Doctors.”

One physician's NY story

Dr. Joel Haas has experienced the big three when it comes to practicing medicine. He worked in private practice for years, put in time with a hospital network and then went to work for the federal government. Haas is now chief of medicine and acting chief of staff for the Canandaigua VA Medical Center and Rochester Outpatient Clinic.

Working for the VA was the furthest thing from his mind when he graduated in 1984 from Sackler School of Medicine in Tel Aviv. On a scholarship through a state and national program, Haas returned from Israel to complete his residency at Rochester General Hospital (now Rochester Regional Health). He then went into private practice — for two decades.

The workload took its toll.

“It was a quality of life issue,” said Haas.

Being on call 24/7 most days, dealing with insurance and overhead costs, and other stresses drove him to seek changes. He joined one of the area’s hospital networks. It had advantages over private practice such as a stable income and benefits.

“But you lost a lot of independence,” said Haas, who met his wife, Paula, a registered nurse, when both were working in Rochester. They have three adult children.

Haas recalled the competitive environment.

“Very quickly it became about productivity,” Haas said. “It was a trade-off.”

He remembered the day he came home and told Paula: “I can’t do this anymore.” About that time a friend mentioned the VA, but Haas wasn’t interested at first. He had preconceived notions about working at a federal facility.

“I didn’t see myself running up my career at the VA,” he said.

That was 11 years ago. Working at the VA “changed my perception,” he said Thursday from the Fort Hill Avenue campus.

Working for the VA has provided better salary and benefits, regular hours and protections he didn’t have previously when it comes to malpractice and other risks associated with practicing medicine.

“You have got the power of the federal government behind you,” Haas said, further explaining the sense of security. “We’ve got your back. You just practice medicine.”

One of the best parts of working for the VA is time with patients, he said. You get half an hour with each patient and there’s a cap of 14 patients in a day, he said. That means he also has time with his family. Now, he comes home and tells Paula: “I had another great day. I love my job.”

With experience practicing in various settings, Haas mentioned pressures on physicians nationwide that just add to what doctors face in New York. Those include a shortage of primary care providers and dealing with an opioid epidemic. Haas thinks the VA has strengths in dealing most effectively with the epidemic that other institutions may lack. He attributes that in part to the support given its providers.

“There is a lot of support,” Haas said. “You have the VA behind you.”

‘A great place to be’

In 2012, Thompson Health became part of the University of Rochester Medical Center network. Branded UR Medicine, operations include Thompson in Canandaigua, Strong Memorial Hospital, Highland Hospital, Wilmot Cancer Center and others. Michael F. Stapleton Jr. is president and CEO of UR Medicine’s Thompson Health.

“There is no doubt it’s very difficult to recruit into New York state,” said Stapleton, referring to drawbacks highlighted in the WalletHub report.

The Finger Lakes region, however, is at an advantage, he said. The beauty of the region and its many recreational offerings make the area “very favorable to recruit to,” Stapleton said.

Still, physician recruitment was one reason Thompson affiliated with UR Medicine almost five years ago. The University of Rochester “produces more physicians in the region than anyone else and provides Thompson with a pipeline,” Stapleton said. “We work with the university to get the coverage we need from their pool of physicians. It makes it much more affordable and allows us to build our programs as we grow.”

According to Stapleton, Thompson has found the number one factor in successful recruiting is family — physicians want to be closer to home, or closer to their spouse’s home. In fact, a new primary care physician who recently signed on with Thompson did so in large part because he wanted to be closer to family.

The new primary care physician is Dr. Dan Harris, who will start at Thompson’s Macedon Kachoria Family Practice in August.

Dr. David E. Baum, Thompson Health senior vice president of medical services, agreed that having roots in the area is a common thread when Thompson brings on new physicians. While other areas of the country may be more financially attractive, “people balance quality of life against the finances,” Baum said.

“This is a great place to be, and a great place to raise a family,” said Baum, who grew up in Utica and did his residency at the University of Rochester. He added that physicians will often stay in the area where they completed their residency. Despite the factors that placed New York at the bottom of WalletHub’s ranking, Baum said Thompson is “holding ground.”

“We still are able to recruit very high-quality candidates,” Baum said. “We have people on our medical staff who are absolutely top of the line, and I wouldn’t work in a hospital that didn’t.”