Top Docs’ Believe It or Not!

Craig OuthierMarch 4, 2021
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Every Year, PHOENIX magazine editors spend dozens of hours poring over Arizona Medical Board records for Top Doctors and other related projects. Our main source of fascination: a digital spreadsheet containing the names of every person who has legally practiced medicine in the state of Arizona – or the territory of Arizona, for that matter.

The most recent list starts with Louis Dysart, a general practice physician who received his medical license on May 23, 1903, nine years before Congress granted Arizona statehood. It ends with John Rizzi, a radiologist from Iowa who – for reasons known only to Dr. Rizzi, and perhaps his colleagues and family – decided to get boarded in Arizona last October after practicing for 35 years in the Hawkeye State. Arizona medical license number: 62279.

The spreadsheet includes more than just names, of course. For each of the 62,277 physicians wedged between Drs. Dysart and Rizzi, there’s a corresponding row of data containing details like license status, professional address, medical school, disciplinary board actions and, somewhat obliquely, “area of interest.”

We use this information to fact-check, to certify and to scrutinize. But something else happens. Gazing into this century-deep ocean of data, we often notice eddies, patterns and statistical swirls. Riddles to crack, arcana to uncode. Mysteries etched into the grain and pith of the professional culture that heals our bodies and extends our lives. Welcome to…

Top Docs’ Believe It or Not!

Terry Gilliam-inspired photo composites by Mirelle Inglefield
Terry Gilliam-inspired photo composites by Mirelle Inglefield

A Visit to the Family Hypnotist

Of the 62,279 names on our list of Arizona medical doctors, most indicate an “Area of Interest” (read: medical specialty) that any reasonably well-informed layman would recognize. Thousands of internal medicine doctors. Several hundred cardiovascular surgeons. Scads of rheumatologists.  

But every once in a while, you stumble upon a super-rare specialty that beggars easy comprehension. For instance, only one Arizona doctor on the entire list indicates “psychosomatic medicine” as their main specialty. (According to WebMD, it’s a field that examines how “social, psychological and behavioral factors” like stress and grief “affect bodily health and well-being.”) Same goes for “clinical informatics,” “surgical pathology” and “nutrition.” Just one M.D. in the entire history of the state has practiced each… which, in the case of the nutritionist, is particularly not surprising. After all, a person need not accrue $200,000 in student loan debt to preach the virtues of a fiber-rich diet. 

But one singular specialty reigns above all others on the oddity index: “hypnotism,” practiced by an M.D. named John D. Looper whose Arizona medical license went dark in the 1980s. Incredible, right? You expect to find hypnotists at cruise ship mixers and séances. Less so at, say, Harvard Med.

Dr. Looper hung up his pendulum decades ago, but it turns out there are at least two M.D.s currently offering clinical hypnotic therapy in the Valley: Dr. Umesh Tiwari of the Arizona Center for Hypnotic Healing and Dr. Lewis Heller of the Medical Hypnosis Institute. 

An internist by training, Tiwari was a self-described “half-baked doctor” with nagging motivation issues when he discovered hypnotism through a business seminar about a decade ago. “I studied it and fell in love with it,” he says. 

A one-time surgical resident who left that field because of what he felt was its mechanical and uncompromising culture, Tiwari immediately saw the clinical potential in hypnotism, which he describes as “simply, the subconscious mind accepting an idea and acting as if it were true… rather than being at an intellectual level, it’s at an emotional level.” 

Using various induction techniques, Tiwari endeavors to plant ideas within his patients, but he stresses the ideas are not discrete or command-based, like “You will stop smoking.” Rather, he targets them with positive, general ideas of self-worth. He gives the example of a female patient who was prone to blackout binge drinking and impetuous sexual entanglements. “[I presented her] with a constellation of ideas that allowed her to fully express her current feelings and replace them with another set of feelings of confidence and worthiness… and it rid her of the compulsion.” 

Tiwari says his peers in allopathic medicine – he also works as a full-time internist at a Phoenix clinic – are generally receptive and supportive of his hypnotic side gig. “Most chronic medical conditions are messy and multifactorial, with a psycho-social-biological basis,” he says. “All three contribute to a person’s state of health… but by year two of medical school, we’ve already dismissed the psycho and social because the biology is so difficult.” 

His career in hypnosis is an attempt to redress that – both for his patients and for himself. He’s on friendly terms with Heller and hopes together they can lift hypnosis into mainstream status in the Valley – or, at least, less stigmatized status. But there’s one place he won’t go with patients. 

“No telemedicine,” he says. “I prefer to see them in the office.”

Terry Gilliam-inspired photo composites by Mirelle Inglefield

The Mystery of the South African Anesthesiologist

Dr. aubrey maze is a legend in Valley medicine. The genial 70-something has made our annual Top Docs list a whopping 25 times – almost every year since we first published the thing. He retired from active practice last year but continues to serve as CEO of Valley Anesthesiology Consultants, a physicians’ group of about 200 Arizona doctors. 

Maze is also the poster child for one of our most uncanny, enduring Top Docs mysteries: the South African anesthesiologist.  

Over the years, we’ve noticed an unusually high proportion of South Africa natives in that specialty. University of Cape Town and University of Witwatersrand, both prominent South African medical schools, appear frequently in our yearly Top Docs data-crunching sessions for anesthesiology. 

Anecdotal? Sure, but board records bear us out: Of the more than two dozen Arizona doctors who attended the University of Cape Town, for example, about a third make their living putting patients to sleep or selectively numbing their body parts during surgery, even though the field makes up less than 3 percent of practicing physicians. 

So why this special connection? The reason, it turns out, is equal parts politics and economics – with an ample dash of prejudice. 

Most of the South African doctors in Arizona came to this country during the apartheid-era 1970s and 1980s, when racist segregation and upheaval – culminating in the Soweto uprising of 1976 – prompted thousands of well-educated dissidents to flee for less troubled lands. Getting accepted into a U.S. residency program was one way to quickly and prosperously do that.

But these South African healers weren’t necessarily at the top of most hospitals’ wish lists. According to Dr. Raun Melmed – also a South African immigrant and also a perennial Top Doc, in the field of child development – American residency programs of the era tended to discriminate against foreign medical graduates (FMGs): “Some [programs] used to brag about how few FMGs they had… because the implication was, if they had too many, they weren’t attracting the cream of the crop.”

Melmed adds that the mostly white South African doctors, with “their accents to be admired and not scorned,” faced less discrimination than residency candidates from the Middle East and South Asia. “There was definitely South African privilege… but often we were nonetheless shunted into the more underserved residencies.”

Maze, recalling his early days as a doctor, echoes Melmed’s thoughts. “One way to get into this country was to apply for residencies that tended not to be full… and often those were pathology, anesthesiology and radiology. You also saw a lot of foreigners in those specialties because there was very little patient interaction, and if you didn’t speak English as a first language, [it was not] a big impediment.”

After initially training as a pediatrician, Maze became an anesthesiology resident at Stanford University, drawn to the specialty for another reason: It was finally getting interesting.

“The pharmacology [in the specialty] became very exciting around that time,” Maze says. For decades, yesteryear anesthesiologists were limited an uninspiring arsenal of gasses and inhalants such as ether and nitrous oxide, but the 1970s saw the beginning of a new era of elegant, specialized drugs like Sevoflurane and Propofol – safer, more effective and more clinically complex. 

Not coincidentally, anesthesiology has become a more lucrative, competitive field in the intervening decades – no longer a fallback for most doctors, immigrant or otherwise. That fact, coupled with the growing diversity of America’s medical field and destigmatization of foreign-born residents, means that the days of the South African anesthesiologist as a Top Docs statistical outlier are probably numbered.

“I don’t think [being foreign-born] makes a difference anymore,” Maze says. “The system has changed completely since [my day].”

Fair enough. But what’s the deal with all those Mormon orthodontists?

Terry Gilliam-inspired photo composites by Mirelle Inglefield

The Birmingham Connection

Here’s a weird piece of trivia: More Arizona doctors live in Birmingham, Alabama, than they do in Buckeye. For that matter, there are more Arizona-boarded docs in Anchorage than Avondale, and almost as many in Pittsburgh as Payson. And there are way, way, way more in New York City than Bullhead City.

Of the roughly 23,000 medical doctors with active Arizona licenses, it turns out less than two-thirds actually practice and live in the state. Why would that be? If you’re a physician, why push yourself through a given state board’s grueling gauntlet of paperwork, fees, training verification and testing, if you don’t even plan to set down roots in that state?

The answer lies in the way doctors are trained and educated in the skills of their chosen specialty – and what they consider a “home base” as they transit the country amassing that education. Following their four years of medical school, young doctors are matched with hospitals and other large clinical facilities for the residency phase of their training – in which they finally lay hands on patients and learn the discrete skills of their chosen specialty. Matching med student to residency used to be a traditional interview-and-offer affair, but that system changed about two decades ago – now, a third-party agency does the matchmaking, using an algorithm to find optimal pairings. Like the sorting hat in Harry Potter, the agency unveils its pairings all at once, to campus auditoriums and lounges full of variously elated and disappointed students.

Wherever they go, that residency is where the student will “reside” for at least the next three years – the standard length of time for primary care fields like family medicine and pediatrics. 

And it’s also why Arizona has so many Birminghamian and Anchorageite doctors.

You see, residents don’t always stay put during and immediately after their primary residencies. They take on fellowships. They do second or even third residencies, in highly specialized fields like hand surgery and interventional cardiology. And they often do them out-of-state, while maintaining an address in Iowa or Minnesota or wherever they did their original residency.

But before joining one of these advanced residencies or add-on fellowships, they have to get boarded in the host state first. Ergo: “Arizona” doctors who only stay here for a year or two and return to their original states. “Statistically speaking, most doctors tend to practice where they did their [first] residencies, or at least a very high proportion,” says 2021 Top Doctor Bryan Ganter, a sports medicine specialist at Mayo Clinic in Phoenix.  

As a highly diversified, multi-state hospital network that also operates medical schools, Mayo is a good case study for this phenomenon. To date, a whopping 448 medical doctors who have identified Rochester, Minnesota, as their permanent address have been boarded in the state of Arizona. That’s a shockingly high number for a city of just 120,000 people. By comparison, Rochester, New York has 205,000 residents, but only eight of them have Arizona medical licenses.

The reason, of course, is that Rochester, Minnesota, is the headquarters of Mayo, which often shuttles its students, residents and even veteran doctors between Minnesota, Arizona and Florida for advanced training.

Other connections, albeit less obvious, help explain why certain cities and towns tend to send a lot of doctors to Arizona. In the case of Birmingham, it’s likely because roughly half of those 22 doctors are oncologists and/or pathologists, and the University of Arizona is a major training ground for Mohs, a skin cancer surgery technology.

This isn’t all to say that every out-of-state Arizona doctor actually lives out-of-state. In some instances, the explanation is much more basic: Doctors are like the rest of us, and sometimes don’t update their paperwork.

Terry Gilliam-inspired photo composites by Mirelle Inglefield

The “Family” Feud

We’re all about taxonomy at Top Docs. Your doctors are sticklers for correctly defining and labeling things, so we try to be, too. And there’s one labeling issue that’s always stuck in our craw as we comb through doctor records: What is the difference, if any, between family practice and family medicine? 

Arizona M.D.s can select either designation with the Arizona Medical Board, and together their all-time population is more than 5,000 strong – one of the single largest fields in Arizona medicine. In terms of respective numbers, they’re split about evenly: half “practice,” half “medicine.”

For PHOENIX magazine editorial purposes, we’ve somewhat capriciously favored “family medicine” in print and lumped them all under that label. (It just sounds more… medical, you know?) But paranoia nags us. Are we committing some kind of grievous error? Have we unwittingly picked sides in a secret clinical war between these two camps? Will one of our readers go to a family practice doc with appendicitis and get nothing more than a vigorous backrub?

As it turns out, no. The practice vs. medicine thing is a complete non-issue – or, at least, an issue only someone with a spreadsheet-deep knowledge of medicine might worry about.

“I don’t think I ever noticed it,” says Dr. Stephen Chakmakian, who, as chief medical officer of UnitedHealthcare Community Plan of Arizona and a family-whatever-trained physician himself, would definitely have been in a position to notice it. 

Chakmakian says all such doctors emerge from identical residencies and training cultures. “I wonder if it’s just nomenclature,” he says. “For instance, I’m boarded with the American Board of Family Medicine. But if someone asks me about my field, I might say ‘family practice’ … maybe [the former] is just the more formal term.”

So, mystery solved. But this dive into the Top Docs rabbit hole was not in vain, because Chakmanian brings up a related and important issue: the gradual disappearance of the general practice doctor. 

You might have gone to a GP as a child. They were the dominant primary care physician in the U.S. and synonymous with family practice doctors until the early 1970s, when the latter became a formal specialty with a minimum three-year residency and a national board exam. Henceforth, the term “general practice” was degraded somewhat: It denoted a doctor who completed only one year of residence training, known as the “internship year,” before hanging a shingle and going into practice. Gradually, over the next three decades, the specialty itself was weeded out of existence, as insurance and hospital groups stopped working with them. There are 1,517 general practice docs listed with the Arizona Board of Medicine, but only 112 are active – either old-timers grandfathered in, or younger primary care docs who simply like the term. 

Chakmakian cautions patients not to make judgments about a given doctor’s skill or experience just from seeing the label “general practice.” He points out there are “GPs who have treated patients for 25 or 30 years with no issues.” Meanwhile, modern nurse practitioners (NPs) – who did not go to medical school – now shoulder many of the same primary-care patient services, independent of a doctor. They’re essentially the new GPs. 

“So you don’t want to draw conclusions,” Chakmakian says.

Terry Gilliam-inspired photo composites by Mirelle Inglefield

Surgeons on the Brain

There is not a single fact, phenomenon or captivating statistical pattern that makes neurological surgery a Top Docs topic unto itself – rather, it’s the constellation of these things. To those of us on the outside, brain surgeons often appear as the apex beings of the medical profession. We assume they trained the longest, got the best grades, make the most money and have the most technically demanding work – i.e. healing an organ of unfathomable complexity where anatomy, chemistry, electrophysiology and quantum physics all intersect. 

To the first assumption: Yes, they do train for a very long time. At minimum, it takes seven years of residency training to become a brain surgeon after medical school, according to Dr. Francisco Ponce of Barrow Neurological Institute, often with a one- or two-year fellowship on top of that for ultra-specialized fields like endovascular aneurysm repair. Other surgery fields like plastics and oncology take almost as long – usually six years of residency.

But it’s not just the investment of time that makes brain surgery residencies unique, Ponce says. It’s the insularity. “In most fields, you respecialize during your residency – you might do three years in internal medicine, and then another three somewhere else to become a cardiologist.”

Neurosugeons do their entire seven-year stint in one place, which makes the matching day for aspiring residents described in “The Birmingham Connection” on page 207 that much more critical. “You basically find out where you’re going to spend the next seven years of your life,” Ponce says. “It’s like Christmas.”

Is it a competitive field to break into? Undoubtedly, given its comparatively small size. The Arizona Medical Board lists only 559 neurosurgeons in the history of state medicine, and Barrow, one of the largest programs in the U.S., accepts only four new residents a year. Interestingly, of those 559 neurosurgeons, only one – Dr. Adrian Harvey, now practicing in Texas – matriculated at an osteopathic (D.O.) college, which supplies the medical workforce with about 20 percent of its physicians. This could speak to lingering bias against osteopath-trained residents, who enter graduate programs with slightly lower average GPAs and MCATs than their medical school (M.D.) colleagues, but Ponce suspects the low numbers of D.O.s in the field is “self-selecting.” Educated in the more holistic ways of osteopathic medicine, D.O.s may gravitate to residencies that give them more regular interaction with patients.

The specialty itself is also older than you might expect. The earliest neurological surgeons listed in Arizona board records are John A. Eisenbeiss and John R. Green, who both licensed on October 4, 1947 – a somewhat astounding fact, given the World War II-era technology at their disposal. 

Lastly, to the questions of whether neurosurgeons are the most well-compensated doctors: Hard to say. – by no means the definitive source – lists their average yearly salary at $619,000, which would certainly place them near the top. But one doctor interviewed for this story, who wished to remain anonymous, believes they’ve been eclipsed by skin doctors. “Dermatology is the No. 1 earner now and attracts the finest minds in medicine,” the doctor says. “Thirty years ago, it was internal medicine, that’s where the curious minds went. But now the focus is on surgical subspecialties.”

And dermatology residencies only last four years. So who are the smart ones?