Reimbursement for doctors is so tight in Cincinnati that some specialists have passed up jobs here to make more elsewhere, as much as $100,000 more annually in Columbus, for instance.

        A growing number of physician groups — especially groups of orthopedic surgeons, neurologists and cardiologists — say they are struggling to recruit highly skilled doctors and to keep them. The problem is pay.

        “When it comes to personal income, most people aren't going to be sympathetic to the plight of doctors,” said Russell Dean, executive director of the Academy of Medicine.

        “But if they make X amount here, and they can make X plus Y amount in Columbus or Indianapolis, then why would they stay here? Once the pay issue becomes a recruiting problem, then it becomes a communitywide issue and we need to understand what's going on.”

        If the problem continues, questions will emerge about the future of medicine in Cincinnati: Will the medical community lose its expertise in certain procedures? Will it fall behind the times? Will it be prepared to serve the needs of the Tristate's aging Baby Boomers?

        The questions are disturbing enough for the Academy of Medicine of Cincinnati, the largest physicians organization here, to hire a marketing firm to study physician recruitment and help prepare a public information campaign. The academy is the local arm of the American Medical Association.

        Several Cincinnati-area physician groups have complained publicly and privately about what they say is unusually low physician compensation.

        They aren't comparing the region's pay to that in bigger, magnet cities like San Francisco or Boston. Instead, local doctors say, there's better pay in cities such as Columbus and Indianapolis. Some even claim they could get raises by moving to Richmond, Ind., or Minot, N.D., Mr. Dean said.

        For instance, an orthopedic surgeon who was offered in the low $200,000s here received a guaranteed offer of $350,000 in Richmond, Ind., Mr. Dean said.

        At the Ohio Heart Health Center, the area's largest cardiology group, doctors can testify to difficulties filling positions that normally pay several hundred thousand dollars a year.

        “Not long ago, we were trying to recruit an electrophysiologist from the Cleveland Clinic. But he was able to start out with $100,000 more in Columbus than we could offer him here,” said Dr. Dean Kereiakes, who directs recruitment for the group.

        Dr. Ted Chow, an electrophysiologist who did agree to move to Cincinnati about 10 months ago, said he weighed lower pay with the opportunity to work in cardiac research with Dr. Kereiakes, a nationally known figure.

        “I could be making 50 percent to 100 percent more at practices in other cities,” Dr. Chow said. “But I wanted to do large-scale clinical trials, and this was one of the few private groups in the United States where I could do that.”

        Cincinnati's physician pay reflects years of tight compensation from large insurers trying to keep premiums low. By most measures, employers here pay less for health benefits than employers in other large Ohio cities.

        But those premiums have been increasing in recent years, in large part because insurers are starting to pay more to local hospitals and some are increasing pay to doctors.

        But the changes haven't been enough, Dr. Kereiakes said.

        “In Columbus, I can get more reimbursement for the same procedure from the exact same” insurance company, he said. “That doesn't make sense to me.”

        Employers don't deny they have pressured insurers, hospitals and doctors to keep health-care costs in check. In fact, some are becoming increasingly receptive to concerns that costs have been cut about as deep as they can go.

        “I don't think employers should take complete and total responsibility for this. Employers also have a stake in affordable, high-quality health care,” said Sharron DiMario, executive director of the Employer Health Care Alliance.

        Many companies have taken on higher health benefit costs without making loud complaints or added pressures on health providers. What employers want is much better data about doctor supply and demand, she said.

        Even doctors say concerns about recruitment aren't just about money. There are frustrations about the changing medical system, concerns about Midwest living, even apprehensions about safety and tolerance after the recent racial unrest.

        “Some of the questions I hear reflect a level of ignorance about our community,” Mr. Dean said. “But perceptions matter. Basically, unless a physician has a compelling reason to come here, they won't.”

        What the Academy of Medicine does not know is how much weight these various factors play in physician recruitment.

        Laine & Lane, the marketing company the academy has hired, will spend a month meeting with doctors, employers, insurance leaders and others to develop a “case report” later this summer. From that, the academy hopes to develop ways to enhance recruitment.

        Said Leslie Laine, a partner in the company, “We're hearing lots of interesting opinions from lots of people.”

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