One of the toughest things for small, rural hospitals like those in Plumas County is recruiting and retaining quality physicians.
During Plumas District Hospital’s recent Measure B debate, one of the main arguments the hospital gave for new construction was the need for a facility that would lure potential physicians.
Every month at PDH board meetings, with the latest blow by blow on the tax-cap battle, former Chief Executive Officer Dick Hathaway reported his ongoing struggle to recruit doctors. At best, he’d have a prospect or two who might come temporarily. Often, that was dependent on the candidate’s ability to get a California license to practice.
Dr. Erin Barnes, a family practice physician new at PDH, is getting rave reviews. She’s here through the end of the year, with discussions continuing regarding an extension.
Dr. Mark Satterfield, emergency room physician and president of PDH’s board, said disparity between primary care doctor’s and specialist’s salaries increased during the Bush years as incentives for doctors to go into primary care were taken away.
Fewer primary care doctors are interested in offering the full spectrum of services required at PDH, which include obstetrics, surgical assistance, hospital rounds and on call.
Satterfield said, “Quality has to be excellent, otherwise rural hospitals go broke.” If you don’t have excellent doctors, word gets around, and patients go elsewhere.
Sometimes, there’s “a reason” a doctor practices in a rural area, and it isn’t always good. “There’s a limited pool of doctors, and half or two-thirds, you wouldn’t want,” he said. “Most rural hospitals are so desperate, if they can get a warm body with a license,” they’ll take it.
On the other hand, “quality begets quality.” He mentioned an EMT who chose to come to Plumas District Hospital about 10 years ago because it had won a Top 100 Hospitals award. “Keeping the momentum of quality medical care is huge. If we lose that....”
Satterfield praised interim CEO Linda Jameson for recognizing the importance of physician recruitment. “It has to come from the top,” he said.
For its part, Eastern Plumas Health Care is constantly struggling to recruit more doctors.
According to Chief Executive Officer Tom Hayes, “Achieving continuity in physician coverage is one of our biggest goals. Yet it’s very challenging to get people to locate permanently to a rural area unless they have some other draw.”
If a physician is married, “the spouse has to be happy — we need to get them connected in the community.” For young, single doctors there aren’t a lot of potential partners.
Hayes said, “One of the biggest things our patients want is continuity. We know that, we want that too, but it’s very difficult.”
One doctor EPHC spoke with has school-age children involved in dance and opera. “We can’t offer that,” he said, “and it hinders our efforts to get them to locate here permanently.”
In March 2009, the California Hospital Association (CHA) hired the nonprofit National Health Foundation (NHF) to do a study of “Physician Workforce Shortage Issues in California Rural Hospitals.”
The study covered a myriad of issues that seemed to affect the 56 (out of 69 total) responding California rural hospitals in a remarkably similar manner.
Most are in isolated areas where the local economy has been severely hit by the national downturn. In many areas, hospitals not only provide health care, they’re also the largest employer.
According to the study, the economic strain has caused six of these hospitals to close in the past four years and 75 percent of the remaining ones to reduce their range of services.
Because a hospital can’t generate revenue without doctors, and these hospitals are already in a precarious position, the difficulty recruiting doctors hits them hard.
With the other difficulties plaguing rural hospitals, the recruiting problem isn’t easy to solve. EPHC and PDH have discussed jointly recruiting a surgeon, but have met with numerous roadblocks. For such an effort to be successful, affected doctors and administrators at both hospitals must be on board.
Hayes keeps collaboration central to his vision of EPHC’s survival. When PDH has been unable or unwilling to work cooperatively, he’s gone further afield, to Tahoe Forest Hospital in Truckee or Renown in Reno.
With PDH and EPHC talking openly and regularly now, there’s a hope some collaboration, as well as shared ideas, will benefit both hospitals.
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