SAUSALITO, CA (NCP-ASSN.ORG)-- Time is almost up for oncologist John Rochat.

For the last four years, he's been an employee of the Mendocino Coast District Hospital under a pilot program that expires in exactly one month.

No more health insurance and other benefits for him and his spouse. He'll be on his own. And if he stays in this picturesque seaside community, which he hopes he can, he will have to become an independent contractor with the hospital.

Elsewhere throughout California, institutional hiring of doctors is limited to teaching and county hospitals and prisons, a policy that sets the state apart from all other states in the nation but four.

The hiring situation is causing concern for rural areas in the state, which are already in dire need of physicians. Fear that patient access to care, and thus care itself, will suffer as a result is not unfounded.

A study last year by the California Healthcare Foundation found a significant scarcity of physicians in 18 of the state's 58 counties. For example, the state average is one physician for every 575 residents but in a rural county like Modoc, which has three physicians, there is one doctor for every 3,520 people. Kings County has one doctor for every 1,324 residents.

Ray Hino, CEO of Mendocino District, says that a survey of the current medical staff shows that in five years, "the average age of our physician will be over 65. We're extremely concerned that we're not going to be able to replace the physicians we have on our staff and in our community unless we can get the ability to hire doctors."

That's why Tom Petersen of the Association of California Healthcare Districts is renewing its push to pass legislation that would allow hospitals in rural areas or those that are part of certain hospital districts to hire doctors.

"If you don't have doctors in rural areas to treat patients who live there, then those people aren't going to get very good medical care," Petersen says. "People want the studies that say so, but why do you even have to study it?"

Petersen and the California Hospital Association are trying to get one of two bills passed through the state Legislature that would bring the state's practices in line with those in 45 other states. A vote on one or both of the bills, AB 648 and AB 726, may be scheduled soon.

A few weeks ago in preparation, Petersen launched  a program which attempts to make the case that the rules for rural healthcare must be changed to entice more physicians to work in underserved areas. That includes guaranteeing them a decent living, which is generally not assured in communities with high percentages of uninsured and Medi-Cal (California's version of Medicaid) patients. So far, more than 50 healthcare organizations have signed their support.

The battle to amend this law, however, has gone on unsuccessfully for years, blocked to the greatest extent by the California Medical Association. The CMA, which represents 35,000 of the state's 125,000 licensed physicians, fears that if hospitals get the right to hire doctors, they will tell them how to practice, and which patients to treat aggressively or not, based on their level of health coverage.

The CMA believes that physician independence will be lost.

"We remain opposed," says Andrew LaMar, referring to one of the two bills that would allow limited employment of physicians in underserved areas. "We don't think it would do anything to improve access to healthcare in rural regions and it would take away an important patient protection," he says.

Dev GnanaDev, MD, immediate past president of CMA, said on a recent Sacramento radio show that the CMA "opposes any bills where a doctor's loyalty has to be split between the patient and an another employing entity like a hospital . . . Basically, when hospitals employ doctors they have their own special interests, especially in rural areas and small towns."

GnanaDev also points out that the existing pilot programs, which expire throughout the state this year, allowed some rural hospitals to hire 20 doctors but only six physicians signed up, proving to him that even the hospitals and doctors weren't sold on the idea.

But the obstacles were much tougher, Petersen and Rochat explain. It's hard to convince younger or older physicians to move themselves and their families to a community and invest in setting up their practices for a pilot program would expire in a few years, forcing them to move elsewhere.

Petersen explains that he's "not trying to pick a fight with the doctors. We're trying to make people realize that the economics of providing care to the poor today do not work, given the tools we have today."

 

 

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