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OUR TOP PRIORITY

The top funding priority of Healthcare Foundation Northern Sonoma County is physician recruitment. To keep donors up to date about the progress of that effort, The Pulse interviewed the chairman of the board of directors of the North Sonoma County Healthcare District (NSCHD), Bill Hawn, a retired hospital administrator with more than 40 years experience recruiting doctors. Also interviewed was Evan Rayner, CEO, Healdsburg District Hospital (HDH). Both are major players in the district’s efforts to attract physicians to our communities of Cloverdale, Geyserville, Healdsburg, and Windsor.

Physicians are retiring or moving away at such an alarming rate that sections of northern Sonoma County have been designated by the state and federal governments as Health Professionals Shortage Areas or Medically Underserved Populations. At the same time, the need for local primary-care and specialist physicians in Sonoma County has never been greater. The following are just a few of the many contributing factors: 

• A higher concentration of retired seniors are in Sonoma County than any other Bay Area county—more than 21% of adults are age 55 or older.


• County healthcare providers, on their own, cannot afford the federally mandated electronic medical records (EMR) system.


• Approximately, 63,000 county residents (more than 13%) are uninsured.

“It’s very competitive to get physicians in the community,” says Bill Hawn. “It’s hard to sustain private practice. There’s medical groups like Kaiser that are very competitive and can retain physicians, while not enough doctors are being educated (see “Physician Recruitment Challenge in the Next Decade,” page 4). So, if you don’t have a physician recruitment plan, you won’t be successful keeping physicians.”

Add to that the high cost of living in Sonoma County and personnel shortages, finding—and keeping—qualified physicians and medical specialists has become an arduous task.

“We wouldn’t be doing our job if we weren’t preparing and responding to market changes locally, as well as on the state and federal level,” says Evan Rayner. “We know that healthcare reform will lead us to larger delivery networks.”

To that end, the medical professionals in the NSCHD have created a long-term physician recruitment plan with four major components: physician recruitment, succession planning, physician redirection (part-time physician services from doctors not on staff, often from other communities outside NSCHD), and physician retention. 

“In the past, we haven’t been too successful,” says Hawn. “Doctors have come here and left within a year because they weren’t taken care of. It’s been only a financial offer. Now, our approach has to be very comprehensive to hire and retain them.”

Collaboration has been key to assessing needs and marshalling resources. In addition to the major players —NSCHD, HDH, Alliance Medical Center (AMC), Alexander Valley Regional Medical Center (AVRMC), and PDI Surgery Center—other specialists in the district have also been included to avoid duplication of effort and to meet the needs of each organization.

“Collaboration is very important to the plan,” says Rayner. “The development plan encompasses all the zip codes in our healthcare district. We also want to collaborate with the physicians and specialists that are here to strengthen their practices.”

After months of planning, adopting policies, and creating the plan, implementation has already started.

“The priority is to enhance the primary care base,” says Rayner. “Currently, we are recruiting and redirecting physicians.”

Now, the good news: The first physician to be hired under the plan, Rachel Mayorga, MD, has signed a contract to join the Healdsburg Primary Care Clinic at HDH in September. Hiring two more physicians (family practice and pediatrics) is planned by the beginning of 2011, and redirecting physicians has already started in the areas of urology, neurology, otolaryngology (ear, nose, and throat), pulmonology, neurosurgery/pain management, and gastroenterology. This part of the plan will be completed by the fall of this year. The provider community anticipates needing more new or redirected physicians by 2013 and beyond.

Because the success of physician recruitment is dependent on having the funds to implement the plan, the Healthcare Foundation is also a key player. As Hawn points out: “You have to pay to find the candidates. There are expenses to bring them here for interviews, for signing bonuses, for relocation. We have to help these new doctors underwrite their expenses and guarantee incomes until their practices are established.”

The cost of recruiting is not cheap. Startup costs, which include building the plan and paying consultants, amounted to $100,000 before finding the first candidate. Says Hawn, “The cost of recruiting, working capital, expenses—it can take $200,000 from beginning to end [for each doctor hired].”

Several other expenses are critical to the hiring of physicians. New physicians expect EMR systems and the latest in medical technology. This expectation means an IT infrastructure must be created and maintained among all healthcare providers in the district, which is one of the long-term goals of the plan (see “Electronic Medical Records: A Collaborative Approach,” page 6). Physical upgrades to facilities and equipment are vital to attracting quality medical professionals and keeping them.

Another consideration for donors to consider is the impact quality healthcare has on the general health of the district’s communities, Cloverdale, Geyserville, Healdsburg, and Windsor. For example, HDH is the second largest employer in northern Sonoma County.

“Investing in physicians is an important factor in the economic and social health of our community,” says Rayner, “and the hospital itself is an economic driver here. So, to support the communities we serve, the growth of the district, and well-being of its constituents, investing in primary care and medical specialists is critical to sustaining not only healthcare locally, but also the overall health of northern Sonoma County.”

For donors looking for specifics about the return on the Healthcare Foundation’s investment, the plan includes hiring more specialists that the district currently does not have. This makes sense not only from a medical point of view but also to the bottom line.

“Specialists enhance any hospital or clinic’s income,” explains Rayner. “There are national statistics that show how much each specialist contributes to hospital revenues. Some returns can be quick and some take longer.”

When community leaders are looking to attract new businesses, the ability to provide healthcare can make or break a lucrative proposition.

“The dollars that are generated for recruitment and retention of physicians enhance our business models,” says Rayner, “which in turn provide a level of local financial sustainability we’ll need to continue healthcare at all levels in our district for the next 20 years and beyond.”

Listing the new Wetzel Family Emergency Department, Kozel Stroke Institute, and Patricia and Raymond Chambers Intensive Care Unit, Rayner points out that many of the physical - plant improvements for the hospital to recruit physicians are already in place due the generosity of Healthcare Foundation donors. There’s also a new program to treat nonhealing wounds, such as those associated with diabetes.

“All these [recruiting issues] are synergistically intertwined with equipment, facilities, and technological innovations. In the future, we will continue to need equipment upgrades, more facilities, and new physicians and specialists to provide the highest quality healthcare locally.”

In addition to financial support, donors can contribute their time to the retention phase of the plan. Rayner says he would like to see Healthcare Foundation donors become actively involved as volunteers: “One of the key points is the formation of an ambassador’s committee in which various members from our district assist in articulating the cultural and social advantages of living and working here. We want to acclimate new hires to the community, religious choices, education, real estate, art councils—maybe even the local bridge club captain—all these things to make sure physicians are happy once they get here. We need people from all walks of life to make our recruiting effort a success.”

Hawn is optimistic about the future if it includes the support of the Healthcare Foundation: “We’re confident that we can replace retiring doctors and recruit new specialists. However, without contributions from the Foundation, it would be difficult — if not impossible — to recruit without their support.”

A higher concentration of retired seniors are in Sonoma County than any other Bay Area county more than 21% of adults are age 55 or older.

County healthcare providers, on their own, cannot afford the federally mandated electronic medical records (EMR) system.