July 2006 Vol. 25. No. 7

Published by the Humboldt Senior Resource Center in Eureka, California. HSRC is a non-profit community-based organization offering services for senior citizens, multi-generational families and caregivers.

Inspirational octogenarians: Three photographers leave a legacy
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Health care on the North Coast

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The predictions about health care delivery on the North Coast are dire - but five local physicians and their guest from the California Medical Association took two hours to talk with reporters about the situation and their plans.

Doctors are leaving both Humboldt and Del Norte counties. That's the bottom line according to CMA board member and Crescent City urologist Mark Davis. And it is because of the bottom line that they are wanting to leave, or taking early retirement. "It's difficult in Crescent City for people to find a primary care physician," Davis said.

Meeting with reporters in a wide-ranging conversation June 20 were Dr. Luther Cobb, outgoing president of the Humboldt-Del Norte County Medical Society; Dr. Ellen Mahoney, incoming president of the HDNCMS, Davis, the District X trustee for CMA; Dr. Kate McCaffrey, membership chair for HDNCMS and medical society board member Dr. George Jutila. They were hosting the visit of Dr. Richard Frankenstein, candidate for president-elect of the state medical association.

McCaffrey showed a color brochure the society has made to help recruit new physicians to the North Coast. But Cobb said that 60 percent of new California doctors don't train in California and that most physicians begin their new practices close to where they did their residencies. Graduates go into the job market with some $120,000 in student loans, a mortgage-sized debt, but no where to live, said Frankenstein.

The biggest issue facing the bottom line for all physicians, the panel agreed, was Medicare/Medi-Cal reimbursement rates which are at the lowest rates ever and are projected to be even more reduced by 2015. When 45 percent of a physician's practice is in Medicare or Medi-Cal business, they have to make up the difference in rates to people who can pay them.

"There's a looming imbalance between the need for care and the resources to pay for it," Frankenstein said. Medicaid (Medi-Cal in California) hasn't updated its price schedule for 25 years; Medicare for the last seven years."

With advances in medicine, physicians have so much more to consider in treating diseases that once were considered untreatable, Frankenstein explained. Also, medicine has become so much more complex, with specialties growing and new technologies that require more visits per year.

They also have to spend less time per patient, a fact that frustrates McCaffrey, new to Arcata. "Reduced reimbursement means that I'm forced to see four people per hour, and in 15 minutes I can't educate people or do prevention," she said.

Another factor Mahoney explained was that rural physicians are paid from 10 to 30 percent less than in metropolitan areas. Jutila said that in negotiating payments from insurance companies for the 320 members of the Humboldt-Del Norte Medical Society, he can't get as high a payment rate as can someone in a larger area who negotiates for 3,000 physicians.

Solutions

• As long as the power to pay physicians is in the hands of for-profit insurance companies and medical providers who owe fiduciary responsibility to their shareholders and not to the physicians' patients, the system will continue as it is - and ultimately reduce the number of physicians willing to practice in the system.
• As long as the power to set Medicare and Medi-Cal rates lies with the state legislature and the federal government whose priorities keep health care spending in the "discretionary" column and not in the "required spending" column, rates will continue to fall farther below anyone's reasonable standard of reimbursement.
• The Humboldt-Del Norte Medical Society members are creating a coalition between themselves and their patients to become a stronger lobbying force with the legislature and intend to create stronger leverage for change.
• Society members Mahoney and McCaffrey are also participating in the Health Advisory Committee, which includes the Community Health Alliance, physicians, health care workers and county officials who are beginning conversations about the possibility of creating a health care district.

Whether or not it ever becomes a taxing district to purchase or operate St. Joseph Hospital, one of the ideas being explored, the strength of the collaboration could build a health care system that everyone in the two counties - physicians and patients alike - could participate in. Mahoney said that the committee is getting support and encouragement from Rep. Mike Thompson's office to continue creating what could become a model for other rural counties to follow.