Recruiting primary care physicians to Sonoma is critical – but difficult

Ellen Akre is looking for a few good primary care physicians.
Akre, director of physician relations for Sonoma Valley Hospital, wears a lot of hats, but one of the tasks she’s been focusing on lately has been recruiting physicians to the Valley.
“It is so critical because primary care is the gateway to medical services,” said Akre.
She considers her biggest challenges the high cost of living in Sonoma coupled with declining Medicare reimbursements to primary care physicians. The uncertainty around the hospital’s future and the political climate have also been deterrents to recruitment.
The pressure is on because of the 16 primary care physicians currently in the Valley, seven are nearing retirement, and several are already working part-time.
Earlier recruiting efforts by the hospital brought three physicians to the Valley – Dr. Brian Sebastian, Dr. Subhash Mishra and Dr. Diane Weissman, who recently left Sonoma and moved to New Mexico.
There is currently a nationwide shortage of primary care physicians coming out of medical schools, with more graduates specializing in fields like radiology and dermatology, which offer both better pay and more regular work hours – a critical lifestyle issue for many doctors.
Primary care physicians don’t earn as much as specialists, and they often spend hours on paperwork and phone calls to the insurance companies. Their fees are fixed by Medicare and insurers, so the only way to increase revenue is to take on more patients, cutting even more into the time they can spend with each patient.
Marcy Territo, director of special projects for Prima Medical Group/Marin IPA, is trying to attract primary care physicians with a new model that lightens the burden of overhead and wrangling with insurers. Prima started in November of 2005 and added Dr. Brian Sebastian’s office in Sonoma to its network in October 2007. Dr. Weissman also utilized the network before she moved.
“The goal of Prima is to take all the administrative and day-to-day things over so the physicians can focus on practicing medicine,” said Territo. “A lot of physicians coming straight out of medical school haven’t been trained in managing a practice.”
Because Prima represents a larger group of doctors, it can negotiate higher Medicare reimbursement rates than the doctors might get on their own. It can also offer better health insurance to the doctors and the employees at their practice.
Prima has tried to pick up one doctor or practice in each market like Larkspur or Mill Valley and hopes to attract another primary care physician to work in Dr. Sebastian’s practice. Prima takes out advertisements in American Academy of Family Practice, posts on the internal medicine job board, and follows up on referrals.
Territo looks both for doctors with existing practices and for new doctors trying to set up. She looks to place new doctors with more experienced doctors so that they have mentors. Prima and the hospital work together on recruitment. One tool the hospital has for attracting doctors is that it can help guarantee a salary as the physician is getting on his or her feet and building up the practice.
Akre said Sonoma Plaza Pediatricians had recently hired a new physician and that the hospital is optimistic about finding a primary care physician soon.
Sonoma Valley Hospital recently started exploring a new employment model called 1206D that the administration hopes could be implemented around the women’s health center. District hospitals aren’t allowed to employ physicians directly, but the 1206D structure sets up a system with some of the same benefits of Prima.
Since September 2008, Akre has also been working with the new physician business-planning group that is looking at a lot of the big issues. “Having a core cooperative medical culture is key for bringing in physicians,” she said.
Sonoma Valley Community Health Center, the Valley’s health clinic, is also recruiting for a full-time family practice physician. According to Patricia Talbot, director of the clinic, a recent offer to a physician was turned down, but recruitment efforts are still underway.