— from Alison Shaw —

The Quandary:

We have three practices on Orcas directed by three MDs. All three struggle at times to make ends meet and depend to some degree on personal and private contributions. Dr. Shinstrom manages by taking little or no salary. That’s extraordinary! Dr. Russell, as described so eloquently by Michelle Russell in an earlier comment, manages carefully on whatever his practice brings in. At OMC, shortfalls are made up by generous member contributions. All of the providers and their staffs work very hard and very long hours. Orcasians, I fear we don’t realize how they spoil us! We expect our doctors to be there every day, working well into each evening to complete our progress notes, review our lab results, renew our prescriptions, and then be on call for us every night and weekend. Not to mention keeping up with medical journals. We are blessed that our MDs are willing to work like this, even at the risk of their own health (and doctors are notorious for neglecting their own health). But think for a moment: Even though we have come to expect and rely on their sacrifices, is it fair to them? Do we want our docs to work so hard they’re exhausted when they see us in the exam room? Do we want them to take care of us when they are sick, because they have no back-up? Do we want them to take vacation only once every few years? Do we want them to neglect their families every weekend because they’re on call? Be honest: would we work like that? For decades?? Our doctors take such good care of us, 24/7. Should we not return the favor by supporting them??

Health care is at a very difficult crossroads. There are a lot of coinciding pressures on the system. Aging baby-boomers require more health care services. The expansion of Medicaid has brought more patients into clinics, many with complex problems that place greater burden on clinics for very little reimbursement. At the same time, there is a reported shortage of primary care physicians; they are in high demand. And the next generation of physicians is not generally willing to sacrifice their family lives by being on call half the time, or more. (The normal amount of call in a mainland group practice is once every 5-6 weeknights, and one weekend per month.) Add to that, many of them are starting practices with more than $200,000 in medical school debt. They will not be able to work for free. On Orcas, both Drs. Shinstrom and Giefer are nearing the end of their careers. Both love their patients and the practice of medicine, and both might like to practice on a reduced level for a few more years. But soon we will need to recruit new physicians. Will we really be able to attract quality physicians to a remote island that offers dubious financial stability, far too much after-hours call, and limited professional employment opportunities for spouses? Compared to what physicians can find on the mainland, how attractive is that? We need to realize our doctors are overworked in the current set up. If we stay the current course, I believe we’ll be severely challenged to find good replacements when they retire.

Some Solutions(?)

Many folks have commented on this topic in Orcas Issues; it seems a majority would like to see a merger of practices. The message I’m hearing is that it’s time to put aside old differences and collaborate, that the old differences are hurting us, hindering us from moving forward.

Some have said there would be no economic value in merging, but I disagree. Some cost efficiencies could be realized. There are eight exam rooms at OMC and now there is room for three nurses at the nursing station, plus a desk in the lab. Having worked there so long, I know the building well and could envision three providers there at one time. It would be full, but with careful planning it would work. Yes, there could be some savings in a merger – but not enough. The services provided on Orcas are similar to those of much larger practices on the mainland, but without the benefit of economies of scale. The provision of urgent care is costly and draws staff away from regular practice. And these days, providing coordinated care means much more paperwork, requiring more staff time. Also, the costs associated with electronic records and IT are here to stay. All these extras are expensive and are not sufficiently covered by insurance reimbursements.

That is why I would strongly support collaboration with the UW Neighborhood Clinics (as per my earlier letter) and the creation of a hospital district on Orcas. I would envision a hospital district that could support merged practices as well as some other things we need, such as staffing for an on-call nurse for the urgent care area. Perhaps even the expansion of the urgent care area so it can dovetail better with our EMS. Maybe even a fund to help folks who are still uninsured or have high deductibles. Let’s imagine what we could achieve with money from a hospital district that would benefit all medical services on Orcas and give our doctors the support they deserve. I’ll bet there are some wonderfully creative ideas out there! Please think beyond what is and imagine what could be. If we can pay to support our library and our school, our parks, and heaven knows what else, how can we fail to support our health care?

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