— 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?
Well said, Alison…and timely with the information we just learned that the Medical Center will have to come up with quite a bit of $$ in order to get us to the place you envision. How will we do it?
I, too feel that UW Neighborhood Clinics is the best choice.
But OMC did recruit a “quality physician to a remote island” and just as quickly kicked her to the curb. (Camille Fleming). Why? I don’t know, but she was just the most recent in a long line of good physicians to leave after a short time. Unfortunately, OMC doesn’t have a lot of credibility left to make the case for UW Neighborhood Clinics, whatever their merits.
That’s a good question, Ann. I retired 7 mos. before she left so don’t know the details. Also, only Dr. Fleming can answer that question with full accuracy. The rest of us can only speculate, which is dangerous. However, I would not lay full blame at the feet of OMF. Remember she was an employee of Island Hospital. Her contract would have been up for renewal. I miss her too – maybe with UWNC and a hospital district in place on Orcas we could lure her back……
Margo,
How many MILLIONS of dollars in how short of a time period did Orcasians come up with to buy a MOUNTAIN?????? I don’t believe it is the money that is the major problem.
Healthcare for our future is at stake here.
I personally feel the only reason a taxing district wouldn’t pass in the future is because some will not be happy about it for SOME of the wrong reasons. Some will just do what others tell them to do and some will just be angry. It will be an interesting process to watch. But we are sending our donation in today and will support any other fundraisers for this very important cause!
Maggie
We need to start discussing the elephant in the room. Why can’t OMC retain qualified staff? We haven’t been on island long enough to know much of the history; I was surprised to learn that the OMC building was built by the community. Is the community in charge, at the top level, of the OMC opperation? What level of control can/does the community exert over the management of OMC? What changes can the community make so that we can retain the qualified staff that we attract and promptly loose?
Much of the discussion so far has been about the infrastructure improvements that UW would be able to bring to the table. But the single most critical piece of infrastructure is the human piece. Until the human aspect is resolved, changes in the technological aspect will be of little long term help.
this program was previously active….maybe it will reopen if the needs are re-evaluated?
Chris Wilkins
360.753.7794
health@wsac.wa.gov
The Washington State Health Professional Loan Repayment Program offers loan repayment assistance for primary care health professionals who agree to practice in a shortage area of Washington. Recipients must agree to serve for a minimum of two years.
Mismanagement by the current Health Center has resulted in problems retaining physicians ( the pay/billing system was one cause; too much call another.)
I practiced as a CRNA for 42 years, many of those years in small rural hospitals. I’ve seen and felt the pressures of 24/7 call; it’s unreasonable to expect physicians, nurse practitioners or RN’s to shoulder that burden. But merging practices ain’t gonna git ‘er done!
UW managing seems the best solution ; they benefit by helping train their residents– who NEED to experience what small rural practices are like; Orcas benefits by overall better medical care. It’s generally understood that UW is among the first , perhaps in the world, certainly in the USA, in primary physician education.
I have seen outlying clinics aligned with major medical centers work very well elsewhere. Perhaps the establishment of a hospital tax district on Orcas would prove the best solution.
Orcas attracts physicians because it is a marvelous place to live, to raise children…but the economics make it difficult. The cost of maintaining an office, paying staff are high.. no stipend can provide them with anything near that which a similar mainland practice could. We are fortunate, and appreciates our physicians, who love Orcas and our very caring community, and bear the financial burden of staying.
But appreciation doesn’t buy groceries.
Jim, thanks for your comment! There are so many factors that impact whether a doctor chooses to stay or not. Choices are often made the way WE make them during our careers: is this job right for my career? Can I grow in this job and will I have opportunities to explore new areas in my field? Is this location good for my spouse and will s/he find meaningful work here too? Are the school options right for my kids? Can we manage this financially? Are the logistics of getting to the mainland just too much? Is the chemistry right with my colleagues? Getting a great doctor on Orcas is a challenge – from start to finish, it took 16 months to recruit Dr. Fleming! Retention is another matter and to keep people here, we need to provide good incentive. Sometimes, you just can’t come up with what’s needed. Perhaps this is another reason to consider a hospital district. And I do believe doctors would be attracted to a UW Neighborhood Clinic, if we had one inplace here.
Alison, a complete and very good posting. But….. can someone please tell me what UW Neighborhood can offer patients care that they (we) don’t have now?
We have the fastest and best transport to critical care facilities possible, between the highly dedicated and fully qualified three doctors on Orcas plus the staff in Friday Harbor we have 24 hour access to physicians, not interns, we have full access to medical records regardless of where they were administered, we have local x-ray and a bunch of other things. What we don’t have is a truckload of administrative paper work designed for huge medical centers to protect them from malpractice claims and more important we don’t have enough population to need that kind of technology and we don’t have the facility or a plan for the contingency of losing one or more of our three doctors to retirement or incapacity. They need to get together for sure and take more advantage of our doctors’ present ability to attract fledgling doctors from UW and elsewhere for the future
Are there currently any physicians at OMC? Was Dr. Fleming the only physician practicing there?
Peg, Dr. Giefer is still at OMC, practicing full time. He’s been there since 2005.
Charlie, you’re right that we have great doctors and a wonderful EMS, but please read again my thoughts above regarding the difficulty going forward, especially when Drs. Giefer and Shinstrom decide to retire. Also, please read Dr. Dale Heisinger’s recent guest column in Orcas Issues. From the outside, all seems well. From the inside, the clinics are stressed in various ways. I deeply believe that we all need to come together to find the best way to go forward.
What would be the next action in asking local residents if they would support creating a hospital district to help fund EMS going forward?
Even if we manage to raise the upfront funds to get on-board with UW Medical, we will need the ongoing support tax dollars that hospital district affords.
I meant OMC not EMS.
How do we get more information about the Foundation and the Medical Center, their mission, their restrictions, and how public funds would be handled?
Yes, Alison, the doctors need to unite for sure and I have no doubt that if the manner in which they unite were in the hands of only the doctors it would happen and the future would look a lot better for all of us. But……Orcas Medical Foundation will probably raise the money needed to make another financial arrangement that doesn’t solve the problem relating to patient care.
Jim’s comment about the elephant in the living room resonates with me…
Good thoughts from everyone, and I remain grateful for your staying engaged on such an important topic. Orcas Medical Foundation (OMF) seems to be perceived in a negative way, starting (probably) in 2003. Having worked with a number of board members over the years, I can say that most were great folks to work with and were all committed to the idea of providing health care to all islanders (yes, all). In 2008 they provided a 3-year, $100,000 grant to subsidize office visits for islanders who were uninsured or underinsured. I loved administering that program! At the end of three years, more funds were made available to help folks in need. However, OMF may not have been as successful in reaching out to everyone as they would have liked.
Now it seems we have three wonderful opportunities before us: 1. Getting a UW Neighborhood Clinic on the island, 2. Merging the practices so we can be unified and thus stronger, and 3. Creating a taxing district that would provide the additional financial support needed to make it work. Clearly, I feel pretty strongly about this. I deeply hope we can pull it off and not bungle it somehow by dwelling on the past and failing to look to the future.
Some extra thoughts:
1. If we could create a taxing district, we would have elected commissioners who would be responsible to all islanders for carrying out the mission of the district. That could alleviate OMF from the burden of involvement in securing a medical practice in the OMC building. OMF’s mission could then return to its original one of owning and maintaining the OMC building.
2. Two more benefits of having a UWNC on Orcas: the UW provides great benefits for its staff, which leads to stability in employment (good jobs). And a UWNC could be more attractive to physicians considering working here.
Thanks for putting up with my lengthy comments!