— from David C. Shinstrom, M.D. —
This letter is to the residents of Orcas Island in the hopes of educating you on the dire situation that is evolving in our medical community. We need people to start taking more interest and actively promote a medical system that will benefit ALL residents and not just a few.
Orcas Medical Foundation hosted a community meeting last Wednesday. Debra Gussin from UW Neighborhood Clinics presented a status report of the discussions between these two groups about a possible management of the Orcas Medical Center by UW clinics. You can read the details of the meeting [HERE]. I attended the meeting and would like to share several concerns.
First I would like to present some history. Prior to 1992, there was a revolving door of physicians on Orcas, they would leave after a short time because they were working too hard or not making enough money. The Orcas Medical Center was built with donations by the community in the hopes of halting this turnover. Having a rent-free building to house a medical center was hoped to greatly enhance the possibility of financial survival. I was the first employed physician to work in the medical center starting in 1993. The charter of the medical center was to treat all Orcas residents and visitors. Over the past several years the board of the medical center, (Orcas Medical Foundation), has ignored the original mission which has resulted in a significant number of patients being denied access to the community-owned and -built medical facility. Currently, 75% of Orcas residents do not get health care at the medical center and more recently visitors are being turned away.
Next I would like to discuss finances. Since its inception, the medical center has lost money, usually in excess of $200,000 per year. For the first 10 years, that loss was absorbed by Island Hospital who ceased managing the medical practice in 2003 because of said expense. Since 2003, the loss has been covered by subsidization from the Orcas Medical Foundation who has spent in excess of $4,000,000 over the past 13 years. Island Hospital returned to manage the practice in 2011 and recently has, again, withdrawn because of the financial losses. I refer you to an article that appeared in The Sounder August 13, 2003 where a consultant concluded that a medical practice cannot survive on Orcas without subsidization. Nothing has changed since then.
I believe the possibility of UW Neighborhood Clinics managing a UNIFIED medical practice on Orcas is an outstanding prospect. You will note that I say unified, which means a medical service that would be for the majority of residents and not for the minority of residents. If, however, the Orcas Medical Foundation continues to pursue their singular approach to provide medical care for only 25% of the Orcas residents and no visitors, no after hour care, with only one doctor and one mid-level provider on staff (this is what is being proposed), there are still significant barriers. The fact that the proposal would only afford two medical staff again raises the possibility of overwork and the revolving door situation. There is a severe financial burden that someone has to pick up. UW will not take on any financial burden. If you read the summary of the meeting, $750,000 needs to be raised by January 15, 2017, for anything to proceed and even then it may not. Orcas Medical Foundation has created a fund to raise these monies. If the $750,000 is raised for start up transition, up to $300,000 each additional year would be needed to sustain the medical practice in the condition as stated above. Remember, there is no after-hour care addressed in this plan. At the meeting there was discussion of an effort to put to vote for a hospital taxing district in November 2017 to cover the ongoing expense. My assumption is this hospital tax would only benefit the Orcas Medical Center patients.
My major concern is that the Orcas Medical Foundation seems to be pursuing this agreement to take care of only the patients of Orcas Medical Center. As I noted above, this is roughly 25% of Orcas residents. I believe this is unacceptable. If things stay as they are, I will be encouraging my patients to not donate to the fund for UW Neighborhood Clinics, and if it came to a vote for a hospital taxing district that would only benefit Orcas Medical Center patients, I would encourage a vote of NO.
In order to bring some clarity to this situation I will give a brief overview of my clinic. It is a nonprofit, rural health clinic medical practice. We have three medical staff, two registered nurses as well as a fully functioning office staff. We provide after hour and weekend care (working in partnership with Dr Russell), so that the load is divided four ways, thus hopefully preventing burn out. We carry a heavy patient load, probably over 45% of the Orcas residents, and do not turn visitors away. We pay rent, Orcas Medical Center does not. I have worked for almost thirteen years in my clinic for basically no pay because my belief to provide a sustainable medical service to all residents is so strong. I am most passionate on this belief but now I need support in order to make it work. I urge you to do something to help or Orcas Island may well end up with very limited medical care if any at all. I have offered to merge my practice with the Orcas Medical Center and have been rejected. Merging would provide better ease of coverage as more medical staff could be supported by the higher patient load. A unified practice with one goal would encourage donations to the UW transition fund and votes for a hospital taxing district.
We need to unify the medical care for the entire community back into the Orcas Medical Center as originally conceived. This could be our chance to set up a system that provides a long term sustainable medical system for the majority of the island.
Now it is up to you, Orcas residents!
UNIFY! This is silly, get over whatever the bias for the good of ALL Orcas
Agreed.
Extremely cogent and well argued. As a physician visiting Orcas and considering retirement here, this discussion is important and helpful. I look forward to meeting you.
Excellent description of the proposed plan and why it is not a feasible solution! The three Orcas medical groups must work together to provide the care we need. There must be a way to address this together for the entire community!
I was at the meeting at Orcas Center on the 16th when members of the Orcas Medical Foundation and UW Neighborhood Clinics talked about the proposed plan to continue medical services at Orcas Medical Center. After listening to the whole presentation I was honestly bowled over and thrilled that this marvelous opportunity is within reach of our community. I applaud Orcas Medical Foundation for looking to the future of medical care on Orcas and trying to establish a relationship with UW Neighborhood Clinics which has the opportunity to benefit all residents of Orcas Island for many years to come. So I will be supporting the fund which has been established at Key Bank.
Once again (or should I say, still) the same old problem exists and there seems to be no end in sight. The group running the medical center seems to be refusing to loosen their hold on a building we all poured money in to have built for our community. How sad that they are so stubborn they can’t see their own noses in front of their faces. They are being offered a golden opportunity, and yet after all of these years they are two damn stubborn to even try to make it work.They need to remember it is our community’s clinic, not theirs to run as they see fit. Haven’t they learned anything yet? Don’t they realize they’re the problem? I also have a very strong feeling that it wasn’t just long hours and low pay that drove other physicians away over the years.
My late husband retired do to health issues after fifty years in practice as an Osteopathic Physician and Surgeon, including, but definitely not limited to delivering over 3500 babies, including one here on Orcas. He was the first DO to serve on the US Surgeon General’s Emergency Health Preparedness Committee (selected by President Nixon),worked on and received honors for Civil Defense, President of the Washington Osteopathic Medical Association, President of the King County (Seattle) Osteopathic Medical Association, and served as President of the Board at Standring Memorial Osteopathic Hospital in Seattle. Even with the credentials he had and the honors he had received he was told he could never work at the Medical Center – – – because he was a DO and not an MD. Interesting because DO’s actually have additional training that MD’s don’t have in osteopathic manipulation. And, DO’s have all the same specialities that MD’s have. Just another discriminatory act on the part of our community medical center. Seems to me many who have run the center aren’t very well educated, besides being bias. One local dentist years ago was shocked when he found out my husband removed a cyst or something in our office and said he wasn’t licensed to do that. WRONG! He was licensed as a “Physician AND Surgeon”. And he never hesitated to make a house call when called on to do so.
Last, but not least, I hope the group running our medical center gets their act together before it’s too late. This disorganized system has gone on far too long. My late husband also had the largest medical practice in West Seattle for over thirty years, had seven full-time employees, worked five full days per week plus made weekend rounds at our hospital, emergency surgeries, and delivered those many little ones who usually decided to come into our world in the middle of the night. Yet he would still be up by 6:00, make rounds around 7:00 and be in his office by 8:00 almost without fail.And his practice made money.And, he sure as hell never turned away tourists, even including a couple of famous movie stars. One other patient was so high up in government my husband’s office was surrounded by FBI. Our med center could have learned so much from him. He truly cared about people. The year before we moved here he had a double coronary bypass. After moving here he had his lower lip removed due to cancer, and later within the period of a little over a year lost both legs because of Diabetes. Even when Dementia set in he was still a doctor in his mind. The ladies at the Convalescent Center in Friday Harbor loved him and said when he talked about medicine he still made sense though he no longer recognized any of our family members. When he passed away sixteen years ago after almost four years in the convalescent center many who worked there came to his memorial service to honor him.
I realize this wasn’t supposed to be about my late husband, but maybe after reading this someone will get the idea across to our medical center that they can be successful if they just cooperate with other doctors here on the island. After this many years they should be making money, not operating in the red. They need to set aside their stubborness and whatever other reasons they have and cooperate to make this a great medical center for the community. And the doctor or doctors who are practicing there should remember the oath they took when they became a doctor and quit turning away tourists. What kind of doctor refuses to treat people who are sick or injured?
why is OMF unwilling to merge?
I too attended last week’s meeting regarding discussions between OMF and UW. Ms. Gussin, the rep who came from UW, oversees the creation and
staffing of UW’s neighborhood clinics and has deep experience in the costs of such clinics. She was quite clear on the matter of how many patients are necessary to keep a medical practice in the black.
She explained that even if Orcas had only one unified practice, the population of Orcas Island, including summer residents, is far too small to keep such a practice
on sure financial footing. In the past, generous individuals have met a very large deficit every year.
I think doctors should be paid and islanders need access to primary physicians. To insure those outcomes we will need to create the kind of hospital district tax base that San Juan Island has achieved. We need to continue the community spirit that first created the OMC and its community supported building.
I agree that it would benefit all residents to have a united front within our healthcare community. Healthcare is changing rapidly and the ability of independent practices to deliver quality, affordable healthcare and have the bandwidth to adhere to new regulations from commercial payors and Medicare is only going to get more complex. I sincerely hope that we can come together on this critical issue as it will have a tremendous impact if we don’t.
Unification is the only logical solution. One cannot defy gravity forever.
I do not believe there is value in publicly debating many of the claims made in Dr. Shinstrom’s letter above.
That being said, I strongly agree with Dr. Shinstrom when he says: “I believe the possibility of UW Neighborhood Clinics managing a UNIFIED medical practice on Orcas Island is an outstanding prospect.”
I encourage all those who are involved in deciding who will participate in this affiliation to make every effort to unify the practices in our community-built medical center. If I understand the model that is being proposed, UWNC would be responsible for deciding who the providers would be in the clinic. It would be important for the Orcas Medical Foundation to lend its support for such a unification. It’s the right thing to do. It will improve service to all the members of our community and create a financially sustainable future for the provision of medical care on Orcas.
With all due respect to both Dr. Shinstrom and OMF, there are several issues which militate strongly against a unified practice. Not all of them are personality-conflict based.
However, although conflicts exist, there could still be a unified medical building, containing two, or even three, separate practices, and thereby some money could be saved while friction is avoided.
The separate medical practices would be staffed separately, too, sharing only maintenance and janitorial services, and maybe utilities costs. There need be little or no interplay between the separate staffs.
To accomplish this, some modifications would have to be made to the existing building. These should be neither extensive nor terribly expensive.
The result would be like a big-city medical-offices building, containing separated individual-practice offices, but much, much smaller in scope.
Since I was unable to attend the meeting, I offer this suggestion here instead. I request that it be considered carefully.
Thank you Ginny Reagles for your wonderful touch of history and thoughts regarding the problem at Orcas Medical.
Apparently no one from Orcas Medical was at the meeting where Ms. Gussin shared the experience of UW Neighborhood in regard to population and finances required to maintain a proper primary medical facility. In 20 years, Orcas Medical has gone from 100% of the patients and income to 25%(+/-) of the patients and not enough income to survive. So.. as Sandy asks, why do they resist a merger with Orcas Family and extend an invitation to Dr. Russell? A merger relieves the immediate problem and buys the time needed to create a sustainable primary care facility for Orcas Island. The offer from UW Neighborhood is interesting but one would have to ask if Orcas Medical can raise $750,000 by January 15 and then $300,000 +/- a year for the privilege of partnership, where is the value to OM patients? Sure, UW Neighborhood has many unique services but so does Peace Health and several major facilities in northwest Washington and membership isn’t required to be a patient – only a referral
I was at the meeting and would like to see the Medical Center’s response to this letter. I don’t dare express my own take on this letter.
I presume “unify” means all three Orcas doctors sitting down and hammering out how they would all work together at OMC and then putting it into practice. Sounds like a dream come true. Why doesn’t OMF want the merger?
Steve Henigson–I am interested in the idnetifying the issues that you describe “which militate strongly against a unified practice.”
Based on my 40+ years in the healthcare arena, it has alway been a puzzle how three separate practices could exist here with such a small patient base.
It would seem that one benefit of merging the practices would be reduced overhead, through shared space, staff and equipment. Having three separate practices would require PAs, nurses, clerical staff and billing for each practice.
I’m not sure that personality conflicts should be allowed to prevent the appropriate use of a community facility. If the OIMC is large enough to accommodate the three physicians, I see no reason why the three physicians in the community shouldn’t practice there.
*interested in identifying the issues
Does the Medical Center Board think that money grows on trees here? $750,000 by January and $300,000 per yr? Apparently so.
If the three Practices work out of one office, the medical Center, which was built for the good of ALL, what is the Problem?? Thank you Dr. Shinstrom for your insightful article.
Ginnie Reagles: Thank you for the information about Dr. Reagles! Truly amazing how such a qualified man was given a hard time by the established medical community!
It sounds like we islanders would have to shell out more money for this merger. We’ve had years of throwing money (taxes)at problems rather than using logic AND compassion.
I have a friend who went to the Medical Center and was “dressed down” (in front of others) for not having Medical Insurance which is not affordable for everyone! I was surprised that one member of the Board is the Head of the Chamber of Commerce and yet the Medical Center doesn’t always treat visitors.
Art Lange’s comment re: a public debate, this is Exactly where it needs to be! People sharing their views on a subject and transparency is vital to a healthy, growing community! Remember OPALCO’s sneaky, way they bought Rock Island without telling the Members first? We do not need a repeat of that!
Spirit Eagle
I appreciate Dr. Shinstrom’s letter and the ensuing comments on this important issue of quality care for islanders. As a newcomer I’ve heard comments about the “politics” preventing cooperation between the medical centers, but until now this issue has been handled by vague innuendo or off-the-record comments, and the stakes are too high for that. Upon reading about the projected costs provided by the UW Neighborhood representative, my immediate thought was the same as voiced by Dr. Shinstrom, Peg Manning, and others, which is the obvious cost efficiencies of consolidation of care. It would be helpful if opponents of this idea would voice their objections in this public forum, as opposed to asserting that other issues mitigate against this idea but not laying them out. We newcomers to the island don’t have access to the oral history you all share.
A final comment about the costs, the present value of the annual projected cost of $300K plus the nitial investment exceeds $3 million over a ten year horizon. Too many requests to burden the tax base in some places has resulted in pushback and ultimately the overall infrastructure suffers.
We should all be very concerned about any loss of medical care for our community. However, spending up to a million dollars to have a relationship with high tech UW would be of minimal benefit. Why would we spend so much to receive so little.
By most formulas for provider to patient ratio in primary care, Orcas Island has an abundance of providers (American Academy of Family Physicians). The typical panel size for a PCP is approximately 1500-2000 patients per provider, (physician, PA, NP). Orcas has a ratio 875:1, counting full time residents. Additional capacity may be warranted by our fluctuations in population (tourist season) and the fact that rural practice takes a heavy toll on providers. Many hours of urgent and emergency coverage and often more patients seen after hours than during office hours, leads to burnout. Rural practice is low volume and low pay. Rural medicine always requires subsidy.
Orcas residents already contribute financial support to OIFHC. As a Rural Health Clinic it benefits from federal dollars. So why when there is this support do we have competing medical practices and redundancy in foundations, bricks and mortar as well as staff? I suggest merging all practices into one for the obvious financial advantages. We could do this under the umbrella of the Rural Health Clinic and then determine if we need a Health District tax.
Lynn Caton, PA, MPAS
Past Congressional Health Policy Fellow
Retired Assistant Professor OHSU Family Medicine
Participant in 1976 study leading to the Rural Health Clinics Act
I am incredulous, AND concerned. I am now 73+ and find that I need medical help more than in years long past.
SO …. I would appreciate information on several questions.
Who is The Orcas Medical Foundation? Did we all vote for community members to serve on that board like we do for OIFR, the School Board, County Commissioners, and so forth? What has been the experience with the Hospital District on San Juan? Its affiliation is with St. Joe’s. Can that District be expanded to include Orcas and the whole County?
The Medical Center is still having a persistent turnover of medical professionals. WHY? This issue becomes increasingly important as the population of Orcas ages. Another element of our medical care is OIFR. They cannot be forgotten in the discussions of blending medical care for all residents of the island.
The current situation is totally unacceptable. I suggest that a representative group from the community be assembled to include medical professionals, and experienced community leaders to work through this issue. It needs to be an independent discussion from OMF.
I am really needing to have answers !! The individual Doctors, all of them, should be commended for their dedication and service to us all !!!
It is time to put politics aside and find the proper solution to our Medical Care Issue.
Thanks to Dr. David Shinstrom to have the guts to bring his views and solution forward .
For the OMF to propose a ballot initiative for hospital taxing district that supports only the Orcas Medical Center and excludes the other two medical practices on the island seems not only a waste of available resources but also grossly unfair to the 75% of islanders who do not use OMC. Without a real public discussion of some of the issues raised by Dr. Shinstrom and other commenters before talking about partnership with UW or how to finance it, OMF is putting the cart way out ahead of the horse.
Hold your horses. Stop the presses. I am seeing a lot of comments based on assumptions, speculation and inaccurate statements. I was at the meeting where the partnership with UW was talked about. That was the purpose of the meeting. Someone from the audience asked about a hospital taxing district. There were no statements made by Orcas Medical Foundation taking a position on a hospital taxing district. You can see in Dr. Shinstrom’s comments above, “My assumption is this hospital tax would only benefit the Orcas Medical Center patients.” Somehow, Dr. Shinstrom’s “assumption” has been accepted as fact by some people. We need to all take a step back and hear what the Orcas Medical Foundation has to say. On a further note, I am familiar with the statistics regarding the number of patients who use Orcas Medical Center. For the most recent year for which there are statistics there were more than 5,000 patient visits made by almost 2,000 separate patients. This, obviously, is far more than 25% of residents of Orcas Island. Let’s slow it down everyone. We’re all in this together.
We have some pretty bright medical minds on this island. From doctors, to service managers, to lawyers to accounting professionals. All very well versed in the topics of medical practice operation.
It is time, for a group of those minds that are unaffiliated with any of the medical organizations to sit down and do an honest, non-biased analysis of the real statistics relating to medical care and need on the island. Lynn (above) has made some very simple, yet important statements.
The Medical Center facility was built well before my time on the island but it is, like many of our institutions, an asset that belongs to the “Community”. I cannot see spending $1 million today to obligate my community to a $300k bill for the rest of the foreseeable future only to continue with an unsustainable three provider model. Without there being a proper analysis of all available options, any plan is a foolish one.
I would call upon a group of 4-5 medical professionals, totally unaffiliated with the current institutions to assemble a review team. I would call upon the three current institutions to make their full books and operational information available (within HIPA regs). I would call upon the practicing doctors to be willing to openly discuss the needs of their individual practices and their willingness to coorperate/collaborate. Finally, I would call upon everyone suffering from old wounds (pun intended) to step back and allow an honest process to take place.
The withdrawal of Island Hospital presents a fantastic opportunity to right the ship of medical care on Orcas. Let’s not waste this oportumity.