— from David Shinstrom, M.D. —
I would like to take this opportunity to respond to several requests I have received to present the history of my time here on Orcas and how we have arrived at the current situation.
First, a little about me. I was born in Kirkland, WA, went to Camp Orkila a couple years, and got to know Orcas well through several family visits. I went to Whitman College in Walla Walla, medical school at the University of Cincinnati and family medicine residency in Augusta, Maine. My first job was at the hospital in Forks, WA for five years. I was then asked by my residency director to return to Maine as a faculty for the Maine-Dartmouth Family Medicine Residency where I was faculty of Dartmouth Medical School. After 10 years I left that job to come to Orcas in 1993.
In a previous letter I summarized the historical difficulty Orcas had in retaining physicians who left either because they were working too hard or not making enough money. The Orcas Medical Center was built in the hopes of being able to retain physicians. I was interviewed by the Orcas Island Medical Building Association (now the Orcas Medical Foundation). They made a recommendation that I should be hired by Island Hospital who would manage the medical practice – which at that time was similar to the current situation which will soon be ending. I was the first employed physician in the new building. There were two other physicians around, Jeanne Olmsted, a pediatrician who saw patients at the medical center two days a week, and Stan Williams, a GP (not board certified) who first came to Orcas to practice medicine in the mid-70s but in 1993 was working off island. I had a strong belief that my mission was to establish a stable, high-quality medical practice. After 23 years, and despite total commitment, my mission to provide Orcas Island with a sustainable medical system has failed. I feel it is due to the reasons listed below which was not of my choice.
Prior to 1993 many patients had decided to get medical care off island due to the previous physician turnover which meant the revenues of the practice were limited, barely $200,000 annually for the year I arrived. For the first four years of my practice, I was the only physician. We would hire locum physicians and mid-level practitioners to help out. The practice grew because of the stability and it was decided to hire another physician in 1997. I convinced a group of generous donors to form the Orcas Medical Support Group who committed to donate $100,000/year to Island Hospital for 4 years which would allow the hiring of two physicians at the same time. I was very invested in sending the message of stability to Orcas residents. Todd Cowdery and Diane Boteler began working in February 1997.
Over the next four years the practice grew with gross revenues peaking at $1.2 million. But, predictably, we were still losing around $200,000/year so in 2000 there was a vote for a hospital taxing district that failed by 47 votes. Jeanne and Stan encouraged their patients to vote no.
Also, during this time, the medical center board (OIMBA) began to be stacked with members supporting Jeanne and Stan. The president, Tom Corbett, asked that I hire Stan. I told him I could not employ Stan because he was not board certified as required by health insurers. Mr. Corbett then went to the CEO of Island Hospital, Phil Sandifer, asking that I be removed. Phil refused to terminate me citing that I was doing an excellent job as medical director. In May of 2000, Phil was replaced as CEO by Vince Oliver. Mr. Corbett made the same request to have me removed and I was fired as medical director at the end of 2000 being replaced by Diane Boteler. At the same time, Todd Cowdery left and Stan was hired. Over the next two-plus years revenues plummeted and losses increased so at the beginning of 2003 Island Hospital announced they would cease management of the Orcas Medical Center practice at the end of that year. Vince Oliver had removed me as medical director in 2000 and cancelled my employment contract the beginning of 2003 but I was able to continue as an independent practitioner using the space at the medical center.
2003 was a very tumultuous year. Diane Boteler resigned in June with two weeks notice. It was determined the medical center board would take over management. There was a lot of pressure from my patients to have me continue at the medical center. There were several meetings in the fire hall attended by hundreds asking the board to hire me. They refused and needed to come up with a reason. In August, 2003, a psychiatrist, Paul Rosenberg, was asked by the board to interview the medical center staff. He issued a report that concluded the staff “unanimously” thought I was disagreeable and impossible to work with. The psychiatrist’s medical license had been suspended for many years by the State Medical Licensing
Board. During his time of suspension he was hired by OIMBA. He received a fee for his interviews and submitted report. I interviewed almost every staff member who said my name did not come up during their interviews. So, clearly it was a falsified report to give the medical board an excuse not to hire me. (As a note here, in my present clinic I have staff members who have been with me for 13 and 10 years, and the same volunteer around since the beginning, and medical students who return for repeat rotations). I engaged a lawyer and was able to read the psychiatrist’s report in his office along with the board president, David Grumney, and Vice President, Bob Lundeen.
It became clear I would not be able to work in the medical center so, at this time, I had three options. I could leave the island which I am certain was the hope of the board. I could sue the board, which, according to the three lawyers to whom I presented my case, all felt it was a slam dunk for breach of contract and defamation of character. Or, I could set up my own practice, which I did almost 14 years ago. I made a slight error in judgement, I did not believe the Orcas Medical Foundation would spend hundreds of thousands of dollars every year to keep their practice viable. As many of you likely have read, I subsidized my practice by taking no
salary for most of the time.
As I said near the outset, my goal for coming to Orcas was to establish a sustainable high quality medical practice. I believe the opportunity is close at hand if we can all agree to find a solution to unify into one practice and work together. Some have mentioned Dr. Giefer and myself approaching retirement age. This is beside the point. The point is I am a long time Orcas physician with great experience in the workings of the medical situation on island and have a wonderful patient following. The point is that I am willing and more than qualified to help get a long-term, sustainable medical practice on track.
Thank you for this Dr. Shinstrom, and for everything you do! Unify Orcas! Do whatever it takes, let’s get this done right asap! No offense to anyone who’s chosen to take “a side” here, but let’s all get over ourselves and seek a unified solution with common sense for the common good. It’s IMPORTANT!
Thank you, Dave. You have not failed. You have provided Orcas with excellent medical care, and have worked hard to extend that care to people who otherwise would not have been able to afford it. There have been years of rancor, unpleasantness and turnover in Orcas medical personnel and boards, as well as occasional bright spots of cooperation. I too am very hopeful that the UW opportunity will help everyone to put the past in the past, and will make good medical care sustainable on Orcas.
Thank you Dave for shedding light on this most unfortunate history…and…for your continued service to the community and positive outlook for the future.
David, thank you for this enlightening history. I always felt there was something amiss that caused the fragmentation of care on the island. I also know that you have many strong supporters on the island.
Up to this point in all of these discussions, the Orcas Medical Foundation has refused to commit to a serious analysis of bringing together 1 or more medical practices.
That is their right but I will say that lacking commitment to a serious review of merging under one roof means that I will not be donating anything to their UW (or any other) venture.
I would also encourage rejection of any initiative to form a hospital taxation district to support the OMF’s operation. If the OMF is serious about desiring to morph into a facility and business that provides care to all islanders they need to change their ways.
It seems to me that one of the primary underlying issues in play here both currently and historically is that we have a medical facility that is owned and operated by an entity which is not in any way medical.
OMF is, at its base, nothing more than a landlord to a building. Yes, it is a great facility to operate a medical practice out of, but thanks to the numerous infractions over the years, it is certainly is not the only building capable of now handling the current patient load.
So, I offer the following as a counter to a $1 million drain on our community’s charitable resvources. I challenge OMF to shutter its doors. Instead of continuing to operate for a minority of patients on Orcas Island, simply shut down. Allow the two other practices on the island to grow their business and continue to serve the needs of Orcas residents.
It’s time to let Doctors be Doctors and Landlords be Landlords. It seems to me that OMF needs to decide which side of that line it really lives on.
I agree with Justin Paulsen on why OMF makes the decisions regarding a medical practice when all they are is the owner of the building and a landlord. Remove OMF and let the three practicing doctors decide and all patients win. Bringing in UW sounds great but do we really need $350000 in upgrades to medical records.
You said: “After 23 years, and despite total commitment, my mission to provide Orcas Island with a sustainable medical system has failed” That is flat not true. Your contribution to the primary medical care needs of Orcas Island’s population, even with the glitches you describe, has been and still is nothing short of remarkable. You cannot be expected to create a miracle and at the same time attend to the medical needs of over half the residents and most of the tourists. And all for sometimes for a little but most of the time nothing.
I join Justin’s offer to OMC He said it better than I can, but how heroic can it get if OMF were to come to the party and in the role of a landlord, offer Shinstrom and Geifer to combine and be housed and pay a reasonable rent in the OMF building. OMC could be moved from Island Hospital July 1st, 2017 to a donated financial management team with Shinstrom managing the medical practice team. With that evidence of stability and funding, the negotiations with UW Neighborhood, Peace Health or even Island Hospital would be on a completely different level – and certainly not one requiring a “buy in fee” of over a million dollar drain in the already over taxed community.
Thanks for getting this conversation started initially – and for the background information many of us were guessing (gossiping?) about.
I so appreciate the conversation around the future of health care on Orcas! However, I do have serious misgivings about Dr. Shinstrom’s claim that he would be able to operate a fiscally sound practice for all islanders. I’m sure his aims are sincere and Dr. Shinstrom has done many a good deed for Orcas patients, but please let’s talk about numbers. Budgeting is my forte; I’ve done it my entire career for NIH grants and contracts, and for medical practices. Expenses of a practice are fairly easy to determine; it’s the revenue that’s unpredictable. What worries me about Dr. Shinstrom’s claim is that his current practice is the fact it has survived because he does not take a salary. If he moved his practice to the Medical Center building and took on all island patients, it would be necessary to hire more physicians. The chances of hiring physicians who would work for free would be practically nil. And doing that over the long term would be even less likely. I also wonder about other aspects of his budget and whether salaries plus health and retirement benefits would be sufficient to retain employees – especially doctors – over the long term? Remember, there is a shortage of primary care physicians and they will not come here for a skimpy compensation package. I’m retired now, but as I recall, personnel costs at OMC were about 80% of the budget. I fear that Dr. Shinstrom, despite his best intentions, would be running his practice at a significant annual loss and we’d all be in the same pickle we are now.
Personally, I’m way more confident that the folks from the UW know quite well the fiscal requirements of running a clinic here. They know it’s not possible to provide the services we need and break even without additional support. The up front cost is indeed high, but remember that the cost includes transferring patient records to a world class, fully integrated, medical record system, EPIC, AND covers operating costs for the first several months while waiting for insurance revenues to start coming in.
I strongly support the UWNC because of its long-term sustainability and superior reputation. AND I strongly support the idea of an eventual taxing district to make up the gap between clinical revenues and expenses. A taxing district could also help pay for urgent care coverage, which is so costly. Some folks view taxes as the greatest enemy on Earth. I see them as a form of INSURANCE that services will be there when I need them. San Juan Island has a taxing district that supports both their medical and EMS services. Our EMS is covered by the Fire and Rescue taxing district, but we have no tax coverage to assist our medical practices. Dr. Shinstrom’s assumption that a taxing district on Orcas would only benefit the practice in the Medical Center building is unfounded. It would have to be be designed by the community to benefit the community for the long term.
In response to Ms. Shaw’s comment. I have reread my letter and no where do I “claim that he would be able to operate a fiscally sound practice for all islanders”. What I did want to convey was that I believe the opportunity is close at hand if we can all agree to find a solution to unify into one practice and work together, which I am willing and more than qualified to do in order to help get a long-term, sustainable medical practice on track. Clearly, no one can operate a medical practice that provides all the care including after hours without requiring a subsidy.
Alison–There is no guarantee that a taxing district would or could contribute the massive amounts needed to cover losses at OMF. A district would have to be proposed, the scope of its undertaking (for example, not a hospital, but then what?) its creation voted upon, and its commissioners elected. Those commissioners then would have an obligation to determine how best to accomplish the goals adopted by the voters. It’s a massive jump to conclude that there would be funds to stanch the losses at OMC.
I’ve posted elsewhere that I think we as islanders need complete information concerning costs, charges, utilization, etc., across all practices on the island, not just the different perspectives presented seriatim without real numbers.
If UW has performed a financial analysis, I’d love to see it, to understand how it proposes to manage the significant losses that OMC and whether it took into account all prospective patients on the island or some subset of them.
This is not a problem that can be solved piecemeal.
Like other commenters, I also have questions about the “bridge” operating money and where the receipts go after claims are processed.
Dear Peg Manning, I posted this on the OMF/UW Q&A Part 2, and thought you might be interested in some of our numbers.
Justin and Ginny—here is some data from Orcas Family Health Center. I LOVE statistics and spreadsheets and analyzing them for trends, strengths, and areas that need improvement; thank you so much for asking! I could go on and on about how much I enjoy this.
As a Rural Health Clinic we are required to analyze our program services annually. I use the previous three years of data to look at trends and to get an idea about what the size of our patient panel is. Not every patient goes to see their provider every year (I use “provider” instead of doctor because Physician Assistants and Nurse Practitioners have become integral primary care providers) otherwise healthy individuals may only go once every two or three years so looking at the bigger picture helps capture those situations.
That being said, here is data from the current annual utilization review I have been working on, as well as a three year summary which shows why OFHC conservatively believes it provides care to over 45% of the Orcas population. The dates are for our fiscal year periods which run October 1 through September 30. Data is from FYE 2014 through 2016. Visits are provider visits; they do not include nursing only visits.
What stood out to me most was that I saw about a 25% decrease in visits generated by tourism last year compared to the two previous years!
Unique individuals who came to OFHC for care during each fiscal year:
2014: 2,348 total, 248 from the San Juan Islands, 382 from other places in the world; all came for a total of 6,813 visits.
2015: 2,341 total, 264 from the San Juan Islands, 396 from other places, all came for a total of 7,346 visits.
2016: 2,188 total, 157 from the San Juan Islands, 291 from other places (~25% visitor decrease)
3 Year analysis FYEs 2014-2016:
4,188 unique individuals came to OFHC for 21,180 visits. 739 came from another San Juan Island, 576 came from other parts of the world.
4,188 minus the non-Orcas patients leaves 2,873 Orcas residents. According to those numbers, and if the Orcas population has been around 5,500, about 52% of Orcas received care at OFHC over the last three years. Since we cover call for Dr. Russell, and we see OMC patients who sometimes can’t get an appointment at OMC, 45% is a conservative estimate of the OFHC patient panel.
The annual data is always submitted with our 990 tax returns which makes it public information. If you are curious about anything else I can answer about Rural Health Clinics or OFHC—please ask!
Aaimee Johnson – You rock!
Would love to see similar info from Shinstrom and Russell operations. That will give is a fairly well rounded picture of total visits, etc.
Correction, Would love to see similar data from Shinstrom and OMC.
Jay, Aaimee’s data is from Shinstrom’s office, Orcas Family Health Center.
Thank you Jay Kimball :)! I realize the office acronyms are so similar it can be confusing! I have been collecting and analyzing data as the office manager for Dr. Shinstrom at Orcas Family Health Center for nearly 13 years.
~Aaimee
Aimee,
Thank you for providing these numbers for OFHC. I realize that posting data in this forum is not ideal, so mine job communicating your numbers!
I think that what we need is this, as well as fully disclosed financial data from all the practices in order to truly analyze the situation. I also appreciate Dr. Shinstroms openess with his statements that he realizes that this is not a simple “consolidate and we are OK” situation. I have heard from no one who believes we will be able to operate without either tax or donor support. The key is to know how much is needed and to make sure that the next step does not keep us in the same situation we are currently in.
Don’s miss the new Dec 16 posting by Dr. Shinstrom.
I have been weighing whether I should add my opinion to this community maelstrom over the future of the Orcas Medical Center. But this is the time in our country when we should not hesitate to stand and be counted, whether in the larger, national culture or in our own small communities. I have been practicing as an Acupuncturist on Orcas for the past 28 plus years. During that time I have been witness to all the tumult that has swept around the Medical Center. Years ago, the UW completed a survey of our community, seeking to discover what people wanted from a community-supported Medical Center. One of the consistent responses from islanders, was to see the Medical Center support all medical practices on the island (yes, even alternative ones!).
Unfortunately, not much came from that particular survey. And, despite all the changes that have occurred since with the various medical practices on the island, it seems we have come full circle once again to that same place. Hopefully the years have given us a little more wisdom to accompany those grey hairs. Can’t we just let go of the past and make the rational decision as a community? Let’s just bring all our great Docs under one roof at OUR Medical Center. Regardless of how we get it done, let’s just do it!
I can attest to the use of the then OIMC board of Dr. Paul Rosenberg, to dismiss Dr. Shinstrom. The Board had asked Rosenberg to interview the OIMC staff members in order to determine their feelings about Dr. Shinstrom. However, Rosenberg had, based on unethical contact with his female patients, been precluded by the State of Washington from having any contact with females in any professional capacity at the time he interviewed the OIMC staff. Furthermore, the interviewed staff members 1) knew nothing about his history and 2) were not aware of the specific purpose of the interviews. I know because I was part of the investigation that uncovered Rosenberg’s conviction.
Now let me be clear, all this happened years ago. I bear no grudge against the current OMF members because none of them were part of this history. I bring this up only to underscore how savaged a doctor must feel to have something like this happen to him. Under these circumstances, I can understand why Dr. Shinstrom feels how he does today.
Now let me be very, very clear, I think that a viable practice can be put together that includes all three practices, as FEMALE MD’s and PA’s from the each practice have long suggested. I still see no reason why all three practices can’t try to work something out. If it’s not possible, then at least people can say they tried.
As has been pointed out, a meeting of the Orcas minds can produce something of superior medical merit at far lower the price.