Healthcare Leaders Talk Recruitment, Retention in Panel Discussion

In the midst of somewhat rambling closing comments at a recent panel discussion on healthcare in Humboldt, Mad River Community Hospital CEO Doug Shaw told a story. Arcata’s first hospital, he said, was built in 1911, though it wasn’t so much a hospital, as a two-story home with a surgical suite on the second floor that was passed from doctor to doctor until there was an accident and the house burned to the ground.

In response, the local community bought a block of property near what was then Humboldt State College and — working entirely with donated lumber and volunteer labor — built a hospital, complete with the county’s first intensive care unit, which opened its doors in 1943.

Shaw’s story seemed to underscore a point made repeatedly by those on the eight-member panel of local healthcare leaders convened by Fourth District Supervisor Natalie Arroyo: Strengthening the local healthcare system demands a communitywide effort.

Arroyo began the two-hour meeting by walking attendees through the findings of her personal listening tour, in which she interviewed nearly four dozen local healthcare workers — from doctors, nurse practitioners and physicians’ assistants to CEOs, administrators and experts — to hear what they see as the challenges and opportunities facing the local industry, primarily with regards to recruiting and retaining practitioners.

The conversations, Arroyo said, took place amid a national physician shortage, noting that some estimate the nation is currently 85,000 physicians short of what it needs, with physicians’ assistants and nurse practitioners in similarly high demand. She also warned the problem is projected to grow worse, with more than 50 percent of the nation’s doctors age 55 or older and downward trends in college enrollment suggesting there isn’t a robust new generation of physicians-to-be in line to replace those soon to retire.

Arroyo said she was also repeatedly told that changes in the industry — including the shift to electronic medical records systems, heavy patient loads, the complexities of insurance reimbursement systems and patients increasingly willing to take their frustrations with the industry out on providers — are prompting healthcare providers to retire early.

After her introductory remarks and a brief break, Arroyo took a seat on a folding chair across from the eight healthcare leaders, who sat in a line behind a pair of folding tables pushed together. She asked them a series of questions aimed to give those attending — or watching online — an overview of the underlying issues. First, she asked what the leaders are doing to recruit and retain providers to their organizations.

“Where we recruit from is everywhere, and how we go about it is everything,” said Redwoods Rural health Center CEO Seth Whitmer, drawing nods of agreement from his fellow panelists. “I think the best way to get results is by trying to find people who are willing to come out and show them what we are like.”

Humboldt County Health Officer Candy Stockton agreed, adding, “Often, personal relationships are what bring people here and keep people here.”

Open Door Community Health Centers CEO Tory Starr said his organization tries to find long-term fits, going so far as to interview not just prospective providers, but their entire families.

“We’re trying to recruit people for their entire careers,” he said. “We don’t just want people to come here to pay off their student loans. We want them to be integrated into this community and to stay here.”

He added that Open Door emphasizes a “team” concept and a positive culture, adding that “it does no good to recruit a doctor if we don’t have a well-trained medical assistant to support them.”

Southern Humboldt Community Healthcare District CEO Matthew Rees stressed that “everyone thinks Northern California is San Francisco,” so it’s important to be upfront about what makes Humboldt unique, acknowledging the challenge and highlighting the area’s strengths.

Providence St. Joseph Hospital CEO Michael Keleman touted Providence’s family residency program in partnership with Open Door, and noted a new partnership with the Idaho College of Osteopathic Medicine, in which third- and fourth-year students rotate through Providence’s hospitals.

“The hope is these individuals may want to come back,” he said.

Humboldt Senior Resource Center PACE Medical Director Jennifer Heidmann recalled her own experience, coming here 23 years ago out of residency, saying some doctors with established roots in the area invited her to go mussel hunting on the Lost Coast on a shared day off. She said it was when she realized she wanted “to stay here forever.”

“There is a special thing about this community and I think that’s what we need to sell,” she said.

Arroyo then asked panelists to explain what “pain points” or challenges in their organization they wanted the community to understand.

Rees started out, saying the financial structures of the industry — and specifically MediCal and Medicare funding — are “kind of ridiculous.” He noted that for MediCal patients who come to the emergency room, his hospital only is reimbursed at about 15 percent of the cost of providing care, saying the reimbursement rate hasn’t been increased for 13 years, even as hospitals have been required to meet new seismic safety standards and the minimum wage for healthcare workers has spiked.

Shaw lamented that “it’s miserable trying to run a business” while providing patient care, and Starr said it’s important to know that reimbursement systems determine “reward systems.”

“We have this Byzantine system of reimbursement in American that is not conducive to giving good care,” he said. “Our providers don’t mind taking care of complex patients … it’s all of the other stuff that sucks your souls away.”

Stockton then asked attendees how many think access to healthcare in this country should be considered a basic human right. Seeing most hands raised, she said most of the challenges surround the fact that it is not treated that way.

“For myriad complicated reasons, we have decided that healthcare is a business in this country and we operate it as a business,” she said. “A business’ primary goal is to make money and stay in business, right? Healthcare’s primary goal is to take care of people, and in many ways, those are mutually exclusive goals. … the pain-point really, fundamentally is that we won’t treat healthcare like a human right in this country, despite the fact that I think that’s what we all want for ourselves, our families and our communities.”

Whitmer agreed, saying healthcare delivery has become “incredibly complex,” and is difficult to explain to people.

“When people are frustrated, it’s like, ‘Look, this is healthcare working exactly as we’ve designed it to be.’ And that’s the unfortunate story. And none of us can really fix that, and that’s another unfortunate bit of the story,” he said. “I can’t change the payment system.”

What Humboldt County residents can do, the leaders stressed, is lobby state and federal representatives to raise reimbursement rates and support loan forgiveness and other incentive programs. But perhaps most importantly, they said, the local community can do more to make itself an attractive place for healthcare providers to bring their families.

That means pushing for more housing development of all types, they said, noting not all providers want sprawling single-family homes, and supporting efforts to bolster air services here, noting that the limited options for flying in and out of the community turn off some prospective providers.

But the low-hanging fruit in this conversation, the healthcare leaders said, is residents promoting a more positive image of the area and simply being kind to service providers, from store clerks to doctors.

“It’s like a mandatory pastime for locals to talk up how bad things are here,” Stockton said, adding that she’s also not blind to the challenges here.

But when a someone contemplates moving here and searches Humboldt to find thread after thread bashing the local community, Stockton said it can be enough to turn them away. Rees agreed, saying he was recently talking to his daughter about this “need to get public perception to change” and all that Humboldt has to offer and she suggested local healthcare organizations collaborate on a social media contest rewarding posts that go viral while touting the positives of life in Humboldt.

“It’s a great idea,” he said. “I think that’s something we should look to do.”
On the general issue of recruitment and retention, Stockton said the good news is that medical providers aren’t “magical beings” beamed down from some other alternate reality in need of special accommodations.

“The things that will make life better for us here are the same things that will make life better for everybody else,” she said. “So … be kind to each other and service providers in the community, whether your local bank teller or the person you get coffee from or the medical assistant in your office. When we do those things, we make life better for our future.”

This article appears in Sanctuary in the Storm.