The Humboldt County Board of Supervisors got a preview this morning of the findings of Fourth District Supervisor Natalie Arroyo’s listening tour on healthcare provider recruitment and retention, which will be the focus of a community forum later this month.
Arroyo, who said she undertook the effort because healthcare delivery is a top constituent concern and something she’s passionate about personally, said she’s spoken to nearly four dozen healthcare professionals, from doctors, nurse practitioners and physicians’ assistants to local CEOs, administrators and experts. The findings of her research will help inform the panel discussion and forum she is hosting Jan. 27 in Eureka with eight subject matter experts.
Walking the board through a slide presentation summarizing what she learned, Arroyo said the picture she emerged with of the challenges facing local healthcare delivery is complex. Arroyo said she spoke to some new providers and others who have been here for a long time.
“The level of conviction was very high for everyone,” she said, quickly noting she’d also heard a lot of different and sometimes conflicting things that people “felt very strongly were the truth.”
Arroyo started with an overview of national healthcare challenges, noting that Humboldt is “in better shape” than a lot of rural communities, and actually “enjoyed a very unique medical provider abundance for many years.” But challenges are pervasive, and more loom on the horizon.
There’s a provider shortage nationally, Arroyo said, noting that some argue the nation needs 85,000 more physicians than it currently has, while nurse practitioners and physicians’ assistants are in similarly high demand. And, Arroyo warned, the problem seems poised to get worse, noting that more than 40 percent of the nation’s doctors are 55 or older, while downward trends in college enrollment suggest there isn’t a robust new generation of physicians-to-be to replace those retiring out.
In addition to the reality of an already short-staffed and aging provider base, Arroyo said a number of “recent changes” have prompted early retirements, including the COVID-19 pandemic, the shift to electronic medical records systems, heavy patient loads and the closure of small practices.
Additionally, Arroyo detailed what she heard local providers describe as “morale killers,” including that the aforementioned shift in records management sees many providers spend less time with patients and more with their records. Additionally, she said she heard that patients increasingly have a “noticeably shorter fuse,” often venting their frustrations with insurance companies and the larger healthcare system at their providers. She also noted that a number of people commented that institutional leadership can “make or break morale,” while also noting a feeling in the medical community that people’s negative talk about Humboldt online — “the overall low self-esteem of Humboldt County” — has an outsized impact on provider recruitment.
A key challenge locally, Arroyo said, is the housing market, which has been and remains tight on all levels. She noted that many physicians report entering the workforce with $500,000 or more in debt, saying this means many are not looking for large, high-end homes but middle-of-the-road rentals, which are hard to find. Many providers moving to the area, she said, end up staying in hotels for a long time, months or even years, prompting some local medical institutions to buy apartments and homes as housing options for their providers.
Other challenges that are potentially unique to Humboldt, Arroyo said, is that new providers report it can take some time to “develop a sense of community and find your scene” here. Additionally, she said providers are increasingly demographically diverse and wanting to connect with affinity or cultural groups, which sometimes do not exist. She said she also heard repeatedly that young providers new to the area would like to see more opportunities to socially network with other young professionals.
Arroyo also noted that she heard that simply practicing medicine in Humboldt County comes with some unique challenges, noting there’s a “large high-need population,” with the county’s high rates of poverty, substance use disorder and mental health diagnoses.
“If people are put off by seeing poor people in the community, they probably won’t do well practicing here,” Arroyo said, adding that poverty in the local community is “very visible.”
Recruitment efforts vary between clinics and hospitals, Arroyo said, but many focus on bringing prospective providers here with their families to visit, “not hiding difficult aspects but showcasing strengths.” She said some offer bonuses and incentives for doctors, physicians’ assistants and dentists while others have tried to get traveling providers to agree to longer-term arrangements by offering scheduling flexibility. She said residency programs have proven successful at getting younger providers to come to the area, with an increasing number staying.
To retain employees, institutions are trying a variety of things, she said, from bonuses for employees who stay 15 years or longer to providing child care, housing and other support.
Looking forward, Arroyo said Cal Poly Humboldt and College of the Redwoods are collaborating on some things in the realms of healthcare workforce development and medical business support that will be announced soon. She also suggested some would like to see the board look at ways to change zoning and land-use designations to allow medical services by right, saying there’s a shortage of clinic space, and streamline production of new housing. Additionally, she said, viewing a robust healthcare provider network as a “form of economic development” and investing in transportation systems, especially air travel, are things the county could do to help, while also looking “upstream” and focusing on crisis care and safety net services.
When the matter came back to the board, all members thanked Arroyo for her time and work on the issue. Fifth District Supervisor Mike Wilson also noted the increased administrative burden that’s been put on providers, saying it contributes to both the retirements and consolidation seen locally.
“Doctors used to be able to much more easily hang their own shingle and have that independent, small business lifestyle,” he said. “That’s not really a thing anymore.”
The forum will be held from 6 to 8 p.m. Jan. 27 at the Eureka Veterans Memorial Building. In-person seating will be limited and those wanting to attend must register online here. But the event will also be streamed live at Access Humboldt’s YouTube page, with a recording available afterward.
In other matters, the board voted unanimously to send a letter weighing in on the draft environmental impact report for a controversial biomass energy project being pushed forward by a subsidiary of the Rural County Representatives of California (RCRC), of which Humboldt County is a member.
Created by RCRC in 2019, Golden State Natural Resources is proposing to build large-scale facilities in Tuolumne and Lassen counties that would manufacture a combined 1 million metric tons of wood pellets annually to be shipped overseas to be burned in biomass power plants. The project has been hailed as a way to foster economic development in rural communities while clearing accumulated fuel loads from California forests, thereby mitigating fire risks. But environmentalists have raised a host of concerns, including that the scope of the project may lead to active logging and deforestation, and that fossil fuel emissions from shipping wood products to the pellet facilities, then the pellets overseas to be burned, would exacerbate the climate crisis.
Fifth District Supervisor Steve Madrone wrote the draft comment letter on behalf of the board, charging that the project’s draft EIR overstates its forest resiliency benefits and underestimates its greenhouse gas impacts while questioning its impacts on air quality and communities neighboring the pellet faculties and the Port of Stockton. The letter specifically asks GSNR to strengthen its environmental analysis, improve mitigation measures, expand proposed alternatives and work to address community impacts in its final environmental impact analysis.
First District Supervisor Rex Bohn, who has been a vocal proponent of the project and served on GSNR’s board until this month in his capacity as the county’s representative to RCRC, opened discussion of the letter by saying that while he could “wordsmith this to heck,” he would be voting in favor of sending it. Bohn encouraged his fellow supervisors to reach out to their counterparts in Tuolumne and Lassen counties to get their input on the project and let them know “we’re going to come in and try to whack the heck out of this … and in all honesty, try to stop it.” Bohn then noted he hoped officials from other counties wouldn’t come to Humboldt and “ask these questions” about offshore wind development or the fish farm proposed for the Samoa Peninsula.
Later in board discussion, Arroyo noted the project plans to pull wood from throughout the state to use as feed stock and will impact more than two dozen counties, noting “it is very robust.”
Wilson said he, too, could nitpick some of the language in the letter but he agreed with the basic recommendations, as did Second District Supervisor Michelle Bushnell. Public comment on the matter was universally in support of the letter.
The deadline to submit comments for the project is Jan. 20. For more information, visit goldenstatenaturalresources.com/deir.
This article appears in The Battle Over Bear River.
We have housed and are happy to continue to provide lodging for newly-arrived medical professionals at Third Street Suites in Eureka.