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Supply and demand
by MARK ST.J. COUHIG
Some time in the next three weeks Olympic Medical Physicians (OMP) will open a new orthopedic clinic in the Sequim Medical Plaza, marking the first time OMP has offered orthopedic services in Sequim.
Among the three medical professionals who will staff the facility is Dr. Keith Ure, who recently was recruited to the peninsula to ply his orthopedic trade. He’ll be joined by another new recruit, Travis Babcock, a physician assistant who performs orthopedic surgery, and by Dr. Loren Larson, who now practices in Port Angeles.
Staffing and reopening the old James-town Clinic facility to house the new orthopedic clinic represents a big investment by OMP, and by Olympic Medical Center (OMC), OMP’s parent organization. But financially, this is hardly a gamble. This is as close to a sure thing as you can get.
Rhonda Curry, assistant administrator for development at OMC, says that recruiting physicians and other medical professionals isn’t a catch-as-catch-can proposition for the health care center. It is the end result of an ongoing, intensive and highly technical process.
Facts and figures
For example, Curry has at her fingertips monthly statistics showing how many Sequim residents have driven to Seattle for orthopedic surgery. Statistics like those helped OMC officials determine the local demand for these services, which made it much easier to create an economic model that supported the opening of the new clinic.
Curry said rather than simply eyeing the bottom line, the medical center, which is a public entity, first looks at “What do we need to do to provide access to health care?”
But, she noted, a healthy margin is required “to supply access. So we do look at economics to a degree.”
Curry said for a hospital system the size of OMC, that means there must be a demand.
“There won’t be brain surgery, no open-heart surgery. That’s tertiary care,” she said, describing it as the kind of special care that only can be provided by a very large medical organization. She pointed out that’s one reason OMC is currently establishing a tertiary relationship with Swedish Medical Center in Seattle.
She said OMC CEO Eric Lewis repeatedly has described the center’s medical goals as providing care “as good as what’s provided in Seattle — in what we do.”
To better ascertain what’s needed, OMC in 2010 turned to Frank Fox, a researcher with HealthTrends. In the resulting medical staff development plan, Fox stated the importance of choosing wisely the health care providers and their specialties, noting, “Medical staff composition determines community access to necessary and appropriate health care services, and thus is central to OMC’s daily operations, viability and success.”
Fox added a bit of urgency to his comment, adding that “Projected growth in demand and expected retirement of physicians will induce much greater physician shortages by 2015.”
In the 2010 report, Fox said the “urgent” physician shortages were in internal medicine, neurology and psychiatry.
With that document in hand, OMC knew exactly what its recruiting priorities were. Working in concert with other health care providers on the peninsula, OMC has made progress in securing additional medical assistance in all three areas.
Dr. Stephen Jenkins, a member of the Swedish Neuroscience Institute, has signed a contract to practice at the OMP Specialty Clinic in Sequim. Dr. Josh Jones, a psychiatrist, is newly arrived at Peninsula Community Mental Health Center in Port Angeles. OMC also recently hired Rebecca Sorg and Bernie Gonsalves, family practice physician assistants.
Curry said there is still a need for more family practice professionals, but said “the pipeline” is small and getting smaller.
According to Fox’s report, the next highest priorities at the time were general and family practice, gastroenterology, general surgery, orthopedics and rheumatology. Some progress has been made toward meeting those needs with the hiring of several specialists, but it is a never-ending battle, particularly when doctors retire.
Curry said the priority list is a “dynamic document,” changing as needs change. Curry provided an example, saying that at this time urology is a low priority for recruiting because “We now have three urologists on the peninsula.”
“But if one retires,” she said, “it goes to urgent.”
In his report, Fox noted the difficulty of recruiting doctors to the peninsula. Curry expanded on that point, noting that physician recruitment is difficult throughout the state of Washington because its federal reimbursement rates for health care rank 48th of the 50 states. OMC is particularly hard hit because of its “payer mix”: Some 73 percent of OMC payments are derived from Medicare, Medicaid and other smaller governmental sources of funds. Hospital officials say those payments are insufficient to cover the cost of providing the medical care — in effect they are a losing proposition.
“Along the I-5 corridor those numbers would be switched,” Curry said.
Curry said hiring companies that specialize in providing certain services has helped. “Radia has improved radiology services,” she said. Prior to the contract with Radia, OMC worked with independent radiologists and found it a difficult proposition. “We needed experts in running radiologists,” Curry said.
Peninsula Emergency Services, Inc. runs the emergency room at Olympic Memorial Hospital, bringing its particular expertise and assets to bear.
Hospital administrators also turn to the current medical staff for advice on needed services and specialists, pointing out that OMC and the physicians have shared goals and a “need for mutually beneficial interactions.”
Reach Mark Couhig at firstname.lastname@example.org.