‘This really is a North Bay phenomenon’ to train, recruit doctors
SANTA ROSA — Kaiser Permanente’s recent announcement that it will launch a family residency program for Sonoma County reflects both local and national health care issues, as providers seek to attract and retain physicians in lieu of a heightened emphasis on expanding primary care capabilities to best serve the community.
The effort, announced last week, is twofold. For one, it hopes to recruit and retain physicians for the region. Secondly, the focus on primary care has been established as a key measure in coordinating better and more cost-effective care, not just in Sonoma County but across the health care landscape, officials said.
But it’s also unique to the county and the North Bay: While Kaiser runs numerous residency programs, the latest effort in Sonoma County is the first family medicine residency program in Northern California for the Oakland-based HMO, according to Dr. Walt Mills, who will be the program’s director.
With an estimated 22 percent of the county’s primary care physicians expected to retire and another percent 6 to 8 percent planning on leaving the area, the issue has become critical if Sonoma County is to maintain a comparatively robust physician community, said Dr. Mills.
“Primary care in the future is going to be family medicine. Everybody recognizes that,” Dr. Mills said. “We need to have a strong primary care foundation.”
Kaiser’s new three-year residency program will train six physicians a year. Currently, Sutter Medical Center of Santa Rosa’s three-year family medicine residency program, an affiliate of UCSF, trains 36 physicians per year, with 12 graduating each year. Sutter’s program also works in conjunction with the Santa Rosa Community Health Centers, where residents typically focus on outpatient care.
By 2017, the two programs combined will graduate 18 physicians each year. The first group of residents is expected to enter Kaiser’s program in July 2014. It will cost about $250,000 per resident per year to train, Dr. Mills said.
The latest effort by Kaiser to secure physicians mirrors other efforts that have taken shape throughout the county, as providers adapt to the primary care physician shortage spurred in part by health care reform.
Last year, Santa Rosa Community Health Centers became one of eight health centers in the country to launch a nurse practitioner residency program, with similar stated goals of being able to provide primary care to as many residents as possible.
The Affordable Care Act has shifted the incentives in much of the medical community to focus on primary care, Dr. Mills said, a development he said is likely to continue.
“It aligns the incentives with what we need to do,” he said. “Whether the mandate is upheld, we’re very clear on what needs to be done — patient-centered medical homes from a quality and economic standing. There are going to be (accountable care organizations) and those patient-centered homes will be integrated with ACOs. So without an adequate primary care workforce, that is going to be very difficult.”
Having the additional residency program will help health care providers confront the shortage — faced by communities across the country, particularly rural counties — and nearly all providers have a vested interest in the matter, Dr. Mills said, noting that resident physicians often stay in the community where they train. That in turn helps in workforce development.
And despite the often competitive nature between Sutter and Kaiser, Dr. Mills said there is broad consensus that cooperation is key when it comes to having a viable physician workforce for the region, something not all communities have.
“All recognize the need for primary care doctors in our community,” he said. “It really is true. It’s the Switzerland of politics to a degree — how can you be against this?”
According to a study commissioned by the Sonoma County Department of Health Services and the Sonoma County Medical Association, the county faces a shortage of up to 200 physicians over the next 10 years. The study said the county has some 350 primary care physicians, which is better than the ideal range of 60 to 80 doctors per 100,000 residents.
In 2006, Sutter had entertained the idea of shutting down the residency, citing cost overruns. The residency costs about $7 million annually. Post 2006, Sutter “actively engaged” Kaiser and Santa Rosa Community Health Centers to help support the residency program.
Kaiser said its Santa Rosa operations will still be involved in Sutter’s program, providing faculty and rotations. Going forward, the organizations plan to collaborate on faculty development, curriculum, conferences and training in the development of the new Kaiser program.
Planning and preparation for accreditation is under way at the Kaiser’s Santa Rosa Medical Center. The organization is expecting to be notified of the outcome in January.
Preparations for faculty and graduate medical education administration and space planning are also on track at the facility, according to the organization. Rotation directors have been selected in the adult medicine, obstetrics and gynecology, pediatrics, musculoskeletal and sports medicine, surgery, behavioral medicine, geriatics and emergency medicine departments.
The facility already is home to residents in podiatry and family medicine rotating from Sutter, in addition to a number of medical students and pharmacy residents.
About 85 percent of graduating medical students go into some type of specialty practice, while only 5 percent go into primary care, Dr. Mills said. The hope is to reverse that trend.
“This new residency program allows us to expand our educational opportunities for physicians and caregivers, and that’s good for everyone in our community,” said Judy Coffey, R.N., senior vice president and area manager of Kaiser Permanente’s Marin-Sonoma region.
Sutter’s residency program has little trouble attracting applicants — this year there were about 600 applications and 110 interviews for 12 spots.
Dr. Mills said the existing residency programs, as well as Kaiser’s new program, go a long way in making Sonoma County a healthier environment, both physically and economically.
“It’s an important question not just for Sonoma County but for the North Bay and the North Coast,” he said. “I think we’re going to be luckier than most communities. This really is a North Bay phenomenon. There is no other residency program until Oregon.”
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