Many see state law as another barrier to more rural physicians
Dr. Robert Hartmann calls himself and other rural physicians "dinosaurs" – and you know what happened to them. But Hartmann, who has had a family practice in Amador County for 21 years, is working to ensure that a new generation carries on in rural medicine.
He does so by mentoring UC Davis Medical School students interested in working in underserved areas. But Hartmann, who serves as Amador County's public health officer, also works for passage of state legislation that would overturn a long-standing ban on rural hospitals and health systems recruiting and hiring doctors directly.
"If a hospital can employ directly, doctors will be guaranteed salaries," Hartmann says. "Those of us in private practice (in rural areas) don't get paid as much as in urban areas, but our expenses are pretty close to theirs. I think that's one of the things that need to be addressed."
Toward that end, two bills aiming to lift the ban (Senate Bill 726 and Assembly Bill 648) are before the Legislature. (Currently, only state and county hospitals and clinics may employ doctors.)
The bills' opponents say passage of either would promote putting corporate profits above patient care. As Dr. Luther Cobb, a member of the California Medical Association's executive committee, wrote in an opinion piece in The Bee in September, hospital executives would focus on "the bottom line" and "foster divided loyalties and erode the quality of care."
The opponents, which include the California Medical Association, say doctors can be recruited for rural areas by beefing up state and federal programs to help medical students repay loans and improving Medi-Cal and Medicare funding.
The bills' proponents include the California Hospital Association and the California State Association of Counties. Anne Platt, CEO of Sutter Amador Hospital, calls the restrictions "antiquated" and an impediment to serving rural patients.
"I came from Colorado, where (hospitals can) employ physicians, and I think the fears are unfounded. (Hospital CEOs) are not going to dictate how physicians practice medicine. It's just not going to happen. I've seen it at other hospitals."
In 2004, the California Medical Board launched a pilot program that allowed direct physician hiring by select rural hospitals. Among the six sites selected were hospitals or clinics in Visalia, Mendocino and Mariposa.
Hartmann says he has heard of no friction between hospital administrators and physicians concerning quality of care.
"We need more programs like that," he says.