The vanishing family physician

The high cost of living and the problems associated with running a medical office make it difficult to recruit and keep doctors in Petaluma

July 20, 2005

By EMILY BRADY
ARGUS-COURIER STAFF

Dan Hendrix always thought he was playing it safe by living near a hospital, but when the eastside Petaluma resident dragged his wife, who was suffering from extreme abdominal pain, into the emergency room at Petaluma Valley Hospital late one night last year, the couple ran smack into a seemingly unsafe reality that has been brewing for years -- a local doctor shortage.

There were no general surgeons on site or on call at Petaluma Valley that night, nearby Memorial Hospital was backed up and wouldn't be able to operate on her until the next morning. So the woman, who it later turned out was suffering from acute appendicitis, was taken to Sonoma Valley Hospital by ambulance. She was later told her appendix was near bursting and she could have died if her treatment had been delayed any longer.

"The reason that Petaluma Valley Hospital gave us was that they were having problems finding general surgeons," said Hendrix, who described the situation as a "bad deal" for any local person in need of a general surgeon's immediate care.

Unfortunately, the local hospital hasn't been alone in its struggle to recruit physicians.

Dr. David Sisler, who runs a busy private medical office in town and who will turn 80 next year, says he has delayed his retirement for lack of a replacement. He says he has been looking for a private practice doctor, the kind who contracts with the local hospital, to take over his practice for the past two years because he wants to avoid closing it down.

"Most family doctors are just holding on by their teeth," he said.

"The reason I am here is that I dearly love my patients," said Sisler, who went on to describe what has happened to family practice as a "tragedy."

Things weren't always this way, says Sisler, who graduated from medical school over a half century ago before opening his Petaluma office in 1957. In the beginning, the family doctor also worked as a qualified surgeon and obstetrician/gynecologist. The rise in the risk of lawsuits and the cost of malpractice insurance put a stop to that. As he put it, "the threat of lawsuits is out of control."

Also out of control, Sisler says, are skyrocketing overhead costs, such as salaries and medical supplies. "It's totally discouraging," he said. "You've got to see 80 patients a day to keep things going."

Daymon Doss, CEO of the Petaluma Health Care district, says costs are also a factor in recruiting doctors at the hospital. The cost Doss points to is the cost of living in the North Bay, which has become daunting even for doctors, one of the classic successful and stable careers.

"Every time we bring people here, they love it -- this jewel of a city so near to San Francisco -- but we often lose them because of cost of living," Doss said.

In the past, the health care district recruited nationally, Doss explained. Today, efforts are focused on areas like Boston, New York and other parts of California where people are already familiar with the high property prices, "so they don't have to go through sticker shock," Doss explained, citing as examples two new doctors, including a general surgeon, who will be coming to Petaluma from Santa Barbara and Hawaii.

Doss also agreed that most medical school graduates these days are opting toward becoming an employee of an HMO, where they have guaranteed medical benefits, vacations and retirement packages, versus starting a private practice.

David Sisler's own physician son chose to work for Kaiser in Hawaii for these very reasons, said his father.

The health care district CEO also points to a nationwide "pipeline" problem of not enough graduates coming out of medical school to meet the rising demand, especially now with the huge wave of aging Baby Boomers.

Doss said he read recently that a nationwide shortage of 250,000 doctors is expected due to the "pipeline" problem alone.

In short, the future looks grim.

"We're not going to fix the recruitment problem; we're going to have this forever," he said, listing recent recruitment victories as well as challenges ahead.

Recently, the health care district was down to one obstetrician/gynecologist; now there are four. Out of four pediatricians, two were set to retire, so two new doctors were brought it. And a new surgeon will be arriving in Petaluma in August. Yet, in the next two to five years, five or six primary care doctors are due to retire and the recruitment process will continue.

"We're going to have to address it every year," Doss said.

(Contact Emily Brady at ebrady@arguscourier.com)