The county’s Health Services Agency has had nine of its 20 doctors leave since 2011. Photo by Chip Scheuer.
Dr. Joann Moschella has a clear message for her bosses in Santa Cruz County government: without better compensation, no one will want to work here.
“Family doctors are going to be in huge demand,” says Moschella, a family physician with the county’s Health Services Agency “and anyone who isn’t accommodating for that is making a huge mistake.”
That includes county officials, she says. The HSA, which provides care to those who are too poor to go anywhere else, has had nine doctors out of 20 leave since 2011. Three were in family medicine, or primary care, like Moschella, and six were psychiatrists. The county struggled to fill the vacancies, but as of last week they had filled all but one of the clinic positions, and all but one and a half of the psychiatric positions.
County doctors, represented by the Union of Physicians and Dentists, are currently in mediation with the HSA, and last week, the physicians signed a petition to the Board of Supervisors about the vacancies, claiming they’re bad for local health.
While discussing whether or not to provide cost-of-living increases, which the UAPD says is essential for filling the spots, the HSA began hiring “extra help” and temporary doctors, or locum tenens, at a cost of $150 to $170 per hour.
Temporary doctors sometimes work at the county for a few months, and then move on. Moschella says county’s poorest deserve consistent care with doctor they know as much as anyone.
“Poverty equals poor heath. Poor health equals complexity of medical problems. That’s directly related to how much people need good medical care, not spotty patchwork from a temp agency,” Moschella says.
Interim health director Rama Khalsa agrees that when doctors get to know their patients, they’re generally more effective. That’s why Khalsa has lately been requesting temps interested in long-term positions.
“They’ll start as locums, but if they’re good, they’ll move up to the next level, because I do want to fill these positions permanently and not have to transfer patients between psychiatrists,” Khalsa says. “It’s an important clinical relationship.”
The revolving door of doctors has been especially apparent on the psychiatric side, where 10 doctors have come and gone from 2012 to 2013, according to the UAPD.
That in turn creates problems for people in need of psychiatric help, causing patients to be shuffled from one doctor to the next.
“If you’re a severely mentally ill person, it’s a different person every time. It’s a problem in terms of providing care,” says Sue Wilson of the UAPD.
When it comes to affordable family care, Moschella says, the majority of her fellow physicians are over 50 and looking forward to retirement, which would mean even more vacancies.
On top of that, the recently upheld Affordable Care Act—“Obamacare” to cable news fans—will require health care for everyone, and send demand for primary care physicians higher. In Santa Cruz County, that translates to a projected influx of 8,600 new patients who will qualify for Medicare, according to a 2012 report from the local Health Improvement Partnership, and another 15,800 who will qualify for subsidized insurance through the state. County supervisors have approved budgeting for new health positions, including two new family doctors.
Moschella says the ACA will make filling positions even more important. She also says the new demand will drive up salaries nationwide, making it even harder for the county to compete for doctors fresh out of medical school.
Khalsa counters that the HSA has a valuable asset at its Watsonville Clinic that will keep the county competitive: a federal loan forgiveness program that covers over $100,000 of med school debt.
The UAPD’s media campaign for more compensation obviously isn’t just about filling vacancies. Any cost of living increase would also benefit current doctors like Moschella. “No one goes into family practice to get rich,” she says, “but we also need to send our kids to college and pay our mortgages.”
Khalsa says there are many reasons doctors accept positions and reasons they don’t. She has offered jobs to three physicians this year, all of whom declined, for reasons such as their spouse taking a job in another city.
As the county prepares for the ACA, assistant health director Giang Nguyen is more worried about whether or not the county has enough doctors rooms than she is about doctor vacancies, which she expects to fill. Her staff is currently looking into moving admin offices to make room for patients.
“Access does not equal quality of care,” Nguyen says. “Adding more people may provide more access, but we also really need to improve our outcomes.”
