NEWS

The Carr Fire didn't chase Redding's doctors away. That's good, because we need lots more.

Michele Chandler
Redding Record Searchlight
Dr. Joie Dunn, a vascular surgeon,  moved from Los Angeles to join the staff of Mercy Medical Center Redding just after the Carr Fire hit. Here she is in surgery, back at her former hospital in southern California.

Dr. Joie Dunn, a vascular surgeon from Los Angeles, accepted a job offer from the Dignity Health Medical Foundation in the spring.

Not even the Carr Fire could scare her away.

She and her family moved to Redding this summer, just after the massive wildfire hit. She now works for the Dignity Health Medical Foundation, which supplies doctors to Mercy Medical Center Redding and other Dignity-owned hospitals.

"There were two other job offers that I had, but this one was ... leaps and bounds above everyone else," when considering her entire compensation package and the region's moderate cost of living, said Dunn.  Her toddler daughter's in swim lessons and dance class, and the family is enjoying the area's beauty.

So far, said Dunn, "we've been super-happy here."

After the Carr Fire incinerated several affluent neighborhoods in July, the question began quietly but urgently circulating around Redding: Was the region’s medical community down for the count?

The fire ripped through many of the upscale neighborhoods on Redding's west side, which are popular with physicians' families.

Would doctors — especially professionals nearing retirement or those new to town with relatively few ties — bother with the stress and expense of rebuilding? Would they move elsewhere in the city? Or would they just leave?

As it turns out, they stayed.

Hospital officials said 22 physicians affiliated with Dignity Health’s three regional Mercy hospitals lost their homes during the Carr Fire. Mercy Medical Center Redding is the biggest, while the other hospitals are in Mt. Shasta and Red Bluff.

Despite the upheaval, Dignity's medical staff director Marci Watson said, “We have not had any physicians move away at this point. The answer is no."

Shasta Regional Medical Center, the second-busiest acute care hospital in town, echoed that message. Seventeen of its physicians lost a home in the blaze. But none have departed since the Carr Fire hit nearly four months ago, CEO Casey Fatch said.

About 424 doctors practice throughout Shasta County, according to a study conducted in 2016 by the Health Alliance of Northern California workforce assessment group. The majority of those physicians are closely affiliated with the area's two major hospital groups — Dignity and Shasta Regional — or with the Shasta Community Health Center, a major provider of primary healthcare for low-income patients.

It's not known whether doctors that are associated with other organizations, or are in private practice, have decided to leave Redding due to wildfire woes.

Now the region's medical leaders have doubled down on a more stubborn challenge — ensuring a consistent pipeline of doctors to Shasta County, which historically has had too few physicians for a region its size.

Shasta Regional is in the process of “inventorying” its 300-member medical staff, in preparation of developing a recruitment plan, said Fatch. The effort is focused on identifying where shortages appear likely in the next three to five years.

The assessment effort began before the wildfires hit, said Fatch, who took over the hospital’s CEO role in early May. “The fire just gave us a lot more sense of urgency,” he said.

"Thin pickings"

A similar physician succession planning effort takes place every three years at Mercy Redding, which is owned by San Francisco-based Dignity Heath.

For the current fiscal year, 26 physicians, including many primary care doctors, have started or are scheduled to begin working at one of the chain's three hospitals, said Dawn Fowler, Dignity's director of physician relations and market development.

In comparison, she said, during the past three fiscal years, 10 physicians left and they've been unable to replace them. "We have a lot of services where there just are just not enough physicians," she said. That leads Dignity to frequently employ 'locum tenens' — traveling physicians who get stationed at the hospital for a temporary period.

"We're short three or four doctors . . . it's just a battle to get them." Dean Germano, CEO of Shasta Community Health Center, a major health care provider in Redding.

Dignity's recruitment efforts can include sign-on bonuses and student loan repayment. Current staff members also help identify potential physician recruits. Those measures are credited with helping to bring in more doctors than the number that have left.

Even so, said Fowler: “Honestly, it's so competitive right now ... we have thin pickings, I would say."

While Redding’s doctors appear to be holding tight, challenges persist for the region.

Shasta County needs between 25 and 30 additional physicians who practice family medicine or general internal medicine, Shasta Community Health Center CEO Dean Germano said.

Family physicians can treat a wide range of medical conditions, making them one of the most highly utilized and aggressively recruited professionals in the health care system for more than a decade. The shortage of primary care doctors nationally is expected to reach 33,000 by 2035, health care experts predict.

Shasta County's doctor base falls short

Shasta County had 47.3 primary care physicians per 100,000 residents in 2015. That's slightly below the state average 49.81, according to the California Health Care Foundation research group.

The scarcity is only expected to grow as primary care physicians in the North State age.

Out of the 424 physicians working in Shasta County in 2016, more than half were older than 55 and likely edging closer to retirement or pared-down work schedules, says the Health Alliance report.

Nearly 20 percent of primary care doctors aged 56 or older indicated that they may retire from practice or relocate from Redding in the next five years, the group found. For specialists, the expected five-year retirement or relocation rate was 35 percent.

Vascular surgeon Joie Dunn received several job offers, but decided to come to Redding. Employed by the Dignity Health Medical Foundation, Dunn began working at Mercy Medical Center Redding in JULY.

“We’re short three or four family doctors in our center," Germano said. "It’s just a real battle to find them."

It can take as long as two years to replace one family doctor who leaves, he said. "We’re not just competing in our region or state. We’re competing nationally, and that’s quite a battle,” said Germano, whose Redding nonprofit health serves a range of patients, from low-income people to those receiving Medicare.

In their hunt for physicians, Redding’s health groups are going up against major medical companies such as Kaiser Permanente and Sutter Health, which typically offer better pay.

Bigger cities can also offer better professional opportunities for physicians' spouses, something Shasta County often can't match, said Shasta Regional's Fatch, who moved to Redding from San Diego. His wife, obstetrician-gynecologist Orna Gil, recently joined Shasta Regional's medical staff.

Shasta County’s rural setting and outdoorsy atmosphere could serve as an attraction — or a turnoff — for some candidates.

“Not everybody’s going to select to live in Northern California surrounded by rural health,” said Dignity's Fowler.

Bethel Church an attraction

A major player in Redding's business community, Bethel Church is not directly involved in recruiting physicians. However, the religious group does hold a continuing medical education conference for physicians and has played a support role in bringing doctors to Redding, according to officials from Bethel and local hospitals.

A former nurse, April LaFrance, is principal of the Chartwell Consulting public relations firm and a member of Mercy Redding’s advisory board. She said the church has helped connect potential physician candidates with the Dignity Health Medical Foundation, the group that employs the hospital group's physicians.

In hopes of findings doctors interested in relocating to Redding, LaFrance said she has reached out to physician residency programs and contacted friends and former colleagues who are doctors. Once, while at the airport, she even chatted up a physician she overhead talking shop.

Her goal: to get doctors interested in working for local hospitals, clinics or private practices.

When she asks doctors about their preferred lifestyle, “A great answer for this community would be ‘I enjoy fly-fishing. We love to go on hikes. I’m an avid water skier,’" she said. "Then, we can get excited that it might be a great fit.”

On the other hand, LaFrance said she tells doctors who are “looking for vibrant nightlife"  that "our city isn’t like that. If someone is coming from a large city and they want a large city lifestyle — that would be a challenge.”

Neonatologist Justin Sharp sits in his office on his fifth day at work at Mercy Medical Center Redding back in October. Sharp moved to Redding shortly after the Carr Fire, drawn to the community because of Bethel Church as well as the professional opportunity.

Plugging the doctor shortage

For years, North State medical sites have stretched their doctor supply by bringing in nurse practitioners and physician assistants to fill shortages.

Both types of state-licensed medical professionals can diagnose and treat patients, prescribe medications and perform some minor surgical procedures under the supervision of a doctor who may or may not be on site.

“I guess you could say ‘supplement,’ but we’re basically taking on the practices,” said Dorothy Bratton-Sandoval, director of the nurse practitioner and physician assistant post-graduate fellowship program at the Shasta Community Health Center. “We don’t really assist (doctors.) We have our own practice.”

Other doctor shortage solutions blend technology with physician specialists like Dr. Nina Boe, an obstetrician-gynecologist who runs the high-risk maternity clinic at the University of California Davis Medical Center in Sacramento.

Obstetrician-gynecologist Dr. Nina Boe runs the high-risk maternity clinic at the University of California Davis Medical Center in Sacramento. Once a month, Boe comes to Redding to treat high-risk maternity patients.

One day each month, Boe comes to Mercy Medical Center Redding to treat women with high-risk pregnancies. Many have diabetes and need their blood sugar levels checked and medications tweaked.

Typically, her first patient arrives at 8:30 a.m. Boe works straight through until 5 p.m., seeing between six and seven patients each day, said Dr. Herman Hedriana, division director of Maternal-Fetal Medicine at UC Davis Health.

Back home in Sacramento, Boe follows up with patients later in the week using teleconferencing, assisted by ob-gyn’s in Redding.

The babies are scheduled for delivery at UC Davis Medical Center. In the meantime, having Boe come to Redding saves local mothers-to-be travel time from to Sacramento for routine care, Hedriana said.

Mercy’s maternity services have been transferred to Shasta Community Health Center. So, starting in January, Boe will begin seeing high-risk maternity patients there.