By Robert Hartmann, MD
California is experiencing a worsening shortage of doctors in rural and low-income communities, in part because of decades-old laws that no longer serve our needs.
I have worked as a “country doctor” for 22 years. It’s the kind of work I always wanted to do, but it’s a tough sell for younger doctors today – even for those who see it as their professional calling. College and medical school tuition and subsequent debt are exorbitant. More patients in rural communities are uninsured or on Medi-Cal than privately insured. The doctors who treat them are routinely paid less than half of the cost of care.
Here in Amador County we have tried to hire an additional internist for over two years without success. That’s an injustice to patients here.
A simple solution is to let rural hospitals and California Healthcare Districts hire the doctors they need. However, in California, state law prohibits hospitals from directly hiring physicians.
That statute made sense when it was originally instituted more than a century ago. Back then it prevented mining companies from determining if and how medical care was administered to employees. The argument for keeping the outdated law on the books is that hospital executives might interfere in the medical decisions doctors make. Today, that simply doesn’t and cannot happen. Laws are in place that explicitly prevent any such interference and make it punishable as a felony.
Unfortunately, the rural hospitals and urban hospitals that need doctors the most are still bound by the “physician hiring ban”, and as a result can’t effectively recruit and hire doctors. This directly contributes to a cycle of greater unmet healthcare needs, which have been shown to increase the rate of preventable hospital admissions by 60 percent. So, essentially, individuals who live in rural and low-income communities are set up for worse health outcomes than other Californians.
Health care policy in California needs to move past protecting the self-interest of organizations and look at the interest of patients. We need to find a way to let both rural and urban hospitals in under-served areas hire at least a handful of physicians directly onto their staffs. This would allow hospitals in areas that are short of doctors to offer physicians (especially recent medical graduates) stable employment, income, and benefits. It would also remove the financial barriers that keep aspiring “country doctors” and those who want to serve the poor from choosing that path.
Letting hospitals in areas with doctor shortages hire physicians would cost California taxpayers nothing and helps even the playing field between more affluent communities and rural and low-income communities in attracting doctors. There’s no good reason to wait – we need to do what we can now to bring doctors to all Californians.
Robert Hartmann, M.D. is the Amador County Public Health Officer and an internist in private practice.
