I first came to Sonoma County’s medical facilities as a medical student in 1981, when I was eager to be a family physician. UC Davis had a rotation available with the Santa Rosa Family Medicine Residency and other programs that trained doctors for rural practice in California. I had a great experience at Community Hospital, where medical students lived in the flophouse across from the ER entrance and made Friday night pilgrimages to the Acapulco Restaurant for dinner. During my rotation in Santa Rosa, I had no firm plan of where and what my medical practice would be, and that same situation has held somewhat true ever since.
After returning to UC Davis, I decided to become a surgeon and was eventually hired at the Kaiser facility in Santa Rosa in 1989. Despite my intentions to enter private practice in the mid-portion of the state, life intervened, and I stayed with Kaiser for 11 years. I then went into private solo practice in Sebastopol after Dr. John Sweeney retired. After 10 years of solo practice, I joined the Sutter Medical Group of the Redwoods.
The only hospital in the county that I haven’t operated in is Sonoma Valley. Like most general surgeons, I almost always have at least one patient to tend to in a hospital somewhere. Given my history, I have some perspective about a surgeon’s relationship with hospitals and how that can differ in various practice settings.
My decision to leave private practice involved three main issues. First were the daunting requirements from regulatory and governmental edicts. In particular, I was using an electronic system that was a horrible medical record but a serviceable billing tool. Getting a better EMR was going to be expensive and time-consuming. The second issue was contracting. The individual has no power in negotiating contracts with payors. While my overhead was increasing, my payments were stagnating or decreasing. My last concern was my slowly shrinking referral base in Sebastopol. Without significant growth in primary care, and with market shifts and expected retirements, I needed a broader network for referrals. My choice of the Sutter system was based on the best fit for the issues listed above. Sutter was the venue that allowed me the most choices regarding the actual practice of medicine.
The main attraction was that Sutter is not a closed system for physician relationships or facility choices. Having options for surgical care is important to me and my patients. A surgeon needs a hospital to do inpatient procedures, and an affiliation with a medical group that has some connection to a hospital is a plus. I must say that belonging to such a group has not affected how I care for patients. I am at the Sutter hospital more than I was in private practice, but that is related to the changes in my referral base.
I have had several hospital relationships during my career. At Kaiser, I had one hospital to use and complete overlap of hospital and outpatient medical group affiliations. This did cut down on driving, but there wasn’t much available as far as choice for me or my patients. In private practice, I was affiliated with Palm Drive Hospital by choice. In fact, part of my reason for going into private practice was an interest in keeping that hospital open. In Sebastopol, when resources were limited, there were hospital options in the county and referral options to tertiary care centers when needed. Palm Drive does what it does very well, but the hospital does have limits in some of its onsite care capabilities.
As a member of the Sutter Medical Group, I have an interest in the Sutter hospital’s success, but I can still offer choices of surgical facilities to non-HMO patients. I am frequently reminded that some freedom of choice, in all aspects of our lives, is a motivator and a condition of living in a free society that is worthy to maintain.
Being affiliated with a hospital system also brings a motivation for the hospital to maintain an interest in its surgeons. As changes occur because of physician-facility collaboration, I hope the hospitals I am active in will want some of my input on how those changes should occur. Being able to have input on the workings of a hospital where you carry out a significant portion of your work life is a benefit.
In a more practical view, as the hospitals get beleaguered by more and more regulatory and economic requirements, the ability to at least soften the share of that burden assigned to physicians is a good thing. We may not like the way we have to document our hospital work and answer to the requirements of outside influences, but it isn’t a trend we can ignore. Failure to be involved in change has had negative results for the medical profession in the past.
Considering all the above, the change to Sutter Medical Group has been a positive move for me. Because Sutter is not a closed system, I am still able to participate in medical care in the Sebastopol area, and also to be somewhat active in Healdsburg and, of course, Santa Rosa. I see all these hospitals as important community assets that need to function well to ensure good patient care throughout our county. I do feel there is more financial security in a group, and as we deal with health care reform, a working relationship or partnership with a hospital will become more important.
Dr. Hill, a Sebastopol surgeon, is affiliated with the Sutter Medical Group of the Redwoods.