Rural rotations

As too many local residents know, the North State has a doctor shortage. Those who need a primary care physician often wind up on a waitlist, regardless of insurance plan. Specialty care—notably for mental health and arthritis, but also myriad other conditions—is heavily impacted as well.

The Camp Fire made a tough situation tougher with the closure of Adventist Health Feather River Hospital and departure of around 50 practitioners (see “Medical migration,” cover story, March 14, 2019).

We’re not alone: According to the Healthforce Center at UC San Francisco, a gap between supply and demand exists statewide and will continue to grow into the next decade. The number of primary care physicians could decrease by as much as 25 percent because not enough new doctors complete primary care residencies to replace those retiring.

Newly minted medical grads, in all fields, tend to gravitate to bustling cities. To meet the need in underserved areas, including rural regions like Butte County, California lawmakers may expand the scope of authority for nurse practitioners, via a bill under consideration (see “Higher midlevels,” Healthlines, Feb. 20).

The Butte-Glenn Medical Society (BGMS) has another idea: bring young doctors here to train—and, hopefully, practice.

An affiliate of the California Medical Association, comprising physicians from Butte and Glenn counties, BGMS recently announced it had launched a regional initiative to host medical residents in Chico, Oroville and Redding. The so-named Northern California Medical Education Program also incorporates scholarships and mentoring to develop homegrown providers.

Kristy Bird MaKieve, the medical society’s executive director, told the CN&R that starting a residency program requires a significant investment of time, planning and resources—particularly challenging for a small regional hospital such as Enloe Medical Center.

“It’s not just something where they can put a flag in the ground and say, ‘Residents, come here!’” she explained. “The Northern California Medical Education Program is really designed to support all of those efforts.”

Even though Redding is located in Shasta County, the Butte-Glenn doctors’ group reached out to hospitals there—such as Shasta Regional Medical Center—in partnership.

“We’ve really gone toward an alliance model for this program, because all the rural counties need to start residency programs,” MaKieve said.

BGMS has requested $25 million in state funding; North State Assemblyman James Gallagher supports the program. MaKieve built a coalition of partners including California Health and Wellness, a Medi-Cal insurer, and Physicians for a Healthy California, the state medical association’s charitable arm.

“This really is a great, innovative idea from the [Butte-Glenn] Medical Society—really looking at the landscape, pulling stakeholders together, and talking about the need and how to fix the problem,” said Alissa Ko, director of Strategic Giving and Community Engagement for California Health and Wellness.

“When Kristy had been talking to all the players and stakeholders, why her idea was so important to us is because [once residents get here] they typically tend to stay because they get to know the community and get to love the community as well. That’s why we decided to help partner [with] and support the program.”

MaKieve understands the phenomenon. She joined the Butte-Glenn Medical Society just over a year ago, having previously worked for the state medical association and for UC Davis. Married to an internal medicine physician, MaKieve lives in Sacramento and commutes here three to four days a week.

“Now that I’ve worked in Chico, spent time in Oroville, I’ve gotten to know these communities, and I feel they’re not ‘rural,’” she said. “They’re not like some dirt road with tumbleweeds. They’re thriving, wonderful places to be.

“I just want to show that.”

Having others experience this firsthand will make a difference, she said—and Ko agreed. So, too, did Dr. Paul Wassermann, a Chico pediatrician and BGMS board member, who said research bears this out. Indeed, a study in the journal American Family Physician reported 56 percent of family medicine residents stay within 100 miles of where they complete their program, including 39 percent who stay within 25 miles and 19 percent within 5 miles.

California Health and Wellness recently partnered with four other nonprofits with similar programs for physicians and/or midlevels; however, they are too new to provide data suggesting potential results here, with initial graduates expected next year.

BGMS determined that the area incorporating Butte, Glenn, Tehama and Shasta counties needs 30 to 60 residents over the next five years. The estimate comes from a task force that formed after Butte County Public Health released its Community Health Assessment in November. That analysis of data from Public Health and local hospitals—except Oroville, which released its own assessment—found access to care as the county’s top issue, followed by mental health (see “Community pulse,” Newslines, Nov. 14, 2019).

In response, MaKieve said, BGMS is working with UC Davis School of Medicine to establish psychiatry training locally—aiming for year-long rotations. This dovetails with an overarching residency program UC Davis recently launched for rural communities between Sacramento and Portland. Additionally, California Northstate University College of Medicine in Elk Grove has committed to partnering with BGMS.

“If we could get that residency here, I think it would be awesome,” Wassermann said. “I think we have a good hospital for that [in Chico], a good inpatient setting to get experience off of.”

MaKieve said 14 medical residents per year “would be helpful” in Butte County, between Enloe and Oroville Hospital, and 10-15 in Redding. The numbers, attainable once the program hits “full stride,” depend on the specialties involved: Should surgeons not participate, Chico might accommodate only a handful in primary care and a couple in mental health. (Neither Enloe nor Oroville Hospital responded to requests for interviews.)

Wassermann noted several logistical considerations, such as how a teaching physician’s pace and workflow would be impacted by instructing and supervising residents. Yet, he added, “I think most of us are happy to teach; we feel it’s kind of an honor to be asked to help nurture, teach, pass along our experience.”

Meanwhile, BGMS members are sowing seeds at home. The nonprofit converted its investment fund into an endowment for scholarships to pre-med students—one a high school senior in Butte County or Glenn County, one a Chico State senior—and physicians will start mentoring and outreach in junior high and high schools.

“The goal [of these drives is] that if you’re from this area, you’re more likely to come back and be a physician if that’s the path you choose,” MaKieve said, “so let’s encourage more youth to pursue that.”