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The Doctors' Bill

"Two years ago, Whidbey Island needed more doctors. At the same time, doctors needed more incentive than open spaces and water views to come to Whidbey to practice.That’s been the theory behind Whidbey General Hospital’s physician recruitment program, which has allocated nearly a million dollars in last10 months to fill in gaps among the island’s collection of local doctors.Since January, the publicly-owned hospital has committed to spending more than $860,000 to bring eight new doctors to the island.The money, in the form of recruiting fees, relocation expenses, and predominantly salary guarantees, doesn’t necessarily guarantee more business for the publicly owned hospital. Nor does it obligate the new doctors to refer their patients there. In fact, that type of quid pro quo arrangement is forbidden by state and federal law. But what it does, said Whidbey General Hospital chief executive Scott Rhine, is help recruit doctors to fill gaps in the island’s menu of medical services and provide better access for residents island wide. “There’s no question it’s part of our mission,” Rhine said last week. “As a public hospital district, Whidbey General Hospital is committed to providing needed health care services, and the key component is providing access to qualified physicians.’’Rhine said the money helps provide an incentive and safety net for qualified physicians. Before they commit to moving, they know there will be enough time to build a profitable practice.The practice of hospitals and hospital districts subsidizing new doctors in rural areas is pretty common, Washington State Hospital Association spokesman Andy Davidson said.“I think it’s safe to say it’s a practice used in rural communities throughout the state,” Davidson said. “Access to physicians in rural areas is a problem across the country, and especially in this state. And this is a way that rural hospitals can ensure access to health care.”Salary guarantees aren’t the only methods they use, Davidson said. Some rural hospitals and communities offer reduced rental rates, pay recruiters fees, or more.“Remember the television show, ‘Northern Exposure?’” Davidson said. “Northern Exposure is a great example. They paid the doctor’s medical school bills, and that’s another method that’s actually used. The community offers repayment of school loans and then the physician guarantees to the community that they will stay for X-number of months or years.”Whidbey General sees twofold benefits to subsidizing doctors, Rhine said.“For the community it means greater access to physicians,” he said.And the hospital?“I think from the standpoint that the community has supported the hospital district with their tax levies, certainly having a full range of physician specialties on the island helps to improve the utilization of the hospital,” he said.Though a portion of the money — $60,000 so far — has gone to pay physician recruiter fees and about $80,000 for relocation expenses for the new doctors, the bulk of the money has been budgeted for salary guarantees — advanced to doctors, as needed, in a form similar to an interest-free loan.Using pre-determined averages of yearly salaries for various medical specialties, like surgery, obstetrics and dermatology, the hospital agrees to advance enough money so that a new doctor is guaranteed to make at least an average income. If, for example, the average annual salary for a family practitioner is $90,000 a year, and business and referrals only net the new doctor $50,000, the hospital kicks in an additional $40,000 to cover the shortfall. Typically, the guarantee lasts 12 to 24 months, after which the physician has 24 to 36 months to pay the district back.Though the funds aren’t technically viewed as a loan — Washington state won’t allow a public hospital district to make a loan to a doctor or anyone else — and doctors aren’t charged interest unless they breech the recruitment agreement, most doctors have seemed disinclined to draw any more then they need.The guarantees are available to all the new doctors, but not everyone has availed themselves of the money and none have drawn the full amount, Rhine said, adding that one new doctor who joined an existing practice has yet to draw any money toward the salary guarantee. “Their incentive is to get their practice going as quickly as they can so they don’t have to pay more back,”Rhine said. “The less they have to take, the better for them.” Still, starting a new practice, especially a solo practice, can involve a lot of outbound cash flow, with not much coming back at first, said Dr. Georgia Heisterkamp, a general surgeon who opened a practice in Coupeville on July 1. For Heisterkamp, start-ups costs included renting an office, hiring a staff, buying office and medical equipment, furniture, licenses and liability insurance. At first, Hesiterkamp said, a solo practitioner relies on advertising or referrals for business. Meanwhile, insurance compensation can lag up to three months behind billing cycles. but payrolls have to be met and medicine and procedures need to be paid for. The key to recruiting a doctor, Rhine said, is to make sure they fill a specific need, guaranteeing more complete health coverage for the community and success for the doctor.To ferret out the community’s medical needs, the hospital district gets a lot of advice, Rhine said. It works with various committees, residents, the Island County Health Department and hospital staff to identify health care needs and how to meet them For example, Rhine said, on the island, there was a need expressed for a surgeon who would take Group Health Insurance. Consequently, Dr. Heisterkamp was recruited and offered a relocation fee, as well as salary guarantee and advances to set up her office next to Whidbey General Hospital.Through recruitment and salary guarantees, Whidbey General Hospital has filled eight gaps in the island’s health care coverage, said Whidbey General Hospital District commissioner Dr. Roger Case. It might be a while before a ninth doctor is recruited.“At this point, the need for additional doctors has pretty much been met,” Case said. “We feel that we have the specialty services covered now to the extent that a small community like this can afford.” "

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