SACRAMENTO — Community health clinics and rural hospitals in the valley struggle to attract doctors, but they are on opposite sides of legislation that seeks to fix the problem.
Senate Bill 726 would relax the state ban on the hiring of doctors by hospitals, greatly expanding a pilot program that started in 2004.
The bill is supported by health districts such as Kaweah Delta Medical Center in Visalia, where a top official says the change is needed to help recruit doctors seeking the security of regular paychecks. Today, most doctors are independent and negotiate hospital privileges.
"Physicians are just not trained to be business people," said Steve Jacobs, who recruits doctors for Kaweah.
The bill is opposed by a network of clinics that enjoy an exemption to the hiring ban.
The Central Valley Health Network fears it would lose staff if nearby hospitals could hire doctors. The network's doctor shortage is "so dire that we don't want to make it worse," said David Quackenbush, chief executive officer of the network, a consortium of 13 federally qualified health centers.
Merced-based Golden Valley Health Centers, which operates facilities in Modesto, is a member of the health network.
California's doctor hiring restrictions are rooted in a ban on the "corporate practice of medicine," which seeks to preserve physician autonomy. The concept evolved from concerns in the early 20th century that doctors hired by mining companies would face conflicts between corporate and patient needs, according to legislative analysis.
Over the years, exemptions were given to organizations, including teaching hospitals and medical corporations — such as a surgical group — that are owned and governed by a physician majority.
Low-income community clinics won the right under a 1975 state attorney general legal opinion. Kaiser Permanente, the large nonprofit health organization, has regional partnerships of doctors that serve its hospitals.
But California remains one of five states that generally prohibit hiring by hospitals, according to legislative analysis. The Legislature in 2003 created a pilot program allowing for health care districts in counties with populations under 750,000 to hire a total of 20 physicians statewide, as long as the district served a high percentage of Medi-Cal patients and was struggling financially. The program will expire at the end of this year.
Hospitals began pushing for an expansion of the program last year but ran into resistance from the California Medical Association, a doctors organization that closely guards physician autonomy.
"We just don't want the financial pressure of a hospital trying to fill beds or meeting the bottom line to be something that is driving decisions about the patient," association spokesman Andrew LaMar said.
SB 726 supporters point to a 2004 state law that strengthened the independence of hospital medical staff, giving them more control over patient care rules.
The bill, by Sen. Roy Ashburn, R-Bakersfield, seeks a compromise by allowing 52 districts in medically underserved areas to hire up to five doctors each. The bill would cover eight districts that operate hospitals in Fresno, Tulare, Kings and Mariposa counties. The legislation would cover most privately run rural hospitals, including three valley hospitals run by Adventist Health.
The California Hospital Association is pushing a separate bill, Assembly Bill 648, that would allow rural hospitals to hire up to 10 doctors each.
The valley's doctor shortage has persisted for years. There are 173 doctors per 100,000 residents, the lowest of any region in the state, according to a 2006 study by the Central Valley Health Policy Institute. Hospitals in the region have trouble attracting doctors because the valley lacks the appeal of more urban areas, and many residents struggle to pay for care, Jacobs said.