FEATURE ARTICLE

What Effect Did Sutter’s Proposed Closure
Have on Physician Practices?

By Joni Schmidt, RN, MPA/HSA

Sutter Medical Center of Santa Rosa, which in January 2007 announced plans to close, has decided to remain open after all. During 2007, however, the proposed closure clearly affected local physicians and their practices. To determine those effects, I conducted an online survey of SCMA physicians in October and November of 2007. The survey examined physician perspectives on the proposed closure and its effect on access to care in Sonoma County. The survey also measured how physician practices had changed since the closure was announced in January 2007, including changes to income, mode of practice or affiliation, and interest in alternative practice models.

Among the key findings:

• At least 42% of the responding physicians had experienced a change in their practice as a result of the proposed closure. Of those, 39% had changed their mode of practice.
  
• Forty-four percent of the respondents were sending their patients to other hospitals, primarily Santa Rosa Memorial.
  
• Sixty percent of the respondents were interested in other practice models, with 46% preferring an integrated group practice.
  
• Seventy-two percent of the respondents believed that the proposed closure would result in less or more difficult access to care.

I used secure electronic survey software to design the 10 survey questions, collect responses, and analyze the results of this study. All questions were reviewed and approved by the Executive Committee of the SCMA board of directors. Of the 658 physicians who received the survey, 55 (8%) responded.

Results
The respondents’ age and specialty demographics were fairly representative of physicians in Sonoma County. Forty percent of the physicians were 50-60 years old, followed by those in their forties (26%), those older than 60 (18%), and those younger than 40 (16%). Forty percent were family physicians, 16% were general and trauma surgeons, and the remainder were physicians from about a dozen specialties.

The respondents’ practice location, group size and practice mode tended to favor small-group practices in Santa Rosa. Eighty-two percent of the physicians practiced in Santa Rosa, with the rest located in Healdsburg, Sebastopol, Petaluma and Rohnert Park. Fifty-six percent were in small-group practices (2-10 physicians), 26% were in medium-sized (11-100) practices, 13% were in solo practice, and 5% belonged to a large group (more than 100). Forty-two percent were self-employed, 28% were salaried, 17% were both salaried and self-employed, and 13% had other modes of practice.

Of the 55 physicians who responded to the survey, only 29 answered questions about how the proposed closure had affected their mode of practice or affiliation. Six said the proposal had had no effect, but the remainder indicated a range of effects, as shown by Table 1. (Respondents were able to select more than one answer, so the percentages do not add up to 100.)

The “Other” changes included joining NCMA and other groups, preparing for an increased patient load at Memorial Hospital, and closing practices to new Medicare patients.

Almost all the respondents (52 of 55) answered questions about how the proposed closure had affected where they send their patients. Forty-four percent reported sending their patients to other hospitals, primarily Memorial (50%) and “not to Sutter” (41%). Reasons listed for not sending to Sutter included patient preference, better services at Memorial, physician preference, lack of specialty services, lack of resources, difficulty in getting operating-room time, and cuts in staffing and services.

All but one physician responded to questions about how the proposed closure would affect their income. Two-thirds said the closure would have no effect. Of the remainder, 67% said their income would decrease. Reasons for the decrease included a lack of patient admissions at Sutter; an increase in uninsured, underinsured and Medi-Cal patients; and an expectation that physicians would deliver more under- or unreimbursed care.

More than half the physicians (60%) expressed interest in other practice models. Integrated medical group practices gained the most attention (46%), followed by cash-based practices (21%) and the Kaiser model (also 21%). Table 2 shows complete results. (Respondents were able to select more than one answer, so the percentages do not add up to 100.)

Finally, nearly all respondents (85%) answered questions about how the proposed closure would affect access to care. The vast majority (72%) anticipated less and/or difficult access to care, particularly for unfunded and indigent patients. Respondents noted problems with access to emergency departments, operating rooms, inpatient beds, and women’s health services. Respondents also commented on Kaiser’s role in providing proportionate care for the uninsured and indigent population; providers losing money because of limited or poor reimbursement for hospital care; participation of outlying hospitals in providing primary care services; an overall reduction in primary care physicians; overwhelmed community clinics; and physician recruitment and training.

Conclusions
This survey showed that the proposed closure of Sutter Medical Center affected local physician practices. Many physicians had changed their mode of practice and/or where they sent their patients. Physicians also expressed interest in other practice models, particularly integrated medical groups.

A significant majority of the physicians who responded (72%) believed that the closure would reduce or complicate access to care, specifically for patients who are poor, uninsured or underinsured. Women’s services (especially reproductive services), emergency departments and inpatient care were listed as areas of particular concern. Respondents also commented on the need for Kaiser to take on a proportionate share of indigent care; the involvement of outlying district hospitals; and the relationship between quality of care and access to care.

Hospital closures can be both a time of tremendous upheaval and an opportunity for physicians and other stakeholders to improve health care services. Few studies have been done regarding physician perspectives on hospital closures or proposed closures. When assessing the impacts of such closures, it is imperative to consider the perspectives of those responsible for providing care.

Periodic surveys are helpful in assessing physicians’ perspectives and in formulating action plans to support and sustain access to health care, especially in times of crisis. My hope is that the results of this particular survey can be used to develop strategies for ensuring the best possible health care future for Sonoma County.