Rural doctors debate California hospitals' authority to employ physicians directly

Two doctors have used the power of the pen in a rural newspaper to argue about a California bill that would allow rural hospitals to directly employ physicians and attract more doctors to such areas. California is one of only five states that ban the practice. Dr. Hamid Rabiee, a neurologist at Shasta Regional Medical Center in Redding writes for The Record-Searchlight that the bill would cost doctors their independence and objectivity, but Dr. John Harch, a general surgeon and trauma surgeon at Mercy Medical Center in Mount Shasta, says the legislation could bring more physicians and better medical care to rural regions.

Rabiee argues that Assembly Bill 648 supports a "corporate" style that first evolved when mining companies hired physicians to care for their employees -- a decision that led to loyalty conflicts for the doctors. In response, "Physicians, courts and legislatures prohibited corporate practice of medicine in an effort to preserve physicians' autonomy and improve patient care." He says reversing that course would gradually transform a physician from a patient advocate into a gatekeeper for cost control, and rural areas should find other ways to attract doctors.

Harch argues that the shortage of doctors in rural areas is too severe to wait for better options. He says the tendency of rural areas to have high proportions of low-income and uninsured patients, who offer less reimbursements for doctors, also hurts promotional efforts. Hospitals directly hiring physicians could alleviate typical administrative and operational concerns that would accompany running a medical practice, he argues. In turn, physicians could put more energy into patient care and serving the unique needs of rural communities. "If rural hospitals had the ability to directly hire physicians, they could provide the economic incentive to attract and retain these physicians, resulting in increased access to quality health care services for millions of rural residents." (To read the articles click the writers' names.)