Staffing may be tenuous, especially for C-sections
All three hospitals in the county are once again delivering babies, since a physician returned this week to Mid-Valley Hospital after a one-month leave of absence.
But the option for women to give birth at their local hospital remains tenuous, with a persistent shortage of physicians with obstetrics training – particularly those certified to do Caesarean sections.
North Valley Hospital, in Tonasket, faces a deadline to recruit another provider or it will have to suspend maternity care in August, according to John McReynolds, North Valley’s operating officer.
Confluence Health, which has provided three family-practice physicians for maternity care at North Valley, informed the hospital early this year that it will no longer have adequate coverage after one of their physicians relocates to Wenatchee.
As a result, North Valley launched its own recruitment campaign two months ago. “The fundamental issue at all three hospitals is C-sections. It’s easy to find OB providers,” said McReynolds.
Hospitals in the county use different combinations of providers, including family practitioners, obstetrician/gynecologists, and midwives to deliver babies. But all need a back-up provider certified to do C-sections.
Mid-Valley Hospital, in Omak, has two OB/GYNs for maternity care, but they’re nearing retirement age, said Mikaela Marion, director of public relations and marketing at Mid-Valley.
Three Rivers Hospital, in Brewster, provides OB services 24/7, said Mike Pruett, chair of the Three Rivers board of commissioners.
The hurdle is having enough physicians on call 24/7 for emergency C-sections, said McReynolds. Most want to rotate their shifts with three or four other physicians. Given the low number of births in the county, recruitment is difficult. Doctors want to be busy and want to keep their delivery skills sharp, he said.
Moreover, being on call means a physician needs to be within 20 or 30 minutes of the hospital. Doctors would either have to move to another community or be prepared to stay in that area whenever they’re on call.
Confluence’s decision at North Valley is a result of the challenges of long-term recruitment, said Alan Fisher, CEO of Mid-Valley Hospital. Family Health Centers is grappling with the same problem at its clinics around the county. “Doctors want to be busy,” he said.
Making recruitment even more difficult is the fact that, as Okanogan County attracts more retirees, the population of child-bearing age is dropping, said Fisher. Both Mid-Valley and North Valley have seen a downward trend in births.
Moreover, the number of family-practice providers in the United States who perform C-sections has plummeted, going from 44% in 1982 to 17% last year, according to numbers from North Valley. There are only about 1,000 such doctors in the entire country considering career opportunities, said McReynolds.
Searching for a solution
Nothing has come out of the meetings on collaboration. Each is clinging emotionally to continuing the service but, for the good of the county, it doesn’t make sense.
— Alan Fisher, CEO Mid-Valley Hospital
Administrators from all three hospitals have been holding OB summits for the past year-and-a-half to brainstorm solutions. Among the ideas that have been floated is centralizing maternity care at one of the three hospitals.
If obstetrics were centralized, it would probably help with recruitment because doctors would be busier, with about 400 births annually in the county, said McReynolds.
But the issue is both emotional and financial. Patients feel a link to their community and its hospital and identify with being born in an area, said McReynolds.
And family-practice physicians have a commitment to providing cradle-to-grave care. “OB is the only happy thing people do at a hospital, so it’s a special thing for people who work there,” said McReynolds.
Beyond the emotional connections, administrators point to advantages at each hospital. Three Rivers has Baby Friendly USA certification. Mid-Valley has the most-central location and serves the largest population. And North Valley has the newest facility, built in 2010.
The Affordable Care Act has significantly decreased the amount of uncompensated care the hospitals provide. But more than half of childbirths are covered by Medicaid, which doesn’t cover all the hospital’s costs, said Fisher. Mid-Valley lost $700,000 on labor and delivery last year, he said.
“It’s an emotional issue, but it’s about economics. How can we make services viable given the low numbers we have here?” said Fisher.
Centralizing the hospitals would also require consolidation of the county’s three hospital districts, an issue that needs more research, according to a county staffer.
Just last week, North Valley got another blow, learning that this fall Confluence is losing another doctor, one who provided in-patient care at the hospital, said McReynolds. The North Valley board is meeting this week to figure out how that will affect the hospital’s plans and recruitment efforts.
Fisher said he couldn’t make any predictions about an agreement among the hospitals for maternity care. “Nothing has come out of the meetings on collaboration. Each is clinging emotionally to continuing the service but, for the good of the county, it doesn’t make sense,” he said.