www.montereycountyweekly.com october 26-november 1, 2023 MONTEREY COUNTY WEEKLY 17 The days of recruiting a doctor with a “help wanted” sign are long over. Big Sur Health Center’s medical director is retiring on Dec. 31 of this year, and the nonprofit is seeking to hire her replacement. Qualifications: You must be a physician, and interested in serving patients in a rural setting, attentively. “We don’t believe in the seven-minute visit,” Executive Director Sharen Carey says. “We believe in giving our patients the sense that we’ve listened and we really care about them.” That might go over well with patients, but when Carey met with a recruiter, she says that premise was met with bewilderment. The recruiter asked for the role’s productivity requirement, but Big Sur Health Center doesn’t have one. “There was this dead silence. Then she said, ‘In all my years of recruiting I have never heard that.’” Carey hadn’t budgeted a signon bonus, but the recruiter said she’d need to budget $50,000, minimum. And the salary range was too low. The changes would put the nonprofit’s budget $150,000 in the hole. “If you look at it as a pure business model, you’d say, ‘It is not worth hiring this person.’ But we’re not a private business—we are in the business of taking care of our patients,” Carey says. The idea of running a small healthcare nonprofit doesn’t make much business sense in general. This is, after all, an era of healthcare consolidation—big-box providers are on the rise, and small health systems are facing bankruptcy (see: Watsonville Community Hospital, or Hazel Hawkins Hospital in Hollister). But there’s a mission to serve patients in a place of relative convenience and comfort, not to mention the only accessible place during many occasions, sometimes for an extended period, when Highway 1 is closed. And to serve those patients, Big Sur Health Center is required (for licensing reasons) to have a medical director on staff. “We have to have a medical director or we can’t keep our doors open,” Carey says. That means the pressure is on to recruit a medical director before the end of the year. Housing is a factor, of course. And it’s a factor that other local health care systems are addressing as well. “There are not enough physicians graduating to replace the ones that are retiring. The gap and the need nationally is massive and growing,” says Dr. Mark Carvalho, CEO of Montage Medical Group. Since its inception in 2001, Montage has supported the recruitment of 194 physicians, with a package of $49.9 million— of that, $21 million was spent in the last five years alone. “It’s a war chest of sorts, a recruitment tool to help bring physicians here,” Carvalho says. Some goes toward relocation costs, sign-on bonuses and student loans. In the last four years, the majority of that war chest, 69 percent, has gone toward housing. “The biggest hurdle is the cost of living—housing is very hard to come by,” Carvalho says. To that end, Montage has long offered forgivable loans on home purchases. In August, they rolled out a new equity purchase program. Carvalho notes that a small entity like Big Sur Health Center has added pressures—for Montage Medical Group, there’s an economy of scale. (Still, they compete with bigger fish like Kaiser in the San Francisco and San Jose areas.) At Big Sur Health Center, there is one physician on staff, plus two part-time nurse practitioners, a registered nurse and medical assistant, as well as three office staff. The nonprofit serves roughly 1,200 patients with 3,000 visits per year. (That’s down from 3,500 visits per year, since the retiring medical director, Dr. Brita Bruemmer, has cut back on her hours, partly to help care for her husband, Steve Bruemmer, who survived a shark bite in 2022.) The Association of American Medical Colleges projects a shortage of up to 125,100 doctors by 2034. Montage’s most recent supply/demand study shows a 21-doctor shortage in its service area. Big Sur Health Center only needs one, but in the past few months has come up empty. “We are looking for somebody who is passionate about the work they’re doing,” Carey says. In the competitive world of doctor recruitment, that might not be enough. Sara Rubin is the Weekly’s editor. Reach her at sara@mcweekly.com. Not Well Doctor recruitment challenge puts a small, rural health provider in peril. By Sara Rubin Park N Pay…Squid spent the last week checking out Halloween costumes for Squid’s dog Roscoe P. Coltrane on Instagram, when Squid’s feed suggested a new account to follow called @needsrepair.csumb. The account was started by an anonymous otter who first posted on Oct. 1, and has shared a few out-ofdate repairs needing to be made by CSU Monterey Bay, often with the hashtag #dobettercsumb. Squid then remembered finding a parking ticket on the old jalopy when it was parked at CSUMB a few weeks ago, which infuriated Squid because the parking pass machine was broken when Squid tried— honestly!—to use it. But @needsrepair.csumb calls out that the parking machine has been out of order for over a year. CSUMB does have ParkMobile signs, but four hours using that app to pay for parking costs more than purchasing a single 24-hour day pass at a parking machine. The @needsrepair.csumb account also shows other problems on campus, like exposed wires and hidden warning signs about asbestos. Fortunately, one repair was made in less than a week after a problem was posted on the account. CSUMB officials say students should not resort to social media for complaints, but given the response rate thus far, Squid is considering appealing Squid’s parking ticket via social media. Maybe Squid will get some traction there. Escape Plan…If the world goes to hell in a handbasket, Squid plans on hunkering down in the lair until the dust settles. Squid isn’t a prepper, but let’s just say there’s a stash of shelf-stable shrimp-flavored popcorn awaiting. Yet Squid was recently reminded that the super-rich have a different way to deal with troubles like climate disasters, war and other emergencies—by vamoosing to another part of the world. Squid learned this from an article that listed Carmel as the #11 location in the world where the “centi-millionaires,” people with over $100 million in assets, like to vacation. (Miami was #1.) The information comes from a company called Henley & Partners, which estimates there are 28,400 centi-millionaires in the world, double the amount that existed in 1997, when the company was founded. Henley & Partners’ website states that it exists to advise people on how to invest in foreign countries that in turn will award citizenship to investors, giving them access to alternate passports. The company’s stated purpose: “Enhancing human potential through global citizenship.” It further states it helps people “live in dignity and security in their countries of birth or countries of choice.” Which sounds to Squid like a fancy way to say that if things go south and you have enough money, you can escape to a less hellish part of the world—your country and less fortunate neighbors be damned. the local spin SQUID FRY THE MISSION OF MONTEREY COUNTY WEEKLY IS TO INSPIRE INDEPENDENT THINKING AND CONSCIOUS ACTION, ETC. “We have to have a medical director or we can’t keep our doors open.” Send Squid a tip: squid@mcweekly.com