Dev GnanaDev, MD, immediate past president of CMA, said on a recent Sacramento radio show that the CMA "opposes any bills where a doctor's loyalty has to be split between the patient and an another employing entity like a hospital . . . Basically, when hospitals employ doctors they have their own special interests, especially in rural areas and small towns."
GnanaDev also points out that the existing pilot programs, which expire throughout the state this year, allowed some rural hospitals to hire 20 doctors but only six physicians signed up, proving to him that even the hospitals and doctors weren't sold on the idea.
But the obstacles were much tougher, Petersen and Rochat explain. It's hard to convince younger or older physicians to move themselves and their families to a community and invest in setting up their practices for a pilot program would expire in a few years, forcing them to move elsewhere.
Petersen explains that he's "not trying to pick a fight with the doctors. We're trying to make people realize that the economics of providing care to the poor today do not work, given the tools we have today."
But he clearly has an issue with the CMA.
"I don't know how long a small group of physicians–approximately one third (of California physicians) belong to CMA–can stand in the way of improving access to care. It's a significant social justice issue and until it is brought out in the light of day we're going to stay at this until we get a bill (passed) that we think solves this problem," Petersen says.
By the CMA's own statistics, 70% of the state's physicians refuse to treat Medi-Cal patients, which are in greater numbers in rural areas. "So you think that people with Medi-Cal don't have a harder time getting care?" Petersen asks.
Petersen and officials for the California Hospital Association don't understand the CMA's arguments. After all, doctors may legally work for academic teaching hospitals, prisons and county hospitals without accusations that the arrangement prohibits the best care for the patient.
Neither does Rochat. "I anticipate a greater hardship. I'm basically taking a demotion by staying. But even so, it's still worth it to me. Maybe that's what the CMA wants to hear: I'm willing to take a pay cut to stay here."