Doctor recruitment challenge puts a small, rural health provider in peril.

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 sign-on 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