More doctors would be in the house if rural California hospitals could hire them directly, Amador County supervisors noted March 24 in supporting a change in state law.

Lawmakers in 46 of 50 states have seen no risk to patients in a physician having a boss who pays him or her a salary, provides benefits and conceivably could order a particular treatment not favored by the doctor.

Supervisors wrestled briefly with the value of keeping doctors autonomous of any control by non-physician administrators. Then, they resolved 4-0 to support Assembly Bill 648 to allow hospital hire of physicians. District 5 Supervisor Brian Oneto abstained.

AB 648 is from Assemblyman Wesley Chesbro (D-Eureka).

"This bill would authorize a rural hospital, as defined, to employ a physician to provide medical services at the rural hospital or other health facility that the rural hospital owns or operates, and retain all or part of the income generated by the physician for these medical services and billed and collected by the rural hospital," a state legislative counsel's digest reads in part. "It would require a rural hospital that employs a physician and surgeon pursuant to this bill to develop and implement a policy regarding the independent medical judgment of the physician."

The 4-0 vote came after urging by Dr. Robert Hartmann, county health officer and chair of the performance committee at Sutter Amador Hospital.

Rural private practice is risky enough financially that medschool graduates currently are avoiding it like the plague, Hartmann told supervisors. As a result, a severe shortage of doctors exists locally, he said.

"The average person coming out of medical training owes $147,000 and is reluctant to go to a rural community and take those kinds of risks," Hartmann said. "So they go into the employ of large groups - for example, Kaiser Permanente. Sutter Amador's department of internal medicine has been trying to recruit a (specialist) to this area for a year."

Another objection to the bill is that competition in hiring could potentially undercut some hospitals' ability to maintain quality staffs.

"Part of the opposition is that that could create a problem in urban areas," Hartmann said.

Havard Staggs, representing the California Commission on Aging, said, "There's ample evidence this can work. A way for the bill to get traction is grassroots support. It's not yet scheduled for committee. That's why time is critical - if there's a groundswell of support, it will get scheduled."

District 1 Supervisor John Plasse said the bill "addresses a lot of problems we have in Amador." Plasse then brought up the concept of "telemedicine."

Hartmann said that Sutter Amador will begin training third-year medical students enrolled at University of California, Davis in September.

"We can use telemedicine to get into conferences at UC Medical School in Sacramento," Hartmann explained. "Medical students tend to stay where they trained. We're looking at that as a pipeline for supply.