These are dynamic times at the Coastal Health Alliance. The federally funded nonprofit is days away from finalizing a merger agreement with the Petaluma Health Center, which would fold clinics in Bolinas and Point Reyes Station into the larger organization.
At the same time, the alliance is dealing with the departure of two of its three primary care physicians. And the dental program, six months after opening a brick-and-mortar facility, continues to grow but faces the same staffing struggles that have plagued the nonprofit for years.
The merger between the Petaluma Health Center—which has 400 employees, two main facilities and five satellites in Sonoma County—and the Coastal Health Alliance—with its 62 employees and two sites—will eliminate the alliance as an entity.
Instead, West Marin would have representation on the health center’s board, for which the structure is not yet determined. Clinical staff would remain the same, and administrative staff would be shifted toward Sonoma County, where many local employees already live.
“Over time, it just became clear that this was important for sustaining health services in West Marin,” said Steve Siegel, the C.E.O. of the Coastal Health Alliance, who plans to retire after a transition period. “The board and our senior staff, we know we’re doing the right thing. And it has to do with meeting the requirements of community health centers, which is a federal designation, and staffing to a level that assures our compliance, and just having more expertise in running a health center.”
The Petaluma Health Center is ranked as one of the highest-quality achievers in the health care industry, and the local clinics will have to match those standards, Mr. Siegel said. The merger will benefit the alliance by giving it access to Petaluma’s better recruiting arm, and by streamlining record-keeping and grant applications. “It’s hard to run a small health center,” Mr. Siegel said. “In the world of health centers, bigger is better, for most things.”
A needs assessment contracted by the Coastal Health Alliance board in 2010 found that the alliance’s already small patient base would shrink over time due to an aging population and the emigration of younger residents. A merger with a larger organization would be necessary if the nonprofit wished to survive, it concluded.
Of the alliance’s 62 employees, only about 10 live in West Marin. The Stinson Beach clinic closed in 2016 amid staff departures and dwindling patient numbers, while the Bolinas clinic’s hours have fluctuated; it currently opens three days a week. On Monday, that clinic had to close for the morning because the primary care provider could not make it to work, and there was no backup.
The alliance most recently lost two of its three physicians for personal reasons. Dr. Gabriel Klapman left after less than two years, and Dr. Steven Aussenburg, who started in April, will leave after January. Dr. Anna O’Malley has been a constant presence for the last decade, but she isn’t seeing new patients because of her popularity.
The alliance has received a signed offer letter from a new physician from Canada—he can start once he is cleared to work in the United States—and is recruiting to fill the third position.
Retaining doctors is a challenge for the alliance for a variety of reasons, Mr. Siegel explained. For doctors who are mission-driven and aim to help as many people as possible, the clinics’ small patient base is a hindrance. Because the health center is federally qualified in an underserved area, young doctors have been drawn to it because they can apply for relief from medical school loans. Yet alliance doctors must have a wide skillset, and although the nonprofit offers competitive compensation, living in West Marin is not for everyone, Mr. Siegel said.
“We’re vulnerable, and it’s really been hard on patients,” he said. “People deserve to have health care where the provider knows who they are, where they don’t have to tell their story continuously. So that’s our intention.”
The alliance offers longer visit times so doctors can establish stronger relationships with their patients. This summer, visit times were expanded from 20 to 30 minutes in response to feedback from patients and physicians. “We are very strong with what they call relational medicine,” Mr. Siegel said. “We’re not a mill, cranking people out.”
Staffing shortages also affect the alliance’s growing dentistry program, which moved in May from a van to an office in the Livery Stable. The space supports two dentists four days a week. Since opening the brick-and-mortar site, the program has expanded its services from an average of 208 patients a month to an average of 332.
Still, with four chairs, the office could be seeing more patients. The clinic newly offers crowns and dentures, and soon hopes to treat simple root canals. Services are available to anyone with Medi-Cal or without insurance.
The biggest challenge facing the dental office is a shortage of dental assistants. In response, the alliance created its own dental assistant training program in partnership with Marin County’s workforce development program. Receptionists and new hires have benefited. “We’re training people from scratch and giving them a career path,” Mr. Siegel said.
After merger negotiations with West County Health Services fell through in 2017, Mr. Siegel reached out to the Petaluma Health Center, with which the alliance shares a founder, Dr. Mike Witte.
Once the agreement is approved by both boards and signed by the C.E.O.s, the United States Department of Health and Human Services can approve the transfer of its operating grant. The California Department of Public Health and the attorney general must also approve the move to ensure that the health center maintains its nonprofit status and has appropriate licensing, and that there are no antitrust conflicts.
Already, the two groups are collaborating. The alliance has contracted work from the Petaluma Health Center’s chief medical information officer, who has implemented software that allows physicians to access electronic medical records easily and immediately before seeing a patient.