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Gerald Starr

As a hospital executive with many years of experience in hospital-based health care in Kern County, I would like to comment on The Californian's Dec. 13 editorial, "Local medical providers must step up for KMC."

The physician shortage in central California and Kern County is real and chronic for both primary care specialties as well as many other specialty physicians. Clearly the "tax exempt" and "tax supported" hospitals should provide educational support in some manner for the training of physicians who may remain in our community. Keep in mind that Kern County hospitals already financially support training programs such as those for registered nurses.

However, the "community benefit responsibility" assumption should be further explored.

Some other factors should be considered when you arrive at the conclusion that "local medical providers must step up":

* Physicians typically become independent, for-profit business entities or employees of professional (non-hospital) corporations. The commitment of the individual physician to treat the poor and underserved may be transitory.

* Physicians can become employees of government-owned (KMC) or -sanctioned health care organizations (such as Clinica Sierra Vista or Kaiser). In this health care environment, the physician can/will serve both the poor and underserved as well as those patients who have financial resources for their care.

* The concept of committing tax-exempt dollars generated by one hospital to the training of individuals in another hospital or health care provider should be evaluated. Consider: Trainees in the process of their training directly and indirectly produce revenue for the educational organization(s).

* Hospitals that take action to meet the "community need" may believe that there is a "community benefit" in their very large investments of reserved, borrowed and, recently, significant donated dollars in service lines such as burn centers, cancer units, pediatric centers, etc. These investments should bear some consideration when they are questioned regarding "flashy marketing campaigns."

* Hospitals that actively enter into arrangements to "increase the number of physicians to benefit the community" are often subject to criticism from the physician community.

* Many of our community physicians -- over many years -- have supported the residency programs and the poor and underserved patients of Kern County. Perhaps those who have benefited financially by the KMC training programs could support a generic financial commitment to local physician education programs. However, we should keep in mind that for-profit entities don't generally contribute to increase the number of potential competitors. They may, however, recruit or support individuals for their own businesses.

Having offered my comments in response to The Californian's editorial, I would want to clearly state that the pre-eminent family practice residency program as well as the other specialty residencies at Kern Medical Center are vital to the health care future of Kern County. The residency programs of Kern Medical Center should be supported, nurtured and, if possible, expanded. The leadership of the health care organizations and professionals of Kern County should effectively communicate and collaborate as necessary to accomplish that objective.

Gerald A. Starr has worked in health care leadership and in community volunteer activities in Kern County since 1982; he has a master's degree in public health and is a fellow of the American College of Healthcare Executives. Another View presents a critical response to a previous editorial, column or news story.