The Jan. 28 edition of The Triplicate contained two letters, raising some points again about the future of the hospital and expressing the desire to see Asante or some other hospital company here to guarantee "full service."

As readers may recall, I was one of three physicians who joined the steering committee for the Camden Group study. The Camden Group went to great lengths to explore the proposal of transferring affiliation of the hospital to a different corporation.

Four other hospital corporations, including Adventist Health and Asante Health, were interviewed and their experience and resources were detailed for the committee. We learned an interesting and important fact during that discussion - the officers from all those corporations, including Asante, told the Camden interviewers that they too, would consider Critical Access for this hospital, were they in charge.

Of the four, Asante Health seemed to me to be the least desirable of the group. Although they have excellent hospitals staffed by excellent physicians, Asante is relatively small and solely Oregon-based. Unlike the others, it is not licensed in California and has no experience dealing with California health-care law.

Furthermore it has no experience recruiting physicians to the coast. Hospitals and clinic operations are very different in a truly small community like ours, compared to a "rural" community such as Medford, and the attractiveness of our respective communities for the average physician are vastly different.

Convenient transportation, social life, cultural events, big-city amenities, even the overall climate - all those things favor Southern Oregon over us.

Don't get me wrong; after 21 years, I still don't want to live anywhere else other than Del Norte County. I love the wild beauty of this place, and the fact I have bear and deer visiting my backyard fairly regularly, and even the occasional cougar.

Experience has shown, however, that most physicians, coming as they do from larger communities where such things are not the norm, are not looking for outdoor adventure as a way of life.

And this raises an important point - the market for physicians has fundamentally changed during the last two decades. When I left residency in 1992, at best about a third of my graduating class were going to look for work as employed physicians. The rest hoped to join a practice, or were undecided.

Last fall, I attended a major family practice conference and happened to listen to a lecture by a vice president of Merritt-Hawkins, the largest physician-recruiting company in the nation. His lecture was entitled "How to Get What You Deserve out of an Employment Contract," and in his opening remarks he frankly stated that over 90 percent of their recruiting effort in today's market is locating physicians for employment - simple paycheck to paycheck employment.

No more joining partnerships in practices, no more starting of small business to open a practice, no more sponsorship by hospitals to support new physicians - it is all employment-based negotiation and contracting.

Dr Greg Duncan's situation is a case in point. He has chosen to not take any scheduled call time for the hospital emergency room for about the last seven or eight years, long before this dispute started. At least part of the reason for this was the departure of his former partner, Dr. Lau.

Hospital records suggest that as many as 90 orthopedics cases were transferred from our ER every year when Dr. Duncan was our only remaining full-time orthopedic surgeon.

Asking someone to be on-call all the time is a tall order, but had he been on-call even 50 percent of the time, perhaps 40-50 additional cases per year could have been treated here.

Unfortunately, most orthopedic surgeons in today's market don't want to do anywhere close to 50 percent call time - they want to join a large group, and want to specialize on procedures for one or two joints, and perhaps take call for their local hospitals at most one day a week, shared among many other surgeons.

Our only new orthopedic surgeon, Dr. Haimson, is sponsored by the Sutter Pacific Medical Foundation. Dr Haimson actually takes call for the hospital, at least 10 days of every month, as do Drs. Polidore and Ritter, all Foundation physicians.

It is likely that the next surgeon brought here will also be a Foundation surgeon, and not just because of improving coverage of the hospital for emergencies (bringing in temporary surgeons of any kind to cover for emergencies literally costs thousands of dollars a day), but because in today's world physician foundations are the only realistic means to make successful physician recruitment happen.

In California, having the resources of a physician foundation is almost essential to have a chance at success. Asante does not have this - in Oregon, the relationship between hospitals and doctors follows different laws.

One last note about Asante Health. About half of the members of its Board of Directors are physicians, a very desirable thing from a physician's perspective, mine included.

It appears, however, to be a single board for all three of Asante's hospitals. Asante, it would seem, has already "gone regional."

Dr. Warren Rehwaldt is the senior physician for the Del Norte Community Health Center, the county's public health officer and the vice-chief of staff at Sutter Coast Hospital.