Quick Take
Dignity Health Medical Foundation’s decision to change its physician contracting structure has prompted more than a dozen doctors and advanced practice providers to work for other health systems. Patients say they're concerned about healthcare access, while hospital officials say they're recruiting new clinicians.
Gail Gay says she received consistent care for eight years from her Dignity Health Dominican Hospital primary care doctor, who helped guide her through everything from her abdominal aortic aneurysm to her antiphospholipid blood disorder.
But in April, when Gay, 75, learned her doctor was leaving, she expected the hospital would establish immediate continuity of care with a new primary care doctor for her complex conditions – some of which require weekly monitoring and regular prescription refills.
Her departing doctor told her to call a Dignity Health physician in Scotts Valley, but she said that office told her the earliest she could get an appointment was June 2027 – a year out. She says Dignity Health Dominican Hospital still hasn’t provided her a new primary care doctor.
“I feel angry and frustrated, that we live in this big community and there’s no doctor to pick up,” she said. “How can this be happening, that you’re referred and you can’t see them for a year? That to me is unbelievable.”
Gay’s doctor is one of more than a dozen physicians and advanced practice providers – like a physician’s assistant – who either took jobs elsewhere or chose to retire early after Dignity Health Medical Foundation changed how it contracts with them late last fall.
The departures, which several doctors told Lookout is more than a regular year of turnover, are a significant loss for a system that has already been facing pressures to address staffing shortages and long waiting lists for primary care access. Some, which included primary care, obstetrics and gynecology doctors, went to places like Kaiser Permanente or Sutter Health.
They were among about 120 members that made up the Santa Cruz Medical Group, which was established in 2014 by a handful of physicians. The group included doctors ranging in specialties from orthopedics, endocrinology, pulmonary medicine, urology and infectious disease. They contracted with Dignity Health Medical Foundation to provide services to Dominican Hospital. In turn, the Santa Cruz Medical Group contracted with the physicians and providers.
Dignity Health Medical Foundation ended the contract with Santa Cruz Medical Group and is now contracting with the Foundation Physicians Medical Group, which the local physicians previously contracted with before the Santa Cruz Medical Group was founded.
Dignity Health Dominican Hospital spokespeople declined to answer Lookout’s questions, such as why the change was made and how many patients had lost their doctors due to the changes. They also declined to provide someone for a Lookout reporter to interview. They instead provided a statement from the medical foundation, which said “unwavering dedication” guides its decision-making.
“While some physicians have pursued other opportunities, we are onboarding new clinicians in multiple specialties — some starting now and others through the fall — with additional offers in progress,” the statement reads, adding that the foundation plans to fill most open roles by the end of the year.
“We remain fully committed to retaining our top clinicians and recruiting the best talent, ensuring the community continues to have access to quality care for many years to come,” it reads.
Dean Kashino, a doctor who retired from Dominican Hospital in 2022, was a founder and the initial shareholding member of the Santa Cruz Medical Group. He said some doctors, who decided to leave or retire this past year, told him they were upset at not only the potential impacts to their income from the change but also how the medical foundation made the change unilaterally rather than having a discussion.
He said doctors had a “take it or leave it” feeling, the loss of the sense of collegiality and pride of ownership of the medical group. There were about 60 shareholders of the group, which is now closing after the contract change.
Kashino said he feels the medical foundation should have consulted the medical group a year ago to let them know it was considering dropping their contract unless other changes were made, such as asking doctors to see perhaps one or two more patients a day. Lookout wasn’t able to reach any doctors who left Dignity Health.
Kashino added, however, that Dignity Health Dominican Hospital has fewer financial resources than providers like Kaiser or Sutter Health, which he said tend to have full-service hospitals. Kashino added that Dignity Health is the “biggest provider to non-managed care MediCal patients in the state, which is a financial challenge.”
At the same time that the contract changes were underway, the hospital’s longtime CEO announced her retirement in November. Kashino served on the interviewing committee to select a new hospital president, Christine McSweeney, who started in April. She also leads Redwood City’s Sequoia Hospital.
Kashino said McSweeney was his first choice “by far” as she sees the “importance of trying to remain full service” as opposed to cutting services to make the hospital more profitable. He said he’s hopeful that Dignity Health can help steer Dominican Hospital through tough financial times, which are also affecting Watsonville Community Hospital.
Not everyone is as hopeful.
Nell Chapman, a registered nurse who works in the emergency department, said the hospital is “continually short-staffed” and nurses are “deeply concerned” about recent changes implemented by CommonSpirit (the owners of Dignity Health Dominican Hospital), which “have led to an exodus of doctors.”
“As members of the community who both work and live in Santa Cruz County, we are acutely aware that as doctors leave, the hospital will struggle to provide the many needed services for our patients,” she said. “We need a healthcare system that can meet the demands and needs of Santa Cruz County, not one that is used as a profit machine to line the pockets of CommonSpirit executives.”
Gay, the Dominican Hospital patient, said her daughter is trying to help transfer her out of Dignity Health and into Sutter Health. Rachael LaCombe said she’s been anxious about ensuring her mom is receiving adequate care. At the very least, she said Dignity Health should have had a team in place to help patients transition and not leave that burden in an “elderly patient’s lap.”
“She’s on medications for blood pressure and her clotting disorder and her pain issues, and just having someone that can manage her medications appropriately is my concern,” LaCombe said of Gay. “Without it, it’s very unsafe for her.”
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