It’s getting easier to find a doctor for a sick child in the San Joaquin Valley.
Valley Children’s Hospital and Community Medical Centers – competitors for pediatric patients – are recruiting pediatricians and spending millions on buildings where they will work.
Community Medical Centers has plans for a five-story pediatric office building near its downtown Fresno trauma and medical center. Valley Children’s Hospital is opening a new clinic in northwest Fresno and has bought or is buying property for new clinics in cities from Modesto to Bakersfield to accommodate growing physician practices.
Both hospital systems say demand for care, not an ongoing feud over pediatric patients, is driving the building boom. Regardless of their motivations, the Valley needs more pediatricians and places for them to practice. The region is a federally designated underserved medical area, and pediatricians and sub-specialists with the expertise to fix tiny hearts, mend delicate bones and heal other health problems are in great need.
Community and Valley Children’s say their goal in expanding pediatric services is to provide access to care so children don’t have to leave the Valley to see a specialist or to have procedures.
Pediatric patients account for 12 percent of our overall patient volume, and that’s a number that is sure to climb.
Craig Wagoner, CEO, Community Regional Medical Center
Craig Wagoner, CEO for Community Regional Medical Center, said that “pediatric patients account for 12 percent of our overall patient volume, and that’s a number that is sure to climb.” Community has 72,000 pediatric visits a year, of which about 56,000 are for outpatient services, he said.
Community Regional is dedicating space in its planned five-story pediatric building to sub-specialty care, Wagoner said. The building could be completed by late 2018.
The hospital is adding a 10-bed intensive care unit for children in its five-story trauma and critical care building, which should be open this summer.
The pediatric building and intensive care unit are part of a $600 million expansion at the hospital.
With the help of a partnership with the University of California at San Francisco Benioff Children’s Hospital, Community has recruited pediatric specialists in such fields as pulmonology, cardiology, gastroenterology, neurology, adolescent medicine and dermatology, Wagoner said.
“Obviously, we’re committed with our partners at UCSF Benioff to provide a vibrant pediatric program that’s befitting for a regional medical center that serves such a large, and growing, portion of the state.”
Valley Children’s Hospital, which is based in Madera County, is casting a wide net for patients, expanding in Fresno and in communities beyond.
The hospital is recruiting pediatricians and pediatric sub-specialists, and so far this year more than 20 primary care providers have been added to the network of physicians. It has hired sub-specialists, including a pediatric neurologist whose expertise is in the treatment of epilepsy in children.
A new pediatric clinic, Sky Park Pediatrics, will open soon inside the Saint Agnes Wellness Center at Herndon and Milburn avenues in northwest Fresno. The center will have four pediatricians and four nurse practitioners.
The hospital will be opening a new center in central Fresno to replace a small clinic on First Street, near Dakota Avenue. Doctors at the new site will continue to serve children in Fresno’s core, many of whom are in low-income families, said Valley Children’s CEO, Todd Suntrapak.
The children’s hospital also is evaluating two locations in Fresno for sub-specialty practices.
Last year, Valley Children’s saw 120,000 children in its emergency department, making it the 21st busiest emergency department – adult and pediatric – in the country, Suntrapak said. And last year, Valley Children’s provided care for 16,000 more children than in 2014. Putting that number in perspective, Suntrapak said: “It’s a Save Mart Center filled to the brim, full of more kids.”
The hospital’s busy emergency department could see some relief soon. Valley Children’s could be back in the pediatric urgent-care business in Fresno again after shuttering two such practices for financial reasons 13 years ago.
We have a strong desire to make sure kids get to the right place at the right time for the right care
Todd Suntrapak, CEO, Valley Children’s Hospital
“We have a strong desire to make sure kids get to the right place at the right time for the right care, and in our minds urgent care plays a role in that,” Suntrapak said.
Children from Fresno County fill most of the beds at the hospital. In fiscal year 2015 Fresno kids were 6,240 of the 13,706 patients admitted.
Growing north and south
But the hospital admitted only 140 more Fresno County patients in 2015 than in 2014, an increase of just 2 percent. Increasingly, growth at Valley Chilldren’s is from patients who live in counties to the north and south of Fresno. For example, the hospital saw a 32 percent increase in children from Merced County – from 1,166 patients to 1,534. The patient count from Kern County increased by 12 percent, from 1,060 patients to 1,185.
The hospital is responding to the needs of patients in the north and south. Last year, it opened a specialty care center in eastern Bakersfield, and it is in discussions to buy a building for specialty care at a yet to be determined site. It’s building a third specialty care center in northwest Bakersfield. It’s closing escrow on a six-acre parcel in Modesto for a specialty clinic and is shopping for six acres in Merced for specialists to practice. Last month, it opened a new maternal-fetal medicine center in Visalia in a leased building it hopes to buy. And a primary care/specialty center, to be built in partnership with Adventist Health on 16 acres in Fowler, is expected to be completed sometime in 2018.
The hospital’s investment in land and buildings is steep. “To accomplish our goal of not being any more than 30 minutes away for any family in the Valley, from Kern County to San Joaquin County, it’s between $100 million to $200 million,” Suntrapak said.
The hospital will pay for the buildings and land from savings, he said. “We’re not borrowing any money. We’re writing checks for this.”
In several instances, the hospital is expanding on services it has provided for years and is collaborating with longtime medical partners.
Valley Children’s has provided neonatal intensive care services at Mercy Medical Center in Merced for 25 years and has had sub-specialists working in the city for 40. This year, it is looking for six acres to relocate and expand its sub-specialty clinic.
But Merced is desperately short of primary care physicians, and doctors in the city have asked Valley Children’s to recruit pediatricians. The city has fewer than a half-dozen pediatricians and should have at least twice that many. So far, two doctors have been recruited by Valley Children’s and the hospital is looking for two more. An office building will be bought or a new one built for the doctors, Suntrapak said.
Rob Streeter, vice president medical affairs for Dignity Health-Mercy Medical Center in Merced, said his hospital sees anywhere from 45 to 55 children daily in its emergency department.
“We’re all behind Valley Children’s adding more pediatricians to see those patients,” he said. “We are hoping that it will not just reduce the number of ER visits per se, but will provide access to care more readily outside the hospital setting.”
In Modesto, the hospital is recruiting sub-specialists and has plans to move from a leased building into new office space. Right now, two doctors live in the community and others travel from the hospital in Madera to Modesto to see patients. “We’re committed that our doctors will improve the health and well-being of our kids more, if they live in the community,” Suntrapak said.
In Visalia, the hospital is on the hunt for two maternal-fetal specialists to live in the city and work at the new Akers Street Specialty Care Center that opened in April in cooperation with Kaweah Delta Health Care District. Six specialists now rotate to Visalia from the Madera hospital to see patients.
The specialists are needed in Visalia, said Edward Hirsch, Kaweah Delta’s vice president and chief medical/quality officer. Obstetricians deliver about 4,500 babies a year, and more than 50 percent are at higher risk of complications, he said.
Julie Rivera, 27, was one of the first patients to be seen at the new maternal-fetal specialty clinic, which is near the accounting office where she works. She was referred by her obstetrician who had concerns after viewing an ultrasound of her baby.
“He said doctors there are more experienced and would do a really thorough look at my baby,” Rivera said. Her baby was deemed to be fine, she said. “It was a nice experience.”
It’s the right way to serve the community.
And it was convenient. Rivera, who is about five months pregnant, said: “It was nice that it was just right there. I think it makes sense. It’s probably expensive, but it’s nice to have it nearby.”
In Bakersfield, the 34th Street Specialty Care Center that Valley Children’s opened last year is helping Bakersfield Memorial Hospital address an unmet need for pediatricians, said Robin Mangarin-Scott, vice president of strategic marketing and communication for Dignity Health Central California.
“It’s the right way to serve the community,” Mangarin-Scott said.
In its first year, the 34th Street clinic saw about a quarter of the 8,190 Kern County patients seen in all Valley Children’s facilities. The 34th Street clinic is averaging more than 400 visits a month.
Valley Children’s has a formula for deciding when to add services in a community, Suntrapak said. “When we get to a critical mass, it makes sense to deploy sub-specialists,” he said.
The freestanding children’s hospital has a role in the Valley that is broader than a couple of ZIP codes in Fresno, he said. “And we are going to stay committed to and focused on our mission, which is to improve the health and well-being of kids who live in this Valley.”