Health Care for the Future: Growing the Family Practice Clinic Report to the Community From the Wahkiakum Family Practice Clinic Advisory Board October 2008

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Near-Term Goals for the Clinic

The Clinic Advisory Board quickly recognized that continued reductions at the Clinic would surely result in its demise and that the only way to provide sustainability was to grow the Clinic. The Clinic Advisory Board, working with the Clinicians and Business Manager, quickly identified the following short-term strategies:

  • Achieve stable funding for the remainder of 2007 and 2008, to allow the Clinic to recruit new physicians and nurse practitioners, open the Clinic to new patients again, and begin to expand outreach and marketing to get new patients.

  • Identify the mix of services and the associated revenues that would be optimal for the community and cost effective for the clinic.

  • Identify the staffing mix, equipment and facilities requirements that allow the Clinic to provide the services agreed to by the Advisory Board, the Commissioners and the Community.

The Board of County Commissioners approved support for the Family Practice Clinic in 2007 and 2008 that would stabilize the Clinic’s funding and staffing levels in September 2007. The Clinic Advisory Board worked closely with the Clinicians and the County to develop offering packages and a hiring process. Recruitment for physicians and ARNPs has been ongoing since September 2007.

A temporary ARNP was added to the staff in December 2007 and she stayed through July 2008. The Physician’s Assistant Certified (PAC) replaced the ARNP in September. In addition, the Washington State Department of Health Recruitment Group connected the Clinic Advisory Board with a physician looking for a project position in a community like ours. This physician, Dr. Janice McClean, a Board Certified Family Practice Physician, joined the Family Practice Clinic in April 2008.
Within the constraints of the current building, with six exam rooms, the Clinic Advisory Board recommended the Commissioners approved an interim staffing mix that is described below:

Figure 5. Family Practice Clinic Staffing Mix in late 2007



Physician, Medical Director


Advanced Registered Nurse Practitioners/Physician’s Assistant


Registered Nurse


Medical Assistants


Business Manager


Billing Clerk (part-time)


Reception & Clerical


Total Staff


The level of staffing described in this table is supportable within the budget provided by the Board of County Commissioners for 2008. The Clinic Advisory Board and Clinicians agreed to reopen the practice to new patients beginning March 1, 2008. A marketing effort will be undertaken in the early summer to expand the patient panel and grow the Clinic’s business.

In addition, the Clinic Advisory Board recommends that the Family Practice Clinic maintain both its laboratory and X-Ray services. The availability of lab and x-ray at the Clinic improves the ability of the Clinicians to make timely and accurate diagnoses. In addition, these services reduce the number of people sent to the Emergency Department because urgent and acute illness and wounds can be efficiently cared for at the Clinic. Finally, maintaining these services in the county reduces the expenses for patients who would otherwise have to travel to Astoria, Ilwaco or Longview/Kelso for lab and x-ray services.

Community Survey

In December, the Clinic Advisory Board conducted a community survey. Two thousand, two hundred surveys were mailed to box holders in Wahkiakum County, as well as Rural Route 1 in Naselle which includes many Wahkiakum County residents. Of these, 422 surveys were returned, representing 19% return of the total surveys mailed. However, the surveys returned covered more than 810 family members which equals approximately 20 percent of the county’s population or 25% of the county’s total households. This is a strong return, indicating that there is a high interest in the Clinic and its future in the county.

Of those families responding, 80 percent said the Family Practice Clinic was very important or somewhat important to them. Most of the responding families use the Family Practice Clinic (77.4% of survey respondents); while 95 surveys indicated that their families either go to Kaiser or another Clinic (i.e., Naselle Clinic). However, even for the 95 respondents who go other clinics, 39 of these respondents indicated that the Family Practice Clinic was important to them.
More than 68% of the surveys indicated a desired level of service that required some amount of subsidy. The choices for subsidy were: 48% favored some form of patient fee, 32% favored a combination of taxes and fees, 14% favored a tax, and the remaining 6% did not want any form of tax or fees.
The survey responses indicated that most people were comfortable being seen by both doctors and nurse practitioners, as 73% of the surveys indicated that seeing the next available clinician was acceptable.
There were 240 surveys that included comments. The most commonly mentioned themes were focused on the unfairness of taxing to subsidize the Clinic (55 comments), the importance of keeping the Clinic for the community (43 comments), and the desirability of returning the Clinic to private control (38 comments).
The Clinic Advisory Board considered the survey findings and analysis of respondent comments in formulating all the policy recommendations developed for the future operations of the Clinic. A more in-depth discussion of the survey findings is available in Appendix 3.

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