Island Exposure : UCLA Residents Discover Challenges of a Small-Town Practice on Catalina

This summer, Dr. Andrea Pana left the sophisticated world of the UCLA Medical Center--with its CT scanners, MRIs and 700 beds--and caught a ferry to the world of down-home medicine.

Her destination was Santa Catalina Island’s only hospital, which boasts one dozen beds and not a single piece of fancy diagnostic equipment. There she spent a month diagnosing fractures, treating bee stings and sampling small-town family medicine. This is a universe where the hospital’s only full-time doctor makes house calls on a golf cart, where people can recite the boat schedule by memory, where phone numbers are given in four digits because everyone on Catalina shares the 510 exchange.

What propelled Pana to this picturesque island 26 miles off the coast is a novel experiment aimed at aiding a financially struggling hospital while exposing young doctors to the rigors of rural medicine.

Since July, third-year residents in family medicine at UCLA Medical Center have been required to spend four weeks at Catalina’s tiny Avalon Municipal Hospital, the quaint tan stucco building tucked away on Falls Canyon Road and the only hospital in Los Angeles County officially classified as “rural.”

One by one, the eight residents--medical school graduates finishing their training--are discovering the challenges of practicing medicine outside the big city. Some call the experience a Southern California version of what a fictional doctor experiences on the television show “Northern Exposure.” The climate may be balmier than Alaska’s--where a young, cosmopolitan doctor reluctantly sets up practice in a small town--but the island offers the same intimate--even quirky--flavor.

After only a few weeks on the picture-postcard island of mountains, coves and Mediterranean-style homes, people on the street and in the bakery were greeting the 26-year-old Pana with a friendly, “Hello, doctor!”

Hospital employees are often stopped on the street by community residents asking for medical advice or inquiring about a bill. Sometimes, the island folksiness can be a bit much.

“I liked the idea of it being a small community, of everyone knowing you’re a doctor,” Pana said. “But there’s something to be said about anonymity as well.”

Avalon Municipal’s small size and staff of 25 can seem positively Lilliputian for young doctors accustomed to the vast UCLA Medical Center, with its 1,400 full-time faculty physicians and support staff of 3,500.

The hospital has X-ray equipment but only a small laboratory, increasing the importance of such clinical skills as examining patients and scrutinizing medical histories, doctors said.

They treat everyone from well-heeled tourists to busboys and waitresses eking out a living on the island. And they see a variety of rural ills: a young swimmer who swallowed too much water, patients with hands swollen from bee stings, a snorkeler bitten by a fish.

Pana recently treated 24-year-old Kirstin Sterosky of Tucson, who tripped and injured her ankle in Avalon shortly after disembarking from the ferry. As she sat in the emergency room--the only patient awaiting treatment that afternoon--Sterosky wondered how a hospital could be so small and friendly.

But like their urban counterparts, small-town hospitals have their share of problems. Many rural hospitals are strapped for funds; about 250 of them closed nationwide between 1980 and 1988, according to the National Rural Health Assn.

Catalina’s tiny, city-owned hospital nearly shut down last year after Long Beach Memorial Medical Center announced it could no longer afford to manage the facility, which was losing an estimated $30,000 a month. (The city of Avalon agreed to pump as much as $520,000 this year into hospital operations in an effort to save it.)

The hospital’s administrator, hired last fall, left abruptly in August as the hospital grappled with cash-flow problems. Just last week, hospital officials were stunned to learn that a private air ambulance had halted its transport of Medi-Cal patients from Catalina because of sharp cuts in state reimbursement.

The news was a rude reminder of how the island is cut off from the emergency network “overtown,” which is how Catalina residents refer to the mainland.

Rural hospitals traditionally have trouble attracting and keeping doctors, nurses and other staff. Before this summer, the island was served by only two part-time physicians.

“It takes a certain dedicated individual who’s willing to work the longer hours, with less pay and less professional companionship,” said Roger Richter, an expert on rural hospitals at California Assn. of Hospitals and Health Systems.

But the UCLA program allowed the hiring of a full-time family physician, Dr. William Holvik, to serve as a faculty member on the island and supervise the residents. Holvik was attracted by the idea of small-town practice, which he says promotes a closer relationship between doctor and patient.

There are drawbacks, however. Doctors in group practices can share the patient load, but Holvik is on call seven days a week, 24 hours a day.

There is the constant sense of acute isolation, of practicing without the security of a metropolitan medical center and its physicians. The UCLA program is still too new to assess whether it will attract doctors to rural practice. Dr. Stephane Garcia, 34, said he enjoyed his recently completed stint on Catalina but will probably settle in a metropolitan area.

But Pana, a devoted city dweller who has trained at hospitals in Washington and Los Angeles, says the Catalina experience gave her a fresh perspective on rural living. “Before I went there, I said I would never do rural medicine,” she said. “I would consider it now.”