Practices Made Perfect for 2 Doctors

For two decades, doctors Joan and Nat Baumer built their lives and their reputations in Ventura, shining brightly in a profession of academic stars while shoring up the county’s tattered safety net for the poor.

Perhaps no couple in the local medical community were better known--or more controversial in their mix of public and private medicine.

Their deeds reached far beyond the routines of doctors’ offices and hospital corridors--to youth sports and Boy Scouts, to halfway houses and history museums, to the American Heart Assn. and Temple Beth Torah.

They lived in Ventura as a young married couple--training here as physicians, staying here as mentors and raising a family of four athletic boys--the oldest of whom was an all-county high school linebacker last fall.

And they never intended to leave.

“We thought we were here for life,” Joan Baumer said recently.

But earlier this week, Joan and the boys packed up the family belongings, loaded them into a moving van and headed for Texas. Nat was already there.

In a mid-career move neither anticipated just a few months ago, they left big jobs in Ventura County for bigger ones elsewhere.

By now, Joan is at work at a public hospital in Fort Worth, directing the largest training program for family doctors in the nation. Nat took over in May as the director of emergency medicine at the same facility--John Peter Smith Hospital, a counterpart to the county hospital here, but twice as large.

Employment headhunters found the Baumers, they said, not the other way around. And before long the couple and the jobs were matched.

“We got an offer that was too good to refuse,” Joan Baumer said. “It was one of those fortuitous situations where two wonderful opportunities existed at the same time in the same place. As my 13-year-old said, ‘Mom, it was just meant to be.’ ”

Admirers say the Baumers will be sorely missed.

“It’s a tremendous loss to our community,” said Samuel Edwards, administrator at Ventura County Medical Center, the center point of the local public health system. “They were prodigious in what they did here. They touched the lives of thousands of people. They cannot be replaced.”

Nat, a 49-year-old former basketball star and team doctor for Buena High football, had directed the county’s busiest emergency room for 13 years until 1997, and in recent months had planned a system of public emergency clinics for Ventura County.

Joan, a 48-year-old lead singer in a traditional Jewish band, had delivered 2,500 babies, lectured on adolescent behavior and researched the causes of childhood disorders while managing a bustling family practice.

Together they had taught 250 young UCLA doctors who came to the county hospital for advanced training in how to care for families: From Nat they learned emergency medicine; from Joan they learned to balance the complex demands of being a modern family doctor.

“They’re both excellent teachers--Nat with his ability to manage and treat emergency room patients in a caring manner, and Joan as an outstanding family practice doctor, who delivered a lot of babies and provided a lot of complex medical care.” said Lanyard K. Dial, director of the UCLA residency program.

Working with the county, the Baumers also opened a series of family clinics in poor communities that were cited statewide as pioneering models of public-private cooperation and then, more recently, as a questionable mix of public dollars and private enterprise.

The first clinic, founded in 1983 and run from a rickety trailer in the Avenue area of Ventura, was then the only public family clinic for the poor in Ventura County. Joan was the doctor and her staff consisted of a nurse and a receptionist.

By 1989, the county had set up four family clinics, but they were struggling beneath a $1-million annual deficit. The Baumers proposed a solution: They would run public clinics as private businesses while agreeing to treat any patient who walked through the door.

They would eventually operate clinics in west Ventura, Santa Paula and Simi Valley. The county covered their overhead and paid them $2,000 to $2,500 a month in administrative fees for each facility.

No one complained at first. It was still a boom time for physicians, since managed care had not yet forced cost-cutting reforms on medicine. Other doctors did not seem interested in running county clinics for the poor. So the county was grateful, even giving the Baumers public service awards for stepping forward.

“When this whole system was in trouble, they were the only ones to get services out of the hospital and into the local clinics,” hospital administrator Edwards said. “They provided access and they provided care.”

As the county system expanded to eight clinics, patient visits soared--from 143,000 in 1987-88 to 280,000 last fiscal year, Edwards said.

But critics insisted that the county was creating an extensive health care network intent on competing for private patients, and not just providing a safety net for the poor.

The Baumers were caught in the middle, partly because they treated not only public patients but private ones as well.

For example, in the west Ventura clinic--the largest in the system with 45,000 annual visits and 10 doctors--one-third to one-half of the patients are private, Joan said. But she said she paid all costs of the private practice in a county facility--subleasing office space at market rate, and underwriting all employee benefits and management costs.

Competitors didn’t believe it.

“There’s no question that their private practice is subsidized with county dollars, and that’s the problem,” said John Keats, medical director of the Buenaventura Medical Group in Ventura. “I don’t want to see my tax dollars going to physicians who are directly competing with me and my group for our livelihood.”

Yet, the Baumers see the extension of health care into poor neighborhoods as their principal achievement in Ventura County.

They accept the controversy and wonder if their many contracts with the county--Nat’s as emergency room director and Joan’s as chief officer at the clinics--contributed to their decision to move to Texas.

They weren’t considering such alternatives until last June--when the county’s emergency medicine contract was awarded to another doctor.

County officials gave Nat a different contract to extend emergency medicine into urgent care clinics countywide. But he missed the swirl of the emergency room.

“I enjoy the day-to-day movement of emergency medicine, dealing with patients and particularly the teaching,” Nat said.

So he responded to an employment firm’s solicitation and ended up in Fort Worth as a consultant advising his future employer on how to update its emergency room. He was offered a full-time job this spring. And when Joan was visiting her husband, hospital administrators quietly scouted her as a potential director of its residency program.

“I had no idea they were looking at me, but then they called and said, ‘You might just be the person for us,’ ” Joan said. “This is a dream job. You practice for 20 to 25 years, and then one day someone comes to you and says, ‘Would you teach young doctors what you know?’ ”

Within six weeks, she had agreed to move on.

Her parents live in Texas, her sons love Texas’ football culture. And the career opportunities are unlimited.

“This was the right thing for us to do,” Nat said.

“But I’ll hold a sweet spot in my heart for Ventura,” Joan said. “We’ve had a very blessed life here. We were able to make a lot happen. And it’s the basis for launching us to a different level.”