Our View

Now that Dr. Pamela Letts, M.D., has closed her Longboat Key primary-care practice, there is a vacuum.

And as economists often say, the market hates a vacuum, and the market always fills a vacuum.

How will the market fill this vacuum?

That’s a tough one.

Financially, opening a medical practice on Longboat Key is not a lucrative proposition. Just ask Dr. Letts or the four dentists who have operated here over the past 20 years.

It’s the same old Longboat story: ugh, the Key’s seasonality.

So the thought of attracting a young, newly educated physician looking to start a stand-alone primary-care practice is not realistic. Not when those young physicians face medical school loans that likely top $100,000, or the prospect of making the $300,000 capital investment required to outfit an office, or the costs of the monthly rent and the personnel required to manage the mandatory, regulatory record keeping.

Forget that idea.

Or what about attracting a physician similar to the profile of Dr. Letts in her latter years here? A physician who is at that stage when he or she is ready to throttle back but still practice.

Even that is thinly viable financially and practically, if at all. Providing urgent care or primary care is episodic and unpredictable. Sure, you can schedule routine primary-care checkups and follow-ups. But there still is hardly enough volume or density of patients on Longboat Key year-round that justifies an individual physician or even a group practice to carry the costs of operating. Especially with the expectation of making a profit worth the effort.

Let’s not forget this, either: The federal government has continued to lower Medicare reimbursement rates. This increases the financial pressure on a medical practice, especially in markets like Sarasota and Longboat Key. No wonder physicians spend so little time with patients; they need to increase their volumes to maintain their levels of income.

Where does that leave Longboat Key? How will the market fill the vacuum? David Novak, a physician management consultant and Longboat Key resident, continues to work on a quasi-concierge-membership model. Rather than pay the going rates of $5,000 to $6,000 per year for 24-7 access to your personal, concierge physician, Novak thinks a scaled-down version of that might be feasible. Residents would pay an annual membership fee, which would guarantee a certain level of access and guarantee a physician at least a base of revenue.

But what comes first — the chicken or the egg? To attract the right physician, the business needs to show minimal risk — e.g., a base of patients and capital for startup — and sufficient potential. But patients aren’t likely to commit unless they know the qualifications of the physician.

Apparently, at least the capital is available for startup. “The [Longboat Key Foundation] is willing to help with a facility and possibly with the capital required for an office,” Bob Simmons, chairman of the foundation’s board of advisers, told the Longboat Observer: But funding would have a limit. “The foundation has a reluctance to subsidize a practice on a regular basis,” Simmons said.

That’s the conundrum — keeping a practice going on the Key.

For at least the past five years, various town leaders have dreamed of duplicating the not-for-profit Boca Grande Health Clinic Foundation Inc., which subsidizes a year-round medical clinic for the residents of Gasparilla Island. Through donations the the 11-year-old foundation has raised an endowment close to $20 million.

That’s not likely to happen here when you consider all of the other charities Longboat Key residents fund and the fact health-care services are only a 20-minute car drive away. You can just imagine the catcalls from the mainland if Longboaters funded a clinic just for themselves.

Then what — if not a foundation or a stand-alone physician practice or a concierge practice?

For years talk has bubbled that the taxpayer-subsidized Sarasota Memorial Healthcare System should be involved. But like everyone else, SMH is reluctant and so far unwilling to invest the capital and support one of its urgent-care centers on Longboat Key — in spite of the annual tax dollars Longboaters send to the hospital each year (see box).

You would think that with all of the tax dollars, patient dollars and charitable contributions Longboat Key residents make to SMH that it would be amenable to helping fill the vacuum.

After all, SMH’s outgoing CEO, Gwen MacKenzie, has spoken frequently in her 10-year tenure of SMH’s mission to fill the health are and medical needs of the community. Nowhere is that more evident than in all of the clinics SMH has opened throughout Sarasota and southern Manatee counties.

Sometimes the numbers on a financial proforma tell you a business won’t work. But rare is the case when those proforma numbers are right.

There’s a vacuum and a need in the medical market on Longboat Key. Likewise, there are committed participants and willing investors who want to fill that need and help carry some of the startup costs.

Given the financial condition of SMH — $32 million in cash and its A1 Moody’s rating — it would not be a “bet-the-ranch” risk for SMH to collaborate with Novak and the Longboat Key Foundation to give a clinic a try. Give it two, give it three years. Better that than not trying at all.

+ Another alternative: a PA
If it’s too costly to operate a stand-alone, around-the-clock urgent-care clinic on Longboat Key with an accredited physician, perhaps another alternative is a physician’s assistant.

Add the position to the town budget, and set up an urgent-care only office in one of town fire stations.

Longboat Key’s Fire Department is fully staffed with emergency medical technicians. It’s not much of a leap — financially or otherwise — to add a PA to the staff.

You can envision it: The PA handling stingray bites, cuts from falls, sniffles, upset stomachs and all of those minor urgent setbacks that don’t require a Harvard-trained brain surgeon.

WHAT LONGBOAT PAYS TO SMH IN TAXES
Sarasota Memorial Healthcare millage rate...........1.0863
SMH annual countywide tax revenue......................$40,611,149
LBK-Sarasota County assessed value....................$3,400,203,897
LBK assessment paid to SMH...................................$3,693,641

Sarasota Ballet Puts Us on the Map
When the Sarasota Ballet search committee interviewed Iain Webb for the artistic director position seven years ago, committee members told Webb they were hoping to hire a candidate who could take what was then a small ballet company to international acclaim.

Webb, of course, told committee members he would like to do the same. What candidate wouldn’t say that?

Webb almost didn’t get the job.

But it was meant to be.

Over the past seven years — a short time for any organization, Webb and his wife and Sarasota Ballet Assistant Artistic Director Margaret Barbieri have infused the ballet company and its dancers with a passion for excellence, ambition, vision, focus and achievement that is, well, a sight to behold.

All of that was in full flower this past weekend at the Ashton Festival, a tribute to the late Sir Frederick Ashton, one of the greatest choreographers of all time.

And judging from the post-festival press reports from New York, London, Toronto and beyond, Webb has done what he said: He put Sarasota Ballet and Sarasota on the world map. Bravo.