Dr. London’s mission
Why would a physician want to take responsibility for more than 60,000 patients, mostly Medi-Cal? Read on …
When Dr. Barry London, a pediatrician, was in private practice in Chico from 1982 to 1999, he had about 3,000 patients, most of them children of well-insured parents. Today, he has 20 times as many patients, most of them low-income Medi-Cal recipients, and he couldn’t be happier about it.
In late September, London became chief medical officer of Del Norte Clinics Inc., which operates a string of 11 community health centers stretching from Wheatland to Orland and Chico. (A 12th center, in Arbuckle, is under construction and slated to open in November. Del Norte also operates a mobile clinic.) London’s job is to oversee 55 doctors and 320 other medical professionals who staff the clinics.
Asked why he took on this daunting job, he replied, “I’ve always had a strong sense that people have a right to health-care access, and community health centers provide that access to people who otherwise might not have it.”
And, although he won’t personally be treating patients, he feels that he’s helping far more people than he ever could in private practice. “It’s very important for me to think my participation can affect the health of 60,000 people, not 3,000,” he explained.
London is 61 years old but looks younger, despite his thinning gray hair. When he was interviewed recently, at the Chico Family Health Center on Cohasset Road, he looked natty in a European-cut pinstriped charcoal-gray suit, light-blue shirt and a red-striped tie. He has a small, spare office at the back of the clinic—"just enough for me to put down my computer and use the phone"—but is based at the company’s headquarters in Yuba City, to which he regularly commutes from his Chico home.
Not only does London have far more patients now, they’re also more difficult to treat. Often they’ve received little or no preventive care or, in the cases of pregnant women, prenatal care. And many haven’t seen a dentist for decades, if ever, London said—which is why five of Del Norte’s clinics offer full dental services.
And the clinics’ patients are culturally diverse, too. There are Punjabis and Pakistanis in the Yuba City area, Hmong and African-Americans in Oroville, as well as Latinos and whites at most sites. This has many effects, some of them obvious—good translators are always needed—and others less so, such as issues of modesty and respect. In some cultures only a doctor will do, while in others nurse practitioners and physician’s assistants are highly trusted.
It’s London’s job to make sure that the clinics are staffed so that these nuances are accommodated—and in a manner that is financial feasible. Money is always an issue, and as London pushes for stronger medical services, he has to keep an eye on the bottom line. As he often tells his staff, “There’s an old saying: ‘No money, no mission.'”
I first met Barry London in the early 1990s, when I spent a day shadowing him as part of an Enloe Medical Center-sponsored program to acquaint people with the working lives of local doctors.
As I wrote at the time, “It was a revelation to watch [London] work. Like all good doctors, he’s a sensitive listener. Diagnosis is as much art as science, and giving total attention is fundamental.
“Most of the kids had respiratory problems. To me they all appeared the same: runny noses, coughs, sore throats. But no two, London discovered, had exactly the same illness. Some had bronchitis, some asthma, others a complex of problems.
“London took special care to make sure each family had the means to obtain medications. He’d talk about insurance. Every insurance program is different, he explained, so he tried to fit the medication to each program. Where a fit wasn’t possible, he turned to his samples closet.”
London’s interest in medical management developed gradually. During the mid-1990s he was one of the attending physicians at the Enloe Children’s Center, where he oversaw the nurse practitioners and others who provided care.
In 1995, he became the regional medical officer for Sutter North Medical Group, in Chico. Realizing that he had a gift for management, he went back to school, obtaining a master’s degree in medical management from Tulane University, in New Orleans.
In 1999 he gave up his private practice. He and his wife moved to Visalia, where he became chief medical officer for the Family Healthcare Network, a group similar to Del Norte.
When he arrived, he said, it had 185 employees, including 40 doctors, at three sites. When he left earlier this year, it had grown to eight clinics with a total medical staff of 80 and 550 employees altogether.
The Londons enjoyed Visalia, but they missed Chico. “It didn’t take me long … to realize I could be doing this at home,” he said, “so I applied for this job.”
Nobody is happier about that than Larry Fong, Del Norte’s CEO. He’d been looking for a CMO for nearly two years, so when London applied, Fong immediately called Harry Foster, the CEO at Family Healthcare Network, a man he knew personally. When Foster spoke glowingly of London, Fong knew he had his man.
“Our business, federally subsidized health care, is unique,” he said. “It’s extremely complicated and full of challenges, but Barry brings tremendous knowledge and leadership to the job.”
London’s biggest challenge will be recruiting, Fong continued. “Right now he’s recruiting doctors for Arbuckle. Who’s going to go to Arbuckle? The clinic isn’t a problem—it’ll be state-of-the-art. But these doctors have families, and they want to know, ‘Where the nightlife? The restaurants? The good schools?’ It’s hard.”
What London has to sell is “the mission,” Fong said, “the desire to provide care to underserved patients. He has to appeal to the idealist in the people he recruits. But he’s an idealist himself, which is why he’s a perfect fit for us.”
London is undaunted by the challenge. “The most rewarding thing for me is recruiting highly motivated, highly qualified clinicians who are a good fit for a community health center,” he explained.
“It’s a challenge,” he added. For one thing, most young doctors are buried in student debt. That not only pushes them away from primary care and into specialization, where they can earn more, but also away from public-service medicine and into private practice.
Fortunately, London is finding a good number of young Latino physicians who grew up in the Central Valley and want to help their people. And he notes proudly that Del Norte employs one of the first Hmong physicians, Dr. Nhia Vang, who practices at the clinic in his hometown, Oroville.
“I am in awe that here’s a Western-trained Hmong physician, one of only about four in the state, who came back to care for his people,” London said. “That’s inspiring to me.”
On a tour of the Chico Family Health Center, London pointed out the many services the facility offers and the tools it’s acquired to do so. Formerly the site of a fabrics store, the building has been divided into three sections—for adults, children and dental patients—each with its own waiting room and treatment area. The dental clinic, for example, has five full-time dentists and fully outfitted rooms for all of them.
The center, London said, is part of the “safety net” in place to catch the people who fall through the cracks in what he calls the medical “non-system.” That includes people without insurance, who are asked to pay on a sliding fee schedule.
Otherwise funding comes from a wide variety of sources—mainly Medi-Cal, but also federal grants for the uninsured, private grants and, to a small extent, private insurance. “It’s always challenging, financially, for community health centers to be competitive with the private sector,” London said.
“The good thing is that they’re highly satisfying places to work.”