Q&A: Sierra Vista's Candace Markwith on her health-care career

jhickey@thetribunenews.comSeptember 12, 2013 

Candace Markwith, who is retiring as chief executive officer of Sierra Vista Regional Medical Center, talks with Bob Westrom, director of laboratory services, as she makes her rounds Wednesday morning at the hospital.

JOE JOHNSTON — jjohnston@thetribunenews.com Buy Photo

Candace “Candy” Markwith, a San Luis Obispo County native whose great-grandfather owned a wheat farm outside Paso Robles, began her health career as a staff pharmacist at Twin Cities Community Hospital in Templeton.

Thirty-six years later, she is retiring Friday as chief executive officer of Sierra Vista Regional Medical Center — San Luis Obispo County’s largest hospital, which is also owned by Tenet Healthcare.

Since Markwith took the helm at Sierra Vista in 2005, the 164-bed hospital has become San Luis Obispo County’s first designated trauma center, expanded its newborn intensive care unit and added a helicopter landing area on top of its parking structure.

Markwith, 64, recently spoke with The Tribune about the accomplishments and challenges of her career.

Q: What are the biggest changes that you’ve witnessed in the hospital industry during your 36-year career in health care?

A: It has changed tremendously, especially in the last few years with the passage of the Affordable Care Act. It is moving from an episodic kind of care to a continuum of care that spreads to when the patient is home. Hospitals are now penalized with reduced payments when a patient is readmitted to any hospital in 30 days for certain conditions. It incentivizes hospitals to work with patients to ensure they understand their discharge instructions, to make sure they see their physician within a timely manner, to make sure they follow dietary restrictions and take medications.

Q: Do you believe that the Affordable Care Act will stabilize health-care costs and expand coverage?

A: I think the intent of providing insurance for folks that don’t have it — so they don’t wait for care and end up in emergency rooms and in a very acute stage — is really a good thing. If that’s really going to happen is a big question mark. The intent is to push preventative medicine to keep folks healthy. If that actually is effective, then yes, it will do what it’s supposed to do. I do worry that enrollment in the exchange program in California begins in October, for implementation in January, and people just don’t know about it.

Q: Critics have said that it’s best for two hospitals in a small regional market like ours to carve out specialties of their own — neonatal care and trauma care for Sierra Vista, for example, and heart care for French Hospital Medical Center. So why is Sierra Vista pursuing heart business again?

A: We are developing a cardiology program that includes open hearts. We are the only trauma hospital in the county, but with that level of service you need a full complement of services. If a patient is here for neurosurgery or hip surgery, they may also need cardiology. It really has nothing to do with what French is doing.

Q: How has the dynamic of two competing hospitals (Sierra Vista and French) affected your decision-making, and Sierra Vista’s operation?

A: Competition always creates raising the level of care for both of us, as competition does, but I have to focus on Sierra Vista. When we make plans to add services, we look at what our patients are leaving the community for, so they don’t have to — such as the neonatal intensive care unit. Those patients sometimes are in the hospital for an extended length of time, and if the family has to leave and go up to Stanford, for example — it’s so hard on them.

Q: What was the greatest challenge of your career?

A: We are the second most highly regulated industry, next to only the nuclear power industry. To be able to balance the regulatory pieces and make sure that the patient is always first is a challenge. It’s a business, and so there’s a balance. You constantly need to look at costs — because it is so expensive — but at the same time you have to focus on the quality outcome.

Q: What are your plans for retirement?

A: I will be living part of the year in Cayucos, and part of the year in Eugene, Oregon — where my oldest daughter has four boys. I will also continue medical missions, which is fun for me, because I go back to my roots as a pharmacist. I have gone to Guatemala and Mexico many times as a pharmacist. I have a granddaughter now who is in pre-med, and it would be fun to do a medical mission with her.

Q: Is there anything you’d like to add?

A: Pick a career you have passion for. You are gonna do that the rest of your life. You need to want to come to work. Walking around, I see the physicians and nurses working so hard, and they take such great care of our patients. Then I go up and walk through our neonatal intensive care unit, and I see the tiny babies, and I go “Wow — I am a little piece of that.” The gratification of being in health care is just phenomenal.

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