This story is part of our January 2026 issue. To read the print version, click here.

The region’s health systems are facing challenges around Sacramento’s sudden population boom and aging demographics, while trying to navigate a supply of physicians that isn’t keeping up with patient demand. There are also other big challenges on the horizon. This month, Comstock’s talks to four local health leaders about some of the most pressing questions our readers have.

Rachael McKinney

President, Sutter Health Greater Sacramento Division

A veteran of Sutter Health leadership since 2004, Rachael McKinney rose through the ranks of the nonprofit health provider’s administration, bolstering cancer center operations, expanding vital oncology programs and later overseeing growth in Sutter’s offerings in neuroscience. In January of 2022, as pandemic protocols were still in effect, McKinney was promoted to CEO of Sutter Medical Center, Sacramento. The following June, she was elevated to president of Sutter’s Greater Sacramento Division, overseeing care for a nine-county radius.

Comstock’s: What is Sutter Health’s strategy to improve how quickly patients are being seen?

There’s a significant shortage of health care workers in the United States, so we’re starting upstream by investing heavily in graduate medical education and training our own future physicians. Here in the greater Sacramento region, Sutter is committed to growing our graduate medical education by about four times what it currently is, doing that by 2030, which will mean we have more than 200 residents and fellows training in our facilities.

Related: The Beat Goes On: Sacramento-area medical centers get high marks for their heart care

We’ve also invested heavily in growing our existing workforce through recruitment in partnership with our medical group. We’ve actually brought more than 400 new physicians to Sutter since 2023, bringing our total up to 2,400 physicians caring for Sutter patients in the region. We’re also expanding graduate medical education in order to feed that pipeline, and really investing in programs to train high school students and preceptorships and nursing students through partnerships. …

We’ve also improved primary care access for new patients, cutting the wait time down by more than a week since the beginning of this year alone. A lot of that is due to the recruitment of new physicians, but we’re also optimizing technology.

Comstock’s: Does Sutter Health have any ability to mitigate the costs of prescription drugs to its patients?

As a not-for-profit health system, we obviously absorb a lot of the rising costs in health care, and government reimbursement is shrinking while the costs of pharmaceuticals and medical devices continue to go up. … While we take steps every day to help make health care more affordable, we’ve really focused on offering financial counseling and assistance for patients to reduce prescription drug costs, connecting them to any available discounts that the pharmaceutical industries might be offering. But the reality is that high drug prices remain a significant challenge for patients, for us and for the industry as a whole. We need to continue to pull the levers that we can as an industry to help drive those costs down.

Comstock’s: What health stories should local reporters be paying more attention to?

McKinney: When a patient comes to the hospital in an ambulance, if the hospital is full because it has no beds to admit more patients, those patients that are already in the emergency departments, who need to go up to a (regular hospital) bed, have to wait where they are. That impacts the ambulances coming in. It impacts where ambulances go.

Sometimes there’s a belief that the reason for this problem is isolated to the emergency department. You’ve got to look at the whole health care continuum to understand that something like wait times, or ambulance drop off times, are all kind of interconnected: They create this complex super problem that everybody is working really hard to address. …

I think shedding more light on the different parts and pieces of the health care delivery system could help the public understand why it’s important to seek care in the best place at the best time, as well as consider the things that we can all do as a community to help keep people healthy in a better way.

Dr. Jay Robinson III

Senior Vice President and Area Manager, Kaiser Permanente Sacramento and South Sacramento

Dr. Jay Robinson III has spent more than 30 years working to create healthy communities. After proving himself at hospital leadership in Memphis, Chicago and the Department of Veterans Affairs, Robinson was recruited in 2022 to be a top executive for Kaiser Permanente’s Sacramento operations. He currently oversees health care for more than 580,000 members, including a Level II Trauma Center and Advanced Neuroscience Center.

Comstock’s: What is Kaiser’s strategy to improve how quickly patients are being seen?

We’ve really enhanced our digital front door, creating ways to connect with a provider virtually or by phone — or even emails — and that’s something that a certain segment of patients really do like. We also have come up with different modalities of treatment, establishing things like advanced care at home, which is essentially a hospital-at-home initiative where patients who may have typically been admitted to the hospital before can now be treated for a condition where they live. In that situation, we set up monitoring equipment and our teams virtually interact with the patients. …

Related: Parkinson’s Is on the Rise in the Sacramento Valley. Dancing and Boxing Can Help

We also have ambulatory treatment centers that we’ve leaned into over the past year, so if there is something a patient needs like antibiotics or some type of infusion, we’re able to treat them in that setting and avoid them having to go to the hospital. We’re expanding our overall footprint, whether by adding a hospital in Sacramento’s Downtown Railyards or by expanding by 135 beds at a tower in Roseville, not to mention adding medical hubs in Folsom and Natomas.

Comstock’s: Does Kaiser have any ability to mitigate the costs of prescription drugs to its patients?

One thing that we do have is scale. We are a large enterprise, which affords us some ability to manage costs. The types of drugs we use are regulated by what’s called our regional pharmacy and therapeutics committee, and that’s populated by physicians and pharmacists who make decisions on the kinds of drugs we’re getting. But we do try, as appropriate, to substitute with generic drugs. … I think we have some of the best pharmacists in the business, and they make really good decisions about the types of drugs we need to use to get the best outcomes for our patients.

Comstock’s: What health stories should local reporters be paying more attention to?

How we’re developing ways for people to age-in-place, if you will, and give them options other than going to a hospital or nursing home. We are leaning into a number of different initiatives around that, including the partnership with Habitat Health for our PACE (Program of All-Inclusive Care for the Elderly) clinic that just recently opened on Howe Avenue. It’s a beautiful building with a really neat program that allows eligible older patients to drop in every day to get access to everything from a gym and rehabilitation therapy, to a host of services around nutrition and primary care.

Rob Marchuk

President, Physician Enterprise, Dignity Health Sacramento

A journeyman leader with Dignity Health, Rob Marchuk was part of the drive to greatly expand its ambulatory services, advanced procedural services and surgical services, particularly in Folsom and Rancho Cordova. A senior health executive, Marchuk is focused on addressing how population growth in the region is straining health resources.

Comstock’s: What is Dignity Health’s strategy to improve how quickly patients are being seen?

Marchuk: We know there’s not going to be enough physicians coming out of training in the next ten years. So, we’re working hard on recruiting and trying to figure out different models for residents coming out of school. We’re also starting our own residency program within Dignity Health. That’s a case where we train our own physicians and engage them once they’re done. We’re creating different care models as well. Our primary express care model that we’ve opened in Roseville and Elk Grove is a perfect example: It’s a low-acuity, easy access, in-your-neighborhood primary care type of clinic with extended hours, 12 hours a day, open weekends.

Related: How Sacramento Health Systems Are Reinventing Care

Comstock’s: Does Dignity have any ability to mitigate the costs of prescription drugs to its patients?

Marchuk: It’s one of the highest expenses within our health care system as we look at how we take care of our patients inside the hospitals. I think one thing we do is work with our patients and make them educated consumers of medications, and walk them through the benefits and risks of certain kinds. I think the second thing we do is really work hard on the generic brands and bio-similars that are coming up, if they’re more cost effective for a patient and have the same outcome and results.

Comstock’s: What health stories should local reporters be paying more attention to?

Marchuk: There’s a lot of really great patient stories out there — a lot of life-saving care that we were able to deliver. I think, a lot of times, health care systems and hospitals get kind of a bad rap for the cost and access. Focusing on the good stories and great patient outcomes — and the lives that we save — could make for compelling stories.

Jonathan Russell

Chief Ambulatory Officer, Marshall Medical Center

Jonathan Russell was born in Placerville’s Marshall Hospital and grew up in the El Dorado County community that it primarily serves. For the last 20 years, Russell has worked to make sure that Marshall Medical Center is evolving as a mainstay for health care in the semirural county it oversees. Russell feels there’s a special camaraderie and sense of local purpose that makes Marshall a unique provider.

Comstock’s: What is Marshall’s strategy to improve how quickly patients are being seen?

The physician shortage, particularly around the family medicine specialty, is a nationwide issue. It’s becoming very, very difficult to recruit family medicine physicians. One of our strategies there is to utilize our physicians as efficiently as possible, as well as lean heavily on our mid-level staff and nurse practitioners and medical assistants to find ways to deliver group-based medicine, so that we can see the most patients possible with the resources available. …

Related: Marshall Medical Center CEO Discusses Health Care for Rural Residents

We’ve got virtual care. We’ve got nurse triage going through some of the communication between patients and physicians; and all of that is trying to off-load as much time as possible so that the physicians and mid-level providers can be there for the patients.

Comstock’s: Does Marshall have any ability to mitigate the costs of prescription drugs to its patients?

Yes and no. We do participate in a very complicated government program that has the ultimate attempt to decrease the drug costs at the patient level, and it does do that. So we’re highly engaged in that program. But that entire program I’d say is on thin ice and has been for some time, from a government support standpoint. …

We opened a specialty pharmacy a couple of years ago. It’s very similar to a retail pharmacy with the exception that it has a very limited formulary, so there’s only certain drug types; but most of those drugs tend to be very expensive and hard to get — the kind that sometimes patients will pursue out of country. And even outside of that, if patients have an inability to pay, we have a mechanism to get them the drugs that they need on either a sliding scale or a free-of-charge basis.

Comstock’s: What health stories should local reporters be paying more attention to?

The fragility of health care. I think the public generally views, especially hospitals and health systems, as these money-making machines that are just flush with cash and have no financial challenges. That’s 100 percent not true.  And I’d say especially urban and rural health organizations are far more fragile and at-risk than they were years ago. The evidence of that is the hospital in Glenn County that just closed a few months ago.

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