Karen Fiducia has held the title of &uot;interim&uot; CEO at Natchez Regional Medical Center for nearly two years. As she nears the two-year milestone in June, the question is obvious — is it normal to take so long to find a permanent chief? Some say yes, others say no.

&uot;It’s nothing unusual to take years to find the right person,&uot; said Shea Davis, director of corporate communications at Quorum Health Group, parent company of Quorum Health Resources which manages NRMC.

&uot;We’re seeing exactly the same pressures around the country&uot; in hiring chief executives, Davis said. Healthcare organizations, both for profit and not-for-profit, are consolidating to negotiate the dire financial straights of the post-Balanced Budget Act healthcare environment.

But some healthcare experts, particularly those familiar with the Natchez situation, say the delay is abnormal.

&uot;Natchez Regional is unique,&uot; said Sam Cameron, president of the Mississippi Hospital Association.

Some of the factors playing into the selection of a permanent CEO for the hospital are &uot;hard to quantify,&uot; Cameron said. &uot;Everything they’ve gone through in deciding whether to stay with Quorum, whether to partner with someone else — has no doubt influenced them to keep the interim CEO there ’til they’ve made up their minds,&uot; he said.

In Mississippi and in other regions, Cameron said hospitals are having a harder time recruiting CEOs for rural areas. A CEO’s willingness to locate in rural areas where there is so much uncertainty, especially to a Medicare or Medicaid dependent facility, has waned, Cameron said.

The impact of the Balanced Budget Act of 1997 is felt more severely in those less populous communities such as Natchez, he said.

Mississippi has too many hospital beds, Cameron said, and hospital closings are inevitable.

&uot;It’s just the way healthcare is changing,&uot; Cameron said.

Aging public facilities face unique challenges in the profit-starved healthcare industry, he said.

&uot;Public entities don’t have the tax base to make many needed updates,&uot; Cameron said.

One of the biggest healthcare &uot;head hunters&uot; in the nation said hospital CEOs are attracted to institutions where they can have a positive impact.

&uot;Where is the ‘win’ in this situation?&uot; asked Dick Gustafson, managing partner in healthcare practice for the Chicago-based recruiting firm of Heidrick & Struggles. &uot;That’s a candidate’s first question. What impact can I&160;have on this place? What are the resources for the organization and me to get it done?&uot;

Gustafson said he has filled some CEO searches quicker than the current NRMC search and others have taken even longer.

Potential CEOs do not want to uproot a family to take them into a &uot;no-win&uot; situation, he said.

&uot;It all depends on the individual local issues,&uot; he said.

Compounding the competition issue of a privately-owned hospital in the same town, Gustafson said a poor local economy removes financial resources that might be brought to bear on challenges ahead for Natchez Regional.

Without a strong industrial backbone to support the local economy, the hospital faces a tough sell to any potential CEO, he said.

The real question, Gustafson said, &uot;is this community prepared to step up and do what has to be done to keep the public hospital?&uot;

At least one supervisor says Adams County is firmly behind its public hospital.

&uot;Before I became a supervisor, there was discussion of the possible sale of the hospital,&uot; said Darryl Grennell. &uot;My position then and it’s consistent today is that I’m totally against the sale of our public hospital.

&uot;We need a county-owned hospital in Natchez and Adams County,&uot; Grennell said. &uot;Hopefully it won’t revert to the tax payers to take care of. But I’ve heard many residents say they wouldn’t be opposed to paying taxes to keep their public facility — our community depends on it so.&uot;

Any potential chief executive for NRMC should feel secure in coming to Natchez, Grennell said.

&uot;We would just ask that any CEO coming in would be sensitive to the needs of the community and employees of the hospital,&uot; he said.

Supervisors President Virginia Salmon said she has always expected the search for a chief executive for Natchez Regional to be long and tedious one. &uot;I am not surprised that it has taken this long — not to say I’m pleased that it has taken this long,&uot; she said. &uot;I encouraged the hospital’s board of trustees to take their time, as long as Karen Fiducia is here to manage the hospital until a permanent CEO is found.&uot;

As for any potential sale of NRMC to another healthcare system, Salmon said she would not speculate on specific actions in regard to the hospital except to say that there is &uot;nothing in the wings.&uot;

Supervisor Lynwood Easterling said he appreciates the need to support the county hospital, but he also believes the county cannot afford to take on the additional burden of financing it.

&uot;We have to look long and hard and decide what is best for Adams County,&uot; he said.