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Can't get in to see the doctor? Why there's a physician shortage and what's being done about it

Across the country, patients are struggling to find primary care physicians
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Posted at 6:32 PM, Feb 09, 2023

If you've called the doctor's office to schedule an appointment as a new patient recently, you've probably been told the wait time to get in will be several weeks or even months. Across the country, patients are struggling to find primary care physicians.

PAGING DOCTORS ON THE CENTRAL COAST

"Oh it's, it's so frustrating, man."

Like many on the Central Coast, Jerry Ross is struggling to find a new primary care doctor.

"Whenever you can't get doctor care, it's a crisis, especially if you need it," he said.

Ross' long-time doctor switched to concierge medicine, which means he would have had to pay a fee in advance for medical services.

The average cost of concierge medicine is usually between $1,500 to $3,000 a year.

Ross, who is a retiree on a fixed income, cannot afford it.

"There's no way," he said. "I mean, if I didn't want to eat or, you know, drive my car. Yeah."

After several calls to different clinics, he finally got an appointment.

"She [the receptionist] goes 'well, I can put you in but she's [the doctor] not seeing anybody. The first appointment she has is January 18, 2024.' I go, 'A year?'"

Ross is not alone. Across the country, and the Central Coast, there is a worsening physician shortage.

In California, only about half, or 49.09%, of the state's primary care needs were met in 2022, according to data from the Kaiser Family Foundation.

PCP need met in 2022
Percent of PCP need met in 2022: Kaiser Family Foundation

I asked Dr. Scott Robertson, the President and CEO of Pacific Central Coast Health Centers, if we have enough doctors to match the need of our population.

"We absolutely do not," he said. "I've been here for 20 years, both practicing primary care and being an administrator with Dignity Health, and during my entire time here we have not had enough."

Dr. Robertson says, on the Central Coast, it often takes several weeks to a few months to get an initial appointment with a primary care physician. If there wasn't a shortage, that would be one to two weeks.

WHY WE DON'T HAVE ENOUGH DOCTORS

What is causing the physician shortage? Dr. Robertson says the answer to that is complex. Locally, the high cost of living on the Central Coast is one of many reasons why we're seeing fewer doctors.

"As you know, the cost of living here on the Central Coast isn't really that much less than in some of these larger California metropolitan areas and so physicians are really challenged with the fact — do you want to take a pay cut to come to the Central Coast? And that's extremely important within primary care which is already one of the lower-paid specialties and many of these physicians now are coming out of medical school with sometimes, 2, 3 even $400,000 worth of debt. So these types of financial decisions are extremely important for them and their future."

In 2019, state data showed nearly a third of San Luis Obispo (33%) and Santa Barbara (31%) county residents live in a primary care shortage area, meaning there's only one full-time doctor per 2,000 or more civilians.

PCP Shortage Area 2019
PCP Shortage Area 2019

The latest state data from 2020 includes nurse practitioners and physician assistants along with doctors, but the Central Coast still falls short.

Primary Care Shortage Area 2020
Primary Care Shortage Area 2020

Also contributing to the shortage and the challenge to bring more doctors to our area, the Central Coast is considered a rural area which means doctors get lower reimbursements compared to those in larger metropolitan areas like Los Angeles or San Francisco. That means lower pay for physicians.

Dr. Rene Bravo is a trustee of the California Medical Association. They've been constantly in touch with lawmakers to address the ongoing shortage.

"I think the biggest issue there is that because there is a shortage of primary care, it is stressing the safety net, which means the emergency care system," he said. "Emergency rooms are having increasing times where they're seeing patients that probably don't have emergencies, but they don't have doctors either."

Bravo says the COVID-19 pandemic burnout among doctors exacerbated the shortage, driving some doctors to cut hours or leave the workforce.

The American Medical Association expects a wave of retirements too — a significant portion of the physician workforce is nearing the retirement age. That's a third of doctors in California.

"I myself am approaching Medicare age and I do not have a primary care physician. They left and I am in the same boat as many, many people here and I'm a doctor that's been here almost 40 years," Dr. Bravo said.

WHAT IS BEING DONE TO MEET THE DEMAND FOR PATIENT CARE

I asked Central Coast Health Centers what's being done to meet the demand.

Lompoc Health created alternatives for those who need a primary care physician by staffing urgent care centers with physicians, physician assistants and nurse practitioners. They offer the option to schedule an appointment and be seen the same day or next day.

Tenet Health works with recruitment firms to attract physicians and conduct weekly interviews with doctors in various specialties.

Dignity Health started a residency program out of Marian Regional Medical Center in Santa Maria. "The program has been very successful," Dr. Robertson said. "You're never going to retain 100% of the doctors but we retain around 60% of the physicians since the program started producing graduates about 4 to 5 years ago."

Cottage Health is expanding its graduate medical education program and recently developed a pediatric residency to recruit and retain physicians. More than 100 physicians who completed residencies at Santa Barbara Cottage Hospital stayed or returned to the area to practice.

On the state level, the California Medical Association is advocating for new medical schools, expanding education opportunities and expanding loan repayment programs. The CMA also backs a bill in the state legislature that aims to bring more physicians to underserved communities through scholarships.

But these solutions will take time.

For patients like Jerry Ross, all he can do for now is wait and hope.

"[I'm] hoping I don't get sick," Ross said.