Rancho Mirage resident Angela Farmer has long struggled with a common problem: finding a doctor’s appointment in the Coachella Valley.
Despite having a desirable PPO plan through Anthem Blue Shield, one of the nation’s most well-known health insurance providers, Farmer said she has been unable to find a primary care doctor who accepts her insurance.
“I tried [to find an appointment] starting last year, but then I realized how difficult it really was even just to find a doctor,” she said recently. “Every doctor I called was a dead end.”
Because Farmer is privately insured, she has a higher chance of finding a primary care provider than those who are uninsured or only have Medi-Cal. Still, she called one doctor’s office six times without receiving a return call.
Farmer isn’t alone; most Americans are feeling the impact of staffing shortages across all healthcare fields. Some places, however, have been hit harder than others.
The Coachella Valley is one of them. The number one barrier to care is the length of time it takes to get an appointment, according to a report released Feb. 28 by Health Assessment and Research for Communities (HARC), a nonprofit based in Palm Desert.
The data is discouraging. The report stated more than 8,000 adults in the valley haven’t seen a healthcare provider within the last five years and more than 4,400 adult residents have never seen a healthcare provider for treatment.
In Farmer’s case, it wasn’t until she asked for help on the social media site Nextdoor did she have success. Of roughly one dozen primary care doctors recommended to her, most were in Eisenhower’s Primary Care 365 program, which requires patients to pay an additional fee outside of insurance, copay or coinsurance costs.
She eventually was able to reach two primary care doctors who would take her particular PPO plan. But the wait time for an initial appointment? Two to three months.
“One of the things that they teach us is preventative care. Well, how are we supposed to do preventative care if we can’t even get a primary?” Farmer asked. “I can’t even get my physical unless I drive to Los Angeles or Santa Barbara.”
Having access to a primary care provider and receiving regular care has been linked to lower mortality rates. A 2019 investigation in the Journal of the American Medical Association found that for every 10 additional primary care physicians per 100,000 population, there was a 51.5-day increase in life expectancy.
“Any care is better than no care, but, of course, we would like it if everyone had a primary care provider that they visited regularly,” said HARC Chief Executive Officer Jenna LeComte-Hinely as the organization presented its findings.
The use of primary care physicians or a regular doctor’s office has waned since the nonprofit began collecting data in 2007. Meanwhile, more and more people – about a third of those surveyed – are getting their regular care through urgent care clinics.
“In 2010, 61.6% of local adults said they went to the doctor’s office when they were sick or in need of care. By 2019, it dropped to 37.6%,” according to the nonprofit’s executive report from 2019. That percentage did increase to 44% in the latest survey, with slightly fewer people seeking regular care in emergency rooms.
Nearly a third of Californians are in areas designated as a “primary care health professional shortage area,” according to data released by the California Health Care Foundation in July 2020 – well before the effects of the pandemic could be taken into account.
Nationally, 76% of people had a usual primary care provider in 2017, according to the U.S. Department of Health and Human Services. One of its “Healthy People 2030” objectives is to increase this number to 86%.
There were 1,555 licensed physicians of all types in the Coachella Valley in 2020, according to HARC’s most recent Community Needs Assessment. With population taken into account, this resulted in a ratio of 361 per 100,000 residents. Because not all licensed physicians are practicing or spending time with patients, this ratio is likely lower.
When it comes to primary care physicians, however, data shows our region has fewer than 30 per 100,000 people. That math equates to long waits, but shows the impact of the healthcare provider shortage, LeComte-Hinely said.
“Many doctors left healthcare during Covid,” added Steven Henke, a spokesperson with DAP Health in Palm Springs.
Primary care doctors, generally, have larger workloads but are paid less than specialists, said Dr. Asma Jafri, a family physician and chair of the Department of Family Medicine at the University of California, Riverside.
“The specialists deal with one problem at a time when they see a patient, the primary care physician takes care of the whole person,” Jafri said.
Training and educational requirements have increased, as has the amount of paperwork that needs to be done each day, she added. That means less time spent seeing patients.
“A lot of things are either put on the backburner or they’re dealt with after hours, which leads to burnout,” Jafri said. “I think that burnout is a big phenomenon in primary care.”
There needs to be more younger primary care physicians, she said, and debt relief and loan forgiveness programs to help defray the costs. While it may seem like doctors are wealthy, most have extraordinary debt burdens and barely get paid while they’re in training, she added.
It’s also especially difficult to recruit doctors to rural areas because those areas may pay less and have fewer amenities, Jafri said. After studying through their 20s and sometimes 30s, physicians want to be able to enjoy a better quality of life.
Recruiting and hiring a physician may take up to a year – for a psychiatrist, it may take nearly two years, DAP Health’s Henke said, adding that there’s just not enough talent to keep up with the surge.
DAP Health (previously the Desert AIDS Project) was created in order to address the healthcare needs of those who are at risk of contracting, or are currently living with, HIV or AIDS. But now, the organization seeks to address health issues of all residents across Coachella Valley’s diverse communities – even providing mental health care, dental care and access to other services.
Federally qualified health centers, like DAP Health, are “seeing patients that should have been seen years ago, months ago, and you see them at a stage of disease where you can’t help them as much” as if they had been screened more regularly, Jafri said.
That means some providers are playing catch-up, trying to see patients who are long overdue for check-ups and treatments.