A growing general population, insurance expansion and an aging populace are all factors in the projections for the need for more primary care physicians. But graduating doctors are not choosing the primary care field, and those who are move to areas where the cost of living is more affordable than Sonoma Valley, where the anticipated physician shortage is expected to grow.
The United States will have a shortfall of primary care physicians by 2033 anywhere between 21,400 to 55,200, according to a report from the Association of American Medical Colleges. A number of factors contributes to the supply and demand shortfall, experts said.
Currently, two health-care providers in Sonoma Valley don’t see a shortage of primary care physicians. Based on the ratio of the number of physicians to the population, “Sonoma pencils out,” said John Hennelly, CEO of Sonoma Valley Hospital.
But while Sonoma’s ratio of doctors to population works on paper for a typical population, Hennelly noted, “In Sonoma, we don’t have a typical population.”
“Our population skews older and as we get older, we need more care,” he said.
Cheryl Johnson, CEO of Sonoma Valley Community Health Center, said her organization is struggling to fill other health care roles such as registered dental assistants, medical assistants and nurses. It’s been an ongoing problem exacerbated by the pandemic, when the center has seen a regular rise in patients who are in need of vaccines and COVID tests.
“We’re having a shortage of everything right now because of the pandemic, quite frankly in all positions,” Johnson said.
The hospital has more than 30 open positions listed on its website, including registered nurses, technicians, janitors and food service workers. At the beginning of the COVID pandemic, the health center staff was eager to gang up on the disease and helping patients, but the weight of it after nearly two years has worn some down, leading to reprioritized lives, she said.
One nurse practitioner left the health center to move closer to family out of the area, and a doctor who decided to have a baby left to take a job where she had more scheduling flexibility and a higher salary, Johnson said.
Finding qualified health-care professionals is challenging in this area, Johnson said, in part because of the cost of living. It’s been a problem since before COVID.
“Doctors can get paid more money and have more housing opportunities in the Central Valley than they can find here,” Johnson said. “They are going to Merced, Turlock and the Fresno area because they can buy a very large house,” and get paid more money than here.
Other health-care specialties pay better and don’t have the time commitment as does a primary care physician. For example, Johnson said a radiologist can get “paid quite a bit of money” and they don’t have to see patients, they just develop their diagnostic reports and tend to have shorter work days. While a primary care physician needs to be the referral point for other specialties as well as follow up with patients who have diabetes or hypertension, refill prescriptions and provide well-person exams, for example.
“You’re touching the patient during the course of the year,” Johnson said.
Compounding the shortfall problem is the prevalence of diagnosed diabetes (projected to increase some 25%) and heart disease (projected to increase 30%), an aging population that requires more care, and doctors in that same age group retiring, according to the Association of American Medical Colleges.
More is being asked of primary care doctors, too, such as more documentation on electronic health records, which according to some medical journals, is turning doctors into administrative clerks and cutting into the time they spend with patients.
After seeing patients, oftentimes primary care physicians spend three to four hours daily on paperwork, Johnson said. The health-care service model requires more screenings now for first-time patients, such as questions about alcohol and drug use, and childhood trauma, for example. It’s all in hopes of “catching depression earlier,” Johnson said.
Medical schools are not producing the number of physicians at the same rate as the population is growing, Hennelly said. “The AMA (American Medical Association) has helped manage the number of medical seats…those seats have not grown proportionately with our population.”
Based on an exemption in legislative rules, the Sonoma Valley Health Care District is allowed to directly hire one physician, he said, through its affiliation with UCSF. One of the district’s strategies is to expand its primary care model through working with its partners such as MarinHealth to encourage and recruit new graduates.
New grads aren’t “wedded” to an existing practice, Hennelly said, making them more open to a move. Those new graduates also come out of school with student loans and some medical facilities, through federal or state programs, can forgive that debt, Johnson said.
There are ways of relieving the pressure on primary care doctors, including increasing the number of advance practice registered nurses (APRN), nurse practitioners and physician assistants who can see patients. Telehealth appointments became an important piece of doctor-patient visits during the pandemic, and Johnson said some patients who find it convenient will probably opt to continue that in the future.
It reduces the amount of time a patient has to sit in a waiting room where they can’t do much to occupy their time, while waiting at home or at the office allows a person to continue to be productive and “control their time.” Avoiding a waiting room also means avoiding coming in contact with ill patients, Johnson added.
But telehealth doesn’t work for those who don’t have reliable internet or a device on which they can communicate with a physician. And telehealth won’t cure the supply and demand.
Onboarding an employee is costly, Johnson said, and getting a physician to full capacity takes about three years. Staying fully staffed is important in the health care business, not only for the care of the patients, but also to stay operational.
“Health care is a volume business. In order for us to get paid we have to see patients,” Johnson said.
There are going to be a lot of changes in health care and the way employees envision their work-life balance, Johnson said. They are looking at becoming a training facility, especially for dental assistants, to help reach and maintain staffing goals.
“Primary care is in crisis,” just not yet in Sonoma, Hennelly said.