Not way back, a pal instructed me, “I switched insurance coverage and might’t discover a physician who will take me.” One other mentioned, “I left Kaiser after happening Medicare and now nobody will see me.” These aren’t remoted complaints. They’ve turn into the brand new actuality in Silicon Valley: It’s simpler to purchase a multimillion-dollar residence than to discover a new main care physician.
I noticed this downside firsthand earlier than I retired from full-time observe on the finish of 2020. At my Palo Alto Medical Basis clinic in Daly Metropolis, solely two of us out of greater than a dozen internists and household physicians had “open panels,” that means we have been allowed to simply accept new sufferers. Everybody else had closed their doorways, maxed out with 1,200-1,500 sufferers every.
In my outdated solo observe, I by no means turned anybody away. If somebody was sick, I squeezed them in. Identical-day care constructed belief, spared ER visits, and stored folks more healthy. However that outdated mannequin doesn’t exist anymore.
Now, most Bay Space main care docs are staff of big well being techniques: Stanford, Sutter, and Kaiser. On paper, this could work: Medical doctors get a wage, fewer administrative complications, versatile schedules, and no hospital rounds or midnight telephone calls. However right here’s the catch: Many work part-time, typically by selection. Youthful physicians, particularly these balancing household duties, understandably go for lighter schedules. The result’s fewer out there clinic hours, longer waits, and fewer open panels.
I skilled this from the affected person facet once I tried to search out my very own physician after retirement. I wished to affix Stanford’s community for entry to their specialists. Regardless of looking for months, I couldn’t discover a single open main care doctor anyplace on the Peninsula. My solely possibility was a video go to with a model new internist 30 miles away 6 weeks out. Not too long ago, I examined entry throughout main techniques in Silicon Valley. The outcomes have been discouraging:
- Sutter/Palo Alto Medical Basis: 4 docs in San Mateo and Santa Clara counties have been taking new sufferers, with waits of 4-6 weeks.
- Stanford Major Care: Zero availability on the Peninsula, even with a six-month search window.
- Kaiser Permanente: A few dozen docs open to new sufferers, with waits as much as 4 weeks.
- One Medical (Amazon-owned): Identical-day visits have been out there, however unclear if docs have been accepting long-term sufferers.
That’s slim pickings for hundreds of thousands of residents.
Why is that this taking place in one of many richest areas on earth? A number of causes:
- Recruitment is hard. Housing prices are astronomical. Major care salaries can’t maintain tempo. Kaiser has helped with home-loan forgiveness, however others haven’t.
- The workforce is getting older. Many docs have retired prior to now decade. Too few younger physicians are changing them.
- Concierge drugs is rising. Extra mid-career docs are switching to boutique practices with just a few hundred sufferers who pay $3,000-$20,000 a yr. Everybody else is left scrambling.
- Substitutes fill the hole. Nurse practitioners and doctor assistants now deal with a lot of main care. Whereas they’re succesful suppliers, many sufferers nonetheless desire a doctor for advanced care.
- Medical college students aren’t selecting main care. The sphere pays much less, carries heavy workloads, and appears much less interesting than specialties.
The irony is painful. Silicon Valley, residence of cutting-edge drugs and unimaginable wealth, is experiencing the identical physician shortages lengthy related to rural America. Sufferers wait weeks for routine visits, depend on pressing look after acute wants, and wrestle to construct lasting relationships with a physician who is aware of them.
Until one thing modifications (higher incentives to recruit and retain physicians, inventive housing options, or daring new care fashions) this scarcity will solely deepen. Concierge drugs will increase, part-time work will rise, and fewer new docs will enter the sector.
The Bay Space might lead the world in know-how. But when we are able to’t assure one thing as fundamental as entry to a main care physician, what does that say about our well being care system?
George F. Smith is an inner drugs doctor and creator of Tales from the Trenches: A life in Major Care.
