Location, health insurance and new provisions make for medical provider shortages

Cierra Shelton has been on the hunt for primary care physicians for the last several years. She said she has been trying to make doctor appointments for herself, her fiance and son but finds it almost impossible.

“It specifically has impacted my health,” said Shelton, 29. “I’ve tried to get in for physicals because I have asthma.”

Shelton said she’s had to resort to emergency room visits when her son needed asthma medication, because he couldn’t wait two weeks for a clinic appointment.

“It might not be life or death, but he needed asthma medication as soon as possible,” Shelton said.

Countless Merced residents are in the same situation, competing for appointments or being turned down from physicians because they have no more capacity for new patients.

According to a recently released health assessment, 43.8 percent of Merced County adults report difficulty and delays in obtaining health care in the past year. In 2015, 11.7 percent of ER visits were due to the lack of access to care, compared to 1.8 percent in 2012.

“It’s so hard to get into a doctor’s office. It’s almost like you don’t know if you’re having an emergency or not,” Shelton said. “You really don’t have a choice in this area.”

Merced County is ranked 43 out of the 58 counties in California on primary care physician-to-patient ratio, according to The Merced County 2016 Community Health Assessment, while the entire county is considered a health professional shortage area.

The assessment indicates several barriers to care such as long wait times for appointments or lack of physicians that can discourage individuals from seeking preventive care.

Lack of preventive care, such as routine check-ups, adds to the high amount of chronic illnesses plaguing the county, according to the report, and results in residents being diagnosed with illnesses when they’re in later stages.

County’s high reliance on Medi-Cal a factor

Kathleen Grassi, director for Merced County Department of Public Health, said there are various factors that make Merced County short on health care providers.

When half of the population is on Medi-Cal, it’s more difficult to compensate physicians, Grassi said, because Medi-Cal doesn’t pay them as generously as other insurance providers such as Blue Cross or Blue Shield.

According to U.S. Census data, about one-quarter of Merced County residents live in poverty. The area’s large low-income population makes it tough for providers to sustain a business, Grassi said, because sometimes the reimbursements of Medi-Cal aren’t enough.

“We sort of have a double whammy,” Grassi said. “Large low-income populations makes it tough for providers. There are more opportunities in other cities.”

Shelton, currently a Gustine resident, grew up in Merced and Atwater and said she’s been insured with Medi-Cal under the Central California Alliance for Health for the last seven years. Shelton said she felt restricted under her insurance because she’s unable to seek medical care outside of Merced County.

“It hasn’t been great,” she said.

Jennifer Mockus, regional operations director for the California Alliance Merced office, said “more times than not,” residents become eligible for alliance insurance after the county determines whether they’re eligible for Medi-Cal.

When insured by Medi-Cal under the alliance, an individual’s insurance is only valid within the county, Mockus said, unless it’s for emergency circumstances or a specialty service not offered in the county.

Shelton said she has been trying to find a pediatrician to see her 7-year-old son, but it’s difficult to find a pediatrician who accepts Medi-Cal. She said her son hasn’t seen a pediatrician in a year.

“It seems like since Merced has been growing and there’s more people on Medi-Cal, there’s not many options,” Shelton said.

Merced competes against metro areas for providers

Merced’s location also comes into play when keeping medical providers, Grassi said. The large amount of debt recent graduates face drives them to larger cities where they can make more money, Grassi said, like San Francisco or Los Angeles.

“It’s hard for Merced to compete with the attractiveness of living in the Bay Area,” Grassi said. “There’s a lot of competition.”

Another factor Grassi pointed out was Merced’s slow growth and the lack of a local medical school, although many hope UC Merced will eventually have one.

“When you have a medical school, you have a better chance of folks training and staying,” Grassi said. “That’s why UC Merced’s medical school is so important to us. It will keep providers.”

Dr. Eduardo Villarama, regional medical director for Golden Valley Health Center, said since everyone is now required to have health care there aren’t enough practitioners for the demand, Villarama said.

“One thing we cannot change here is the locations,” Villarama said. “There is more demand now than we can actually accommodate.”

Villarama said since the mandated law to electronically enter medical records was implemented two years ago, there is less time to be spent with patients because learning the systems and requirements takes up more of the practitioner’s time.

“It takes time away from direct interaction with patients,” Villarama said. “It becomes frustrating.”

The extra time spent filing records electronically means providers can see only half the patients they’d see otherwise, Villarama said. Although the new system is more beneficial when it comes to the quality of patient care, Villarama said it is more time-consuming.

Everyone at Golden Valley wants to serve their patients, Villarama said, but there are only a certain number of patients that can be seen daily. Villarama said they don’t want to overwork providers, and it can be difficult to find a balance, especially when the demand for care is so prominent.

“We really just need to bring more providers in and make Merced County somewhere people want to live professionally and individually,” Villarama said.

This story was originally published September 5, 2016 at 2:42 PM with the headline "Location, health insurance and new provisions make for medical provider shortages."