Health care providers at Golden Valley Health Centers work tirelessly to serve the underserved in the Central Valley – that is our mission and passion. On average, we are required to see 24 patients per day, but we are scheduled to see from 35 to 40 patients per day.
We were disheartened by Dr. Peter Broderick’s op-ed, “Golden Valley Health Centers had to prepare for the future.” We write to provide facts for the public to consider so they can discern the truth regarding access and work environment.
First, according to the Association of American Medical Colleges, there will be a shortage of 45,000 primary care doctors in the United States by 2020. It’s a grim number. But for the Central Valley, the shortage might be even worse. Many primary care doctors do not accept Medicaid or Medi-Cal patients because of low reimbursement rates, and many of the newly insured are covered through Medicaid or Medi-Cal.
This shortage of doctors and non-acceptance of Medicaid or Medi-Cal means that patients will endure longer waits or have to travel farther for appointments. Golden Valley, however, accepts both Medicaid and Medi-Cal – including patients who are uninsured – at its more than 20 sites in Stanislaus and Merced counties.
We share Broderick’s concerns regarding access. However, we respectfully disagree that it is a “simple solution.”
Broderick wrote: “A simple solution – made after discussions with our medical and nursing leadership teams – was to dedicate some of these unfilled appointments so new patients could access our high-quality clinicians.”
To blame Golden Valley’s providers for not seeing enough patients is disingenuous. In 2012, the Physicians Foundation, a nonprofit group, surveyed 13,575 doctors across the United States and found that 39.8 percent see 11 to 20 patients per day and 26.8 percent see 21 to 30 patients a day, which roughly translates to an average of 15 to 24 patients per day. While some providers at Golden Valley are seeing 20 complicated patients per day, others see as many as 30 or more each day.
Tony Weber, the CEO of Golden Valley Health Centers, said in a November meeting with health care providers that “access problems are not your problems; you see all the patients that show up.”
Weber said Golden Valley “missed a big opportunity during the open enrollment” by not being prepared to take new patients. “If you are a new patient, you need to wait four whole months to be seen. That’s not acceptable. … (We) need new patients; there’s going to be a time, coming shortly, where we are not going to be paid on the number of visits we do, but we are gonna be paid based on the number of members we have in our network.”
The “simple solution” might increase access for “first-time” visits for new patients. But as new patients are added, access overall will decrease – eventually even for new patients. It is simple economics: You cannot increase demand without increasing supply and still resolve the access problem for patients.
To improve access you must correctly match patient demand with the number of appointments available. You can’t have delays or harm continuity of care. Adding new patients simply increases the “number of members we have in our network” and will decrease access overall for all patients.
This is troubling, particularly in view of the allegations that some Veterans Affairs Department health clinics used elaborate schemes to hide the records of patients who had waited months for care.
Despite shortages of physicians, we remain optimistic and committed to serving the underserved in the Central Valley. However, making unilateral changes to a doctor’s schedule to accommodate new patients is not a magic-wand solution.
It is documented that Golden Valley has received numerous grievances concerning a hostile work environment. Recently the Golden Valley board announced the creation of an ombudsman position and retained an independent investigator to investigate the hostile workplace allegations and other issues.
We are discouraged that Broderick, a board member, would express a presumptive opinion of “unfair and inaccurate allegation regarding morale and our workplace environment” before the independent investigation is concluded.
The public is invited to discern facts vs. fiction and become voices for patient care and quality.
Dr. Liza Pham; Dr. Theresa Ng; Sheila Hernandez-Lee, FNP; and Alex Abarca, LCSW, are all employees of Golden Valley Health Centers.