EDITOR’S NOTE — See earlier story of Oct. 25, 2014, “North Olympic Peninsula faces its doctor shortage” — https://www.peninsuladailynews.com/article/20141026/NEWS/310269997.
VIOLET, 2, AND her baby sister, Lily, have a doctor at the Family Medicine clinic in Port Angeles.
Their mother, Emily Evans, does not.
Lately, she’s been suffering from shoulder pain, so she started calling clinics. Family Medicine: not taking new patients. Olympic Medical Physicians: lengthy waiting list.
Evans, who is covered by Medicaid, then heard that the Jamestown Family Health Clinic in Sequim might have room, but “I can’t always afford to drive to Sequim.”
And though Jamestown opened its new-patient window for a while last year, it’s closed now.
“I’d rather not go to the emergency room,” said Evans, 35, but “if the pain gets too bad, I may end up there.”
In the past, Evans has gone to VIMO, the Volunteers in Medicine of the Olympics clinic in Port Angeles, where care is free thanks to volunteer doctors.
VIMO moved just this month to a larger building at 819 E. Georgiana St. to meet the needs of people who have neither a family doctor nor the money to pay for a trip to a walk-in clinic.
Even with the advent of the federal Affordable Care Act, “there are still a lot of people who make too little money to afford an insurance policy,” said Gary Smith, VIMO’s executive director.
VIMO isn’t a walk-in clinic. Patients must call or stop in to make an appointment — and more than 4,000 did so last year, Smith said.
For now, Evans is doing without health care, as are many people across the North Olympic Peninsula.
Maybe you’ve recently moved to this rural place or gotten health insurance coverage at last. Or you could be a longtime resident whose doctor just retired.
Your access to health care can depend on two factors: how long you can wait and how deep your pockets are.
In Port Angeles, patients without doctors might go to CliniCare, the walk-in clinic on Front Street whose motto is “sick today, seen today.”
On a recent afternoon, CliniCare’s waiting room was full of men, women and children.
The clinic makes no appointments and takes no insurance while providing primary, acute and women’s health care to about 20 people on any given day.
CliniCare offers reimbursement forms patients can to send to a private insurer, if they have such a thing.
“This of course will not help those with a large deductible” or those with Medicaid or Medicare, “the people who need the most help,” CliniCare nurse practitioner David Kanters said.
A former combat medic, Kanters founded CliniCare in 1989. It’s open six days a week now, no appointment needed unless you’re having a drug screening for employment, in which case you do need to call ahead.
Come in to CliniCare with a health complaint for the first time, and your visit will cost $105 out of pocket. Subsequent visits cost $74.
So all too many patients wait until they’re quite ill before they make it in, Kanters said.
Lately, he’s seen some people battling advanced flu.
Kanters also told the story of a man who saw blood in his urine and tried to get an appointment with a primary care doctor.
He could not, so after eight months, a friend told him to try CliniCare.
The man had kidney cancer, Kanters said.
Nearly half of Washington state’s counties are “severely underserved, with 10 or fewer doctors per 10,000 residents,” according to a Washington State University report.
People in both Clallam and Jefferson counties know this situation well.
Jefferson’s 2014 Community Health Assessment reports just 7.2 doctors per 10,000 people. The national average is 24.2 physicians per 10,000.
There is a kind of Band-Aid at Jefferson Healthcare: its Internal Medicine & Walk-In Clinic near the hospital on Sheridan Street in Port Townsend.
Open seven days a week, it sees 20 to 30 patients a day — up to 25 percent of whom have no primary care provider, said Dr. Joseph Mattern, Jefferson Healthcare’s chief medical officer.
Up to 25 percent of these patients don’t have a primary care provider, he said.
Unlike CliniCare, the Port Townsend clinic is part of the hospital system and bills most insurances including Medicare and Medicaid, while “we have financial counselors who work with people who lack insurance,” Mattern said.
Port Townsend also has Madrona Hill Urgent Care, an independent clinic, open six days a week at 2500 W. Sims Way.
In Sequim, the Olympic Medical Physicians Walk-In Clinic also sees patients who don’t have family doctors.
“We had as high as 45 visits [per day] in December — the day after Christmas,” said OMC spokeswoman Bobby Beeman.
The medical center is also looking to open a walk-in clinic in Port Angeles next year, with construction to start in July, pending the Board of Commissioners’ approval, and completion in fall 2016.
The waiting list for Olympic Medical Physicians is now at about 500 people, according to Beeman in an email, a number that is down from 1,100 in September, “and the clinics are whittling that list every week,” she wrote.
“New patients that call in are being appointed in the fall (versus added to the waiting list),” she added.
Walk-in clinics can’t cure the shortage of providers. OMC is strenuously recruiting them to Clallam County, Beeman said.
For patients such as Ed Telenick of Sequim, more specialized attention is in order.
Telenick, 56, is a registered nurse who has always enjoyed good health — until this fall, when “I had some stuff trigger [illness],” he said, adding that he thinks it may be an autoimmune problem.
Telenick’s doctor retired last year, so he sought a new provider.
None in Clallam County could fit him in, so he’s made an appointment with a doctor in Port Townsend. He also plans to go to Seattle to see a rheumatologist.
As a nurse, he knows his symptoms could mean a serious illness.
There is a place nearby, Telenick added, where he would love to go, if he could afford it.
Sequim Medical Associates has four physicians in what’s called a concierge practice.
There, adults 65 and older pay a retainer of $70 per month, while those ages 21 to 64 pay $55 monthly, whether they need to see their doctors or not.
Patients younger than 21 pay no additional charges provided at least one adult 21 or older is in the program.
Clallam and Jefferson counties’ veterans have the option of getting outpatient medical care at a newly expanded Veterans Affairs clinic in Port Angeles.
In February, the clinic moved to a 7,800-square-foot facility at 1114 Georgiana St. from its former 1,400-square-foot space a block away.
At that time, nearly a year ago, the clinic served about 1,600 veterans, with the potential to grow to 2,500.
“We’re close to being at capacity,” said Chad Hutson, public affairs officer with VA Puget Sound Health Care System. “If we’re not at capacity, we’re very close to it.”
Hutson said the clinic “hit that number in July or August.”
An estimated 14,000 military veterans live in Clallam and Jefferson counties.
Veterans must make appointments and provide paperwork showing military status.
Among staff members are two physicians.
CliniCare’s Kanters does not water down his opinion of the medical climate here.
He believes that the shrinking access to care calls for this community’s providers to work harder, extend their hours and be more flexible.
Kanters, 66, still has his combat-medic mentality, learned in Vietnam in 1968: When you have a man down, you “man up.”
At CliniCare, he and nurse practitioner Deborah Wheeler “will be here,” he said, even if it means longer hours.
There apparently is some manning up going on at Pacific Family & Internal Medicine in Sequim. The clinic is expanding and taking new patients, manager John Charalambides said last week.
“We are accepting new patients,” he said, adding that Pacific has two medical doctors, a certified physician’s assistant, two nurses and five support staff.
“Dr. Mathew is here every day,” including Sundays, Charalambides said of Dr. George Mathew, who founded Pacific Family & Internal Medicine 15 months ago and has since hired two more providers plus two nurses and a support staff.
Pacific’s doctors treat all types of health conditions and provide basic care for children, and the clinic bills insurances — but not Medicaid.
So Evans, the Port Angeles mom, would be excluded.
But late last week, Evans got some good news: A friend suggested the Lower Elwha Health Clinic, which is open to non-Native people as well as tribal members.
“We are taking new patients, and we are getting lots of calls,” receptionist Gail Dunmire said, and “we do take Medicaid.”
As for Evans, she filled out the necessary forms and is awaiting an appointment in the next couple of weeks.
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Features Editor Diane Urbani de la Paz can be reached at 360-452-2345, ext. 5062, or at diane.urbani@peninsuladailynews.com.
