EDITOR’S NOTE — See our Jan. 18, 2015, followup story, “No doctor? Where do you go? . . . The challenge of finding health care on the North Olympic Peninsula” — https://www.peninsuladailynews.com/article/20150118/NEWS/301189977.
IF YOU HAVE a medical home — a primary care doctor — consider yourself fortunate.
Across the North Olympic Peninsula, people are searching for that home.
They’re phoning clinics and doctors’ offices in hopes of making just one appointment.
And many, newly insured via the federal Affordable Care Act, are after health care they’ve long done without.
“We have dozens of people a day calling, wanting to register,” said Larri Ann Mishko, medical director at Sequim’s Jamestown Family Health Clinic.
Trouble is, those callers will wait months before getting in to see a doctor, nurse practitioner or physician’s assistant.
“The staff feels horrible,” Mishko said. Though they’re making appointments for people who registered last spring, they must tell those who phone the clinic now to try again after the first day of 2015.
At Family Medicine of Port Angeles, about 250 calls come in weekly, clinic administrator Karen Paulsen estimated.
Some ask her if she can squeeze them in somewhere, somehow.
The answer is no.
And Family Medicine doesn’t keep a waiting list.
Doctors there each have some 1,500 patients on their rolls already.
At least one caller wept when told Family Medicine can take no more.
Back in Sequim, Linda Klinefelter takes these calls, too.
People know her from her work as Olympic Medical Cancer Center’s patient navigator.
She’s retired now but still knows the health care landscape.
What to do?
She suggests the Jamestown clinic, and “if worse comes to worst, you can go to Port Townsend.”
At Jefferson Healthcare’s clinics there, a few primary care doctors are taking new patients.
But Jefferson County faces a looming crisis much like Clallam County’s: Family doctors are leaving or retiring, and their replacements are tough to find.
“We are actively recruiting,” said Mike Glenn, Jefferson Healthcare CEO (and former CEO at Olympic Medical Center in Port Angeles.)
Glenn adds that he hopes to bring one or two new practitioners to his rural clinics in the coming six months.
It may not make those lacking a doctor feel better, but much of rural America is dealing with this scarcity.
Small-town clinics are struggling to attract primary care doctors, and “I don’t know that I’m aware of a community that has this figured out,” Glenn added.
As the population grows older, demand for health care rises, even as old-fashioned family doctors retire.
Their young successors don’t come to rural places; instead, they head to urban teaching hospitals for their training.
At Family Medicine in Port Angeles, founder Dr. Stanley Garlick retired last winter; Dr. Jennifer Brown, another of the clinic’s doctors, moved away.
Family Medicine also lost Dr. Bill Hennessey, a longtime family physician, when he died of cancer last year.
At the Jamestown clinic, Dr. Esther Kittle left some months ago.
She was Klinefelter’s doctor, though Klinefelter didn’t learn of her departure until she called to schedule an annual checkup.
She was able, fortunately, to make an appointment with one of Jamestown’s nurse practitioners.
“I was already an established patient,” Klinefelter said.
“What were they going to do, kick me to the curb?”
She feels for her contemporaries who can’t get in to see anyone — or are rushed through their appointments.
Older median age
Clallam and Jefferson counties’ median age is older than that of Washington state as a whole.
In Clallam, it’s about 55; in Jefferson, it’s 50; while the state median is 38, according to a 2012 report by Clallam County Health & Human Services.
Rural communities tend to have a higher demand for health care, said Tom Locke, the public health officer for Clallam and Jefferson counties.
From the West End of Clallam County to unincorporated Chimacum, he sees plenty of need — and a supply of doctors that hasn’t kept up.
Tribal health clinics in Sequim, the West End and on the Lower Elwha Klallam reservation provide care for their members, Locke said.
But for those who are not enrolled members, the waits can be long.
In this rural place, “we’re older, sicker and poorer,” he added.
1,200 on waiting list
More people are insured thanks to the Affordable Care Act, “and this is a great thing,” Locke said, “but no way can we expand the primary care workforce rapidly.”
Following a concerted effort by its recruitment team, Olympic Medical Center has been able to attract two new providers to its Sequim Primary Care clinic. And Drs. Pallavi Sindhu and Eric Waddington are taking new patients — in the face of fierce demand.
The waiting list for the Olympic Medical Physicians clinics swelled to 1,200 earlier this year, and while people on the list are getting in, their appointments are spread out over several months.
“In the meantime, the Olympic Medical Physicians Walk-In Clinic in Sequim is an excellent resource,” said Dr. Rebecca Corley, Olympic’s chief physician officer.
This recruitment business is “a huge effort,” Corley said.
Olympic Medical Physicians — and the patients of Clallam County — must compete of course with doctor salaries across the country.
To that end, the salary Olympic offers a family doctor the first year is $205,000; it dips to $168,000 the second year.
Not bad, especially by Clallam standards. But family physicians are paid considerably less than their colleagues in the specialties.
The median annual salary for a gastroenterologist in the Western United States, for example, is $463,791, according to a Medical Group Management Association (www.mgma.com) report on physician compensation.
For a urologist, it’s $414,380 a year.
The median pay for a family doctor in the West, according to the MGMA report, is $202,740.
If OMC seems to pay well, the numbers fall below the median.
In April, the hospital’s board of commissioners approved a contract for Dr. Dale Russell, a urologist, with a salary of $304,472.
Also last spring, the commissioners approved the hiring of Dr. Aya Sultan, an obstetrician-gynecologist, with a $15,000 starting bonus, a four-year retention incentive of $15,000 and an annual salary of $237,993.
In June, medical oncologist Marion Chirayath came on board at OMC for $341,676 per year.
Word-of-mouth recruiting
Doctors go into the job market with formidable student loan debt, which makes particular specialties that much more attractive, said Family Medicine’s Dr. Mike Maxwell.
He and Dr. Rob Epstein are primary care veterans and do their recruiting by word of mouth across the region.
“We love what we do,” said Maxwell. “We just wish more [doctors] wanted to do it with us.”
Recruitment hasn’t gone so well lately.
The clinic came close to negotiating a contract with a new doctor, but then that practitioner chose to go elsewhere.
“We’re looking for people who want to be in a rural community. The bottom line is that there are relatively few,” Epstein said.
A solution could come in what’s called a teaching health center, or THC in clinician parlance.
With this model, a clinic would grow its own family doctors by training them during their three-year residencies.
Nationwide, doctors tend to stay in the communities where they were trained, said Epstein.
Clallam County badly needs a THC, and Family Medicine “would be a great one,” he added.
Democratic U.S. Sen. Patty Murray, D-Seattle, has introduced a bill to fund new THCs in underserved places: NYC’s Harlem instead of midtown Manhattan; Port Angeles instead of Seattle.
As they wait for Murray’s bill to move through Congress, family doctors on the North Olympic Peninsula work longer hours and provide a much wider variety of care than their urban counterparts.
“The variety is what makes it interesting,” said Epstein, who added that he and his colleagues at Family Medicine do it all, just about, from delivering twins to caring for elderly diabetics.
Dr. Jerry Oakes, head of OMC’s recruiting team and a family doctor himself, is acutely aware of his community’s shortage.
Oakes is the son of Dr. Roger Oakes, who practiced family medicine in Port Angeles for decades before his retirement in 2011.
The younger Oakes moved back here in 2005 after finishing his residency in Boise, Idaho. He has since built a patient roll of 1,300, last time he looked.
‘All the time you have’
Dr. Margaret Bangs, a Port Angeles family doctor in private practice, has been taking about five calls a day from people hoping she’ll take them on.
She’s added some hours to her workweek but emphasized that she receives more queries than she could ever respond to.
“I absolutely love my patients. I love listening to them,” Bangs said. But “it takes all the time you have” to care for the existing patients without adding new ones.
“The nation needs to educate more doctors,” and not just in medical schools, Bangs said.
She hopes to see doctors, nurse practitioners and physician’s assistants do their post-graduate training in communities such as hers.
Then Bangs spoke of other ways to address the problem, ways that have little to do with the traditional clinic model — and everything to do with treating one’s own body well: a good diet, exercise and stress management.
All are effective means of primary care.
“As a society, we need to be teaching people to take better care of themselves,” Bangs said.
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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.
