Green Valley feels national doctor shortage

This article was originally published by Green Valley News 

Dale Sprinkle is 85 and hasn’t seen a primary care physician in more than a year. He’s crossing his fingers his July appointment doesn’t get canceled because he’d like to talk to someone about his worsening spinal stenosis symptoms.

Gilda Nelson, 84, lost seven PCPs over 20 years including the latest late last year. After spending hours on the phone being told doctors weren’t taking new patients, she found one in January. His staff said the soonest she could be seen is August.

Sharon Deno, 72, trusted her doctor so much she followed him from practice to practice. He recently left his last medical group and now she’s on the hunt for a new doctor — and praying her former doctor opens his own practice despite being in his late-60s.

These three Green Valley residents are not alone.

The number of primary care physicians across the U.S. and Arizona is far below what it should be, and according to several medical experts, GV has two pressing issues in addressing patient needs — demographics and location.

According to the University of Arizona’s Center for Rural Health, Arizona is ranked 42nd in the nation when it comes to the number of licensed PCPs per capita. For every 100,000 residents, the state has 80. Even the national number — 94 — is woefully inadequate and is getting worse, experts say.

According to the American Association of Medical Colleges, there will be a shortage of up to 86,000 physicians by 2036. In the January/February edition of the AARP Bulletin, the AAMC is quoted as saying the number of people 75 and older will have increased 55% by that point. 

Local perspective: Dr. Tarin Bynum Neal, chief medical officer for United Community Health Center, said in the past four months at least five physicians left the Sahuarita/Green Valley area or retired. She has several theories why the U.S. is experiencing a shortage in physicians.

“Some reasons would be a decrease in medical students entering primary care residency programs; limited primary care residency programs (especially in rural areas and across our state); provider fatigue and burnout post-COVID; and the excessive cost associated with medical school,” Bynum Neal said.

Dr. Chad Prior has been living and working in the Green Valley/Sahuarita area for over 12 years, the last several with Arizona Community Physicians. Two of his partners — a husband-wife team — recently retired, leaving him to run a practice with a nurse practitioner. He sees about 30 patients a day and works 14- to 15-hour days. He spends weekends following up on medications, going over lab results and making follow-up calls to patients. Dr. Prior said Green Valley residents don’t want to drive to Tucson to see primary care physicians. Tucson doctors don’t want to drive to Green Valley either. “We’ve been recruiting. We’ve been going places. I’ve talked to residents. I’ve talked to nurse practitioners. I’ve talked to multiple, multiple people and a lot of the doctors that are moving here…they’d rather work in Tucson because they don’t want to drive down here,” Prior said. “And then we have a very busy clinic, that sometimes scares them away because they don’t want to be that busy.”

It is standard for corporations to schedule each patient for 15-minute appointments, and according to the Physician Advocacy Institute, nearly 80% of all doctors now work for corporations or hospitals. But doctors often have a hard time keeping to 15 minutes, Prior said. The number one reason, particularly in Green Valley, is more than one serious ailment, he said. But there are other reasons, too. “The common thing in primary care, and we all kind of joke about it, is you take care of the hangnail and the dry eyes and the rash and the knee pain and the shoulder pain and the back pain, and then you’re about to stand up and walk out, and they’re like, ‘Doc, I've been having this killing chest pain.’ And it’s like, why did you not bring that up first? That should be the number one thing we talk about, but everybody always brings up the worst thing last because they want to make sure they get everything taken care of,” Prior said.

Doctors are overburdened nowadays because of the internet, Prior said. Patients research their symptoms and test results before every appointment and come up with their own diagnosis and treatment ideas and they’re less trusting of doctors because of the media, he said. “It’s so difficult because I’m fighting the internet, their friend, their nurse that’s retired, the doctor that retired 20 years ago that lives down the street and hasn’t practiced anything in the field of medicine since the day they left med school 60 years ago. And yet they’re trusting all of them over what we say. It’s difficult and it takes up more than 15 minutes because we do have to educate and try to teach them,” Prior said.

According to the American Board of Family Medicine, the average doctor cares for 1,700 patients in an 18-month period. However, a 2019 University of California study found that if a physician worked 43 hours a week and saw patients for eight to 12 minutes each, they could only accommodate 983 patients.

More specialists: Prior said more doctors are specializing because they can see more patients in a shorter period since they only focus on one issue. Bynum Neal has also noticed an increase in the number of doctors pursuing specialty medicine. “Many physicians choose to specialize because of their genuine interests in that area of medicine, and hospital residency programs are also often geared toward developing specialists due to procedural reimbursement rates,” Bynum Neal said. “There is also the reality that many physicians are burdened with massive amounts of loan debt after completing medical school and residency, therefore this decision may be, at least in part, financially based.”

Money is an issue when it comes to geriatric patients, Prior said. According to the American Medical Association, Medicare reimbursement for physician services declined 29% from 2001 to 2024, when adjusted for inflation. The government “keeps playing with ideas” on how to pay doctors more but they’ve not figured it out, he said.

“That’s scary, too, because you’re like, ‘Well, now you’re going to change a model from paying me based upon what I do versus how sick my patients are.’ OK, maybe I don't want sick patients then. Because if you're paying me for ‘quality care,’ we all know that diabetic that doesn’t take their insulin and eats cheesecake every day. Why would I want to care for that patient? If you’re not going to pay me for all the time that I'm going to have to spend on them, and I don’t get paid for it, my time is valuable still. Yet you don’t think it is, even though I’m working with that patient to try to help them, and they choose not to,” Prior said.

Prior, who is board certified in internal medicine, had hoped to become a surgeon but familial tremors killed that dream. Still, he enjoys his days as an internist. He defines a good day as one with “good patient outcomes, patients being healthier, patients progressing in their care. Having people that can’t get up out of their chair being able to get up out of their chair after they do the exercises and the treatments that we recommend…being able to figure out what’s going on with someone, helping them, making a difference in their lives.”

Bynum Neal said she believes more people could be attracted to the medical field if they were exposed to it at an early age and if there were more scholarships to help mitigate the cost of medical school.

Moving forward: In the meantime, there are efforts to fill the gap. “Many community health centers have started internal primary care residency programs or collaborate with local medical schools and hospital-based residency programs to expose medical students and residents to community and rural health,” Bynum Neal said. “The nurse practitioners and physician assistants are also essential to helping close the gap access to care for patients.

Telehealth has really been a game changer for allowing patients access to care.” UCHC has been partnering with higher educational learning institutes to develop the next generation of medical workers, she said. “We have felt the effects of this shortage and work diligently to continue seeking innovative ways to provide more access to care,” she said. 

Dr. Daniel Derksen is director of the Center for Rural Health at the University of Arizona, and he sees another reason for the doctor shortage in Arizona: Population growth has outstripped the ability to train and place physicians in areas of high need. “We have needs across all specialties in Arizona, but the highest need by far is in primary care,” Derksen said. “If you want to look at location, at least as far as access to care, it’s really the areas outside of Metropolitan Phoenix and Tucson where almost all the training occurs.”

The state is also limited when it comes to the number of residency programs, he said. Depending upon what the doctor wants to study, they must participate in a residency program of three to seven years. “A lot of our graduates from our undergraduate medical education, our medical and osteopathic schools in the state, must go outside the state to find a residency program to be eligible for board certification. Our data shows that 75% of the time they don't come back,” Derksen said. “The evidence is pretty clear that a lot of people settle into practice within a mile or two of where they trained in residency and graduate.”

Residency programs: Derksen said he’s spent a lot of time trying to increase the number of residency spots over the past 13 years. Two years ago, the state Legislature passed a one-time appropriation to help set up more.

“We’ve already met with community health centers that might be interested in setting up residencies. It’s a lot of steps to go through to set up an accredited family medicine residency, for example, or primary care residency in internal medicine,” Derksen said. “There are nine sites that received awards from this funding we got from the state to start going through all the steps you must go through to start a residency program. They’ll start matching residents in the next year or two, and then it takes, in primary care, about three years to get them out into practice.” Some of the programs will be expanding and others will be new, Derksen said. He has also been trying to create more academic-community partnerships with rural partners so physicians who want to practice in smaller communities are better prepared.

“Your skill set is a bit different because what you’ll be seeing and taking care of in smaller communities can be quite different than when you’re in a place like Tucson or Phoenix, where you might have a whole cadre of not only primary care, but specialty services within a floor or two, or within walking distance of where you see patients in primary care,” Derksen said. The state and universities have also been working on the front end of the equation by trying to offer more scholarships and loan repayment, Derksen said. For example, some future doctors can get help paying off their medical school loans by working in tribal communities. The UA is also working with community health care systems in Mariposa, Nogales and Tucson to create an “interprofessional health workforce” to ensure patients receive care. 

“These academic community partners provide great training milieus because that’s where you really learn interprofessional care. You work with a team,” Derksen said. “You’re working with physician assistants and sometimes midwives and physical therapists and others to do what’s really needed in primary care, which is having continuity of care with a provider.”

“What people really want is their own personal physician and you can certainly extend the reach and the access to care by including in that interprofessional team physician assistants, family nurse practitioners, with family medicine physicians and others,” he said.

When he worked at the University of New Mexico, they worked with a federally qualified health center system like UCHC. “They had multiple sites and that was the milieu that we trained our health professions students and our residency programs folks and they’re much better prepared to practice scenarios with the types of skills they really need to be successful, from both physician and business perspectives, taking care of patients and making sure they can deliver high-quality care,” Derksen said.

Brian Sinotte, market CEO for Northwest Health Care, turned down two interview requests but released a statement that read in part: “With our internal medicine residency program, a transitional year, and our recent addition of family medicine launching this year, we will have 79 residents in training when all programs have become fully operational. By investing in the next generation of physicians, we are strengthening access to high-quality care and a healthier future for Southern Arizona.”

Feeling frustration: Deno and her husband, Jerry, moved to Green Valley from Connecticut five years ago during the COVID-19 pandemic. Although she’d only seen her doctor once, when she became desperately ill, he came to her home to examine her.

She’d never had a doctor pay a house call and so every time he left a medical group, she followed him. She suspects he left the last group because he doesn’t believe in limiting his patient visits to 15 minutes.

“We have his private phone number, we have his email, and we can call him, we can text him and we can email him, and he gets right back to us, and he’s done that from Day One,” she said. “I hope he opens his own practice, but everybody we talk to says the doctors are leaving and what are they going to do, we’re here in Green Valley.”

Nelson and her husband, Norman, 87, moved to Green Valley from Park City, Utah, and her daughter is pleading with her to move back because of the lack of doctors here.

Although the numerous specialists they both see have remained static, they have had a terrible time keeping family doctors, she said.

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