Cape Cod primary care doctor shortage causes long waits for visits - Cape Cod Times

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New patients looking for a primary care physician on Cape Cod will likely wait weeks, even months, for a routine first visit.

The workforce shortage that has plagued the Cape — and the nation — has extended even to medical doctors, according to several health care officials interviewed by the Times.

Demand is up, but supply is down.

"The population of the Cape is increasing. We have more people, and we have an older, sicker population," said Dr. Theodore Calianos, medical director of the Cape Cod Healthcare Employed Physician Group.

At the same time, healthcare workers — including physicians — are exiting the field rapidly, driven by factors that include COVID-19 burnout and reaching the age of retirement, Calianos said.

The combination of factors means new residents are finding it difficult to land a first appointment with a primary care physician, said Jean Butler, senior vice president for Employed Physician Group.

Now, when people call Cape Cod Healthcare looking for a new physician, someone takes their name and number and says they will receive a call when there is availability, Butler said.

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And it's not just Cape Cod Healthcare that has wait times for primary care services.

Dr. Matthew Libby at Outer Cape Health Services says that new patients can wait up to six months to have a first visit with a doctor. 

Karen Gardner, CEO of the Community Health Center, said it is taking about 60 days to get a first appointment with a primary care doctor at the health center based in Mashpee.

People with urgent health care concerns or who have recently been released from the hospital can get earlier appointments, but well visits are taking a while to schedule, Cape health providers said.

'Then COVID hit'

The Cape has had a long-standing problem with physician recruitment, being located away from major urban centers that tend to attract young MDs.

But the region had made inroads in recent years, Gardner said.

"I thought it was getting a lot better for a period of time," she said. "Then COVID hit."

Local health care officials are doubling up on recruitment efforts to meet the needs of the Cape's growing and aging population.

Butler said Cape Cod Healthcare is in the process of recruiting 10 physicians, a few of whom are scheduled to start work in January.

The needs are strongest in Falmouth, Orleans, Hyannis and Yarmouth, she said.

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The Community Health Center recently added four medical doctors to the team, and Outer Cape Health Services has a new nurse practitioner starting this winter.

Cape Cod Healthcare also is using nurse practitioners and physician assistants to help ease the strain on primary care physicians, said Calianos, who is a plastic surgeon.

The housing problem

The Cape's high cost of housing adds to the recruitment burden, Calianos said. 

"The Cape is a wonderful place. I love it here," he said.

But with houses costing $500,000, young doctors with medical school debt of $200,000 to $500,000 may not find the Cape so attractive, Calianos said.

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Two nurse practitioners that Outer Cape Health Services wanted to hire in the past year declined the offers due to housing costs, Libby said.

"It's been harder because of housing availability and prices."

In the meantime, healthcare organizations are relying on temporary staffers, also known as "locum tenens" workers, to fill in the gaps.

Outer Cape Health Services has two temporary nurse practitioners who have signed on to work this coming January through April.

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"It will take some of the pressure off this winter," Libby said. 

Butler said Cape Cod Healthcare has a locum tenens physician working in Falmouth and had one working a 90-day assignment in the Hyannis/Centerville area this summer.

But there's lots of competition for temporary physicians as well, she said. "Everybody's looking for locums."

More pediatric services?

Barnstable County Public Health Nurse Deirdre Arvidson said she is seeing such a great need for pediatric services that she would like the county to establish a temporary children's clinic for immunizations, checkups and lead screening.

She said she has seen an unprecedented number of children visit her office for childhood vaccinations. Many of the children are immigrants from Brazil, and the numbers also include recent arrivals from Ecuador.

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"Nobody will take these people, especially if they don't have insurance yet. It's a huge need."

Outer Cape Health Services has seen an increased demand for pediatric services as families moved to the Lower and Outer Cape during the pandemic, Libby said.

There's also been a slight increase in the number of newborns, he said, adding that Outer Cape Health Services finds a way to get them immediate appointments.

The lack of primary care physicians is a nationwide problem that will only get worse if root causes aren't addressed, Calianos said.

Nationwide shortages

A June report by the Association of American Medical Colleges projected a shortage of 17,800 to 48,000 primary care physicians by 2034.

Even the lower number "is huge," Calianos said.

The shortage is aggravated by an aging workforce. In the next decade, roughly 40% of physicians will be over the age of 65, Calianos said.

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But there are also systemic issues that need to be addressed, including the emphasis on "episodic" treatment of health problems in the U.S. rather than the preventative and integrated care models used in other industrialized nations, Calianos said.

"We spend more per capita in healthcare" and have worse health outcomes than other nations, he said.

"We have not invested as much as we should have in prevention. We're supposed to have the best healthcare. We don't."

Don't give up

People looking for primary care doctors should not give up, Cape health providers said. 

Libby said prospective patients should go to the Outer Cape Health Services website and fill out the form for new patients.

Patients who are willing to travel a bit — say, from Harwich to Provincetown — have a better chance of being seen sooner.

Butler said Cape Cod Healthcare officials are telling people looking for new doctors that they expect to have new physicians on board soon.

It's not as though it's easy to find a primary care physician elsewhere, Calianos said.

The doctor shortage "is really not just endemic to Cape Cod."