Photo by Anna Shvets.

A March 2024 report published by the Association of American Medical Colleges predicts that by 2036 there will be a shortfall of 86,000 physicians in the United States. Many of those shortages are expected to occur within specialty fields, and limited access to specialty care is likely to hit rural communities especially hard due to sparse population making it less financially feasible to run specialty practices.

A growing physician shortage nationwide

Nationwide burnout among all levels of healthcare delivery is often attributed to the shortages in staffing.

Enrollments in medical schools are also down, even as there’s currently a bubble in the number of medical students well into their studies owing to an increase of enrollments during 2022 and 2023. Yet many specialties are not attracting the number of students needed to meet the needs of America’s aging and increasingly unwell population. 

Not surprisingly, nationwide burnout among all levels of healthcare delivery is often attributed to the shortages in staffing. From local primary care clinics to the many specialists who face a growing demand for services in the wake of the pandemic, Americans are struggling to connect with the services they need.

A variety of issues contribute to the increased demand for specialist services, including long covid and other post-covid complications, the fact that many patients put off getting care during the pandemic out of fear of infection and their conditions have now worsened and become more complicated, and the dramatic rise in behavioral health issues and metabolic disease.

It’s not just specialists who are in short supply. Primary care physicians are also in critical shortage as are physicians in the so-called “primary care specialties” such as family medicine, general internal medicine, and pediatrics.

Here in Humboldt, primary care offices are either not taking new patients or they are booking out as far as a year around Humboldt Bay. Fortunately, now that the SoHum Clinic is once again fully staffed, people are making the drive to Garberville to get their primary care needs addressed.

Meet Serena Meadows: Humboldt’s Referral Navigator

But what happens when there is a need to go to the next level and see a specialist? Fortunately, patients facing that often daunting and sometimes scary situation will find themselves in the capable hands of Serena Meadows, Referrals Coordinator for Southern Humboldt Community Healthcare District. 

Meadows, a long-time Humboldt transplant who grew up in the Bay Area, has worked in various healthcare support positions, from billing to prior authorization to referrals over her 27-year career. She’s been doing referrals to outside providers for SoHum Health patients for the last decade and draws on her vast experience in related fields to guide patients efficiently to the next level. “I like working in referrals because it is people-centered, and I like helping people maneuver through the maze. I still get lost in the maze occasionally, but I have a little more scent on the cheese,” says Meadows, whose appreciation for the importance of her role is matched by her willingness to seek out the best matches for patients going to the next level of care, weighing all aspects of the situation from a refreshingly sympathetic perspective.

Meadows’ specialty is in finding alternatives that can reduce the wait.

Her choices are sometimes hemmed in by lack of availability in Humboldt, which she says was not great before covid, and has become much more dire during and since the pandemic. Now, she says a lot of local specialists are retiring and they are not necessarily being replaced by young physicians. Cardiology and GI (gastroenterology) have been especially impacted and waits to see a specialist in those fields can be a month or more and in the case of GI, may require a trip to the Bay Area.

Meadows’ own specialty, however, is in finding alternatives that can reduce the wait if patients are willing to travel south to Willits or Ukiah, and she is always eager to work with patients to determine the best access available, depending on insurance, ability to travel, and urgency of need. 

Advocating for your healthcare needs

She encourages patients to advocate for themselves every step of the way, to ask questions and to “be a squeaky wheel, but not a screeching wheel” when scheduling appointments with specialists. “It never hurts to ask questions, because once an office has accommodated all the more urgent cases and is left with a pile of 150 non-urgent referrals, a phone call might get you moved to the top of the stack.”

Further advice Meadows offers is to not wait for a specialist’s office to call you to schedule an appointment. Because these offices are overwhelmed and sometimes manned by temporary workers unversed in medical office practices, it has become more necessary for referred patients to make the call, even if you have a letter from the office stating you will be called. “Never wait for anyone to call you for anything. Even if they are not ready to schedule you, they can explain to you where you are in the process.”

A phone call might get you moved to the top of the stack.

Because specialists require a specific number of workups done at the primary care level in order to best assess what care is needed, it is not advisable to attempt to leapfrog through the system by going to the emergency room for a non-urgent primary care issue. Referrals from the ER are usually declined because impacted offices do not have the time to gather information that is best done at the primary care level. Nevertheless, the ongoing shortage of primary care services creates a hiccup in the system and patients continue to use emergency rooms like clinics when they see no alternative.

Insurance issues can limit where patients can be sent. “If you have an HMO, you can be limited to Humboldt physicians, so if the wait for the Humboldt specialist you need is three months, so be it, unless you can make the drive as far south as the Santa Rosa area, UCSF or Stanford,” says Meadows.

General surgery is another service that is currently requiring long waits depending on the urgency. “How far do you want to drive,” says Meadows, adding that triage will sort out the more urgent cases, but once again, living rural proves to be difficult when it comes to accessing advanced healthcare.

One positive area of growth that came out of the pandemic is telehealth. Sometimes specialist care can be done remotely, often after an initial face-to-face exam has been done to establish a relationship. Various kinds of consultations can be handled through telehealth and it’s always worth asking if this type of service would work for you.

When long-distance travel is a necessity, most rural patients must rely on family or friends to make the trek to the city, and in some cases that can be a barrier to care. Partnership, California’s low-income public insurance system, has some spotty coverage for getting people to out-of-the-area appointments, but can’t be relied upon.

Adapting to rural healthcare challenges

The clinic is once again taking new patients with far less wait time.

With Humboldt being behind the Redwood curtain, recruiting and retaining physicians is a long-time problem, only made worse in the wake of the pandemic. “We give up a lot to live here, and it takes a special person to want to live here. Not everyone is attuned to the rural life,” says Meadows. “I’m sure Providence (Humboldt’s main network of specialist providers) recruits all the time, but I haven’t seen any indication that we are going in the right direction when it comes to bringing in more providers.”

As bleak as that picture may seem, Meadows remains optimistic, noting that just when the lack of providers in the Garberville clinic was becoming a crisis, new ones were found and the clinic is once again taking new patients with far less wait time than was being experienced just a few months ago.

Meadows’ long experience and dedication to serving the best interests of the patients she refers enable her to gracefully navigate the constantly changing medical and insurance rules that create a backdrop of upheaval. She sometimes wonders if the constant flux were “designed to make us crazy” even as she offers clarity and compassion to not just the patients she assists, but to her local colleagues and out-of-town office workers.

As our nation can only look into the future with apprehension for how healthcare shortages and overwhelm will play out in the big picture, we can be grateful that Meadows, our local link to the next level of care, possesses the wisdom and perseverance to guide us there extending the sense of our rural Humboldt community as far as your plan of care may take you.

Ann Constantino, submitted on behalf of the SoHum Health’s Outreach department.