Union workers picket outside Providence Community Health Centers on October 12, 2023.
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Union workers picket outside Providence Community Health Centers on October 12, 2023.
Lynn RTD/The Public Radio
First, her favorite doctor in Providence, RI retired. Then another of his doctors, at a health center a few miles away, left the practice. Now, Pete Fred has developed a new chronic condition: distrust of the American medical system.
“I don’t know,” she said, eyes wide. “To go to a doctor who doesn’t know who you are? You don’t know what you’re allergic to, what medications make you feel bad? It’s hard… I know I feel betrayed, sad, and my hands are tied.
At 71, he has not been vaccinated against COVID-19. She no longer gets her annual flu shot. Despite her age and her asthma, she didn’t even think about whether she should be vaccinated against respiratory syncytial virus or RSV. High risk Severe infection.
“It’s not that I don’t believe in vaccines,” Fred, a Colombian immigrant, said in Spanish one morning at his home last fall. “It’s just that I don’t trust doctors.
Losing a trusted doctor is not easy. But it’s an increasingly common experience.
The stress of the pandemic has prompted many health workers to retire or leave. Now, there is a nationwide shortage of doctors and other primary care specialists, making it difficult to find replacements. As patients are transferred from one provider to another, this erodes their trust in the healthcare system.
Pete Fred, 71, describes a desperate visit to a community health center after injuring his knee in a fall in his kitchen in Providence, RI.
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Pete Fred, 71, describes a desperate visit to a community health center after injuring his knee in a fall in his kitchen in Providence, RI.
Lynn RTD/The Public Radio
President of the American Medical Association Dr. Jesse M. Ehrenfeld recently called the physician shortage a “public health crisis.”
“This is an urgent crisis, hitting every corner of this country — urban and rural,” Ehrenfeld said. said Reporters told reporters at a press conference in October that it would “directly hit families with high needs and limited means.”
In Fred’s home state of Rhode Island, the percentage of residents without regular health care Increased from 2021 to 2022Rhode Islanders still do Better than most of the country.
According to the nonprofit Rhode Island Foundation, Hispanic residents and those with less than a high school education are less likely to have access to regular health care.
Labor shortages fuel labor unrest
Community Health Centers Federally Qualified Health Centers (FQHCs) are health care networks that serve the uninsured, underinsured, and other vulnerable populations.
There are more than 1,400 community health centers across the country, and 67% of them will lose between 5% and 25% of their staff over a six-month period in 2022. Report By the National Association of Community Health Centers.
Another 15% of FQHCs reported staff attrition rates of 25% to 50%. It’s not just doctors: the shortage is acute, survey finds Nurses.
In a domino effect, the shortage of such doctors has placed additional burdens on support workers such as medical assistants and other unlicensed workers.
Their additional tasks include “disinfecting equipment, keeping more records, keeping more documents, working with heavy patient loads,” said Jesse Martin, executive vice president of Service Employees International Union 1199 New England.
“When you put that work into the same eight-hour day, you can’t get everything done,” Martin added.
Last October, scores of SEIU members working at Providence Community Health Centers, Rhode Island’s largest FQHC, staged a picket outside the clinics to demand improvements in staffing, work schedules and wages.
Brett Davey, a spokesman for PCHC, declined to comment.
This staff dissatisfaction has spread to community health centers across the country.
In Chicago, workers held a two-day strike at three health clinics strike In November, it demanded higher pay, benefits and a lighter workload.
At Unity Health Care, the largest federally qualified health center in DC, doctors and other medical providers Voted to unionize Just before Thanksgiving, they say they are forced to prioritize patient volume over quality of care, leading to burnout and turnover.
Fewer providers for more patients
Community health centers are understaffed as they care for more patients. Between 2015 and 2022, the number of people served in community health centers increased by 24% nationally and 32.6% in Rhode Island. Rhode Island Health Center Association (RIHCA).
“As private practices close or shrink, we see increased patient demand at health centers,” said Elena Nicolella, RIHCA’s president and CEO. “With staffing challenges right now, it’s very difficult to meet patient demand.”
In Rhode Island, according to RIHCA, community health centers served 1 in 5 residents in 2022 — more than twice the national average of 1 in 11.
Employment rates at Rhode Island’s community health centers are 21% for physicians, 18% for physician assistants and nurse practitioners, and 10% for registered nurses, according to the state’s six agencies. Eight Health centers that responded to a survey conducted by RIHCA for public radio and NPR.
Pediatricians are also in short supply. Last year, 15 pediatricians left staff positions at health centers, and 7 of them have yet to be replaced.
Research Shows some of the biggest Burning drivers Workload and job demands.
Community health centers tend to attract career-oriented doctors, said Nellie Burdett, who worked at health centers for several years before becoming the nonprofit’s senior director. Care Transition Collaborative of Rhode Island.
These physicians often want to “give back” to the community and are motivated to practice “less corporate medicine,” and they may develop close relationships with patients and multigenerational families.
So when workplace pressures make it difficult for these doctors to meet their patients’ needs, they’re more likely to burn out, Burdett explained.
Urgent care visits instead of primary care
When a doctor leaves or retires, Dr. Carla Martin is often called upon to fill in. A week before Thanksgiving, he was filling in at two urgent care clinics in Providence.
“We see a lot of people coming in for really primary care problems, not urgent care problems,” Martin said, “because it’s so hard to get appointments.”
A patient recently came to the emergency room seeking a refill of his asthma medication.
“She said, I’m out of my asthma medicine and can’t get a hold of my PCP for a refill, and I keep calling and I can’t get through,” Martin said.
Stories like Christopher F. Koller, President Concern Milbank Memorial FundA non-profit philanthropy focused on health policy.
“When people say, ‘I can’t get an appointment with my doctor,’ that means they don’t have a regular source of care.,” Koller said.
Koller points out Research Studies have shown that having a stable relationship with a physician or other primary care physician is associated with improvements in overall health and fewer emergency room visits.
Primary loss of confidence
If that relationship breaks down, patients can lose trust in their healthcare providers.
That’s how Pete Fred, a Colombian immigrant who stopped vaccinating, felt.
Fred would go to a community health center in Rhode Island, but accessing care there was frustrating.
Described calling multiple times for same day appointment, got nothing, try again tomorrow.
After one visit, she recalled that one of her prescriptions had not arrived at the pharmacy.
And there was another time when she waited 40 minutes in the exam room to consult with a physician assistant — who then said she couldn’t give him a cortisone shot for his knee.
Fred says she won’t come back.
What will she do the next time she is sick or injured and needs medical attention?
“Well, it’s going to the hospital.”
“Okay, I’m going to the hospital.”
But experts warn that overcrowding in hospital emergency rooms will further strain the health care system and the people who work there.
This story comes from NPR’s Health Reporting Partnership Public Radio And KFF Health News.
