Doctor shortages accelerate as patients pour in for care

By Katie Kerwin McCrimmon

WHEAT RIDGE — Newly insured patients are pouring into Colorado’s safety net clinics, but in some cases, sparkling new exam space sits empty because there aren’t enough doctors to care for the influx of patients.

The Metro Community Provider Network (MCPN) this month celebrated its first anniversary at a large new state-of-the-art clinic in Wheat Ridge, the newest of its 22 locations in the Denver area. One pod is ready to serve older patients and those with mobility issues. Extra wide “barn” doors allow easy access for people in wheelchairs and there’s a special spot to park walkers and other devices for people with special needs.

Daniel SanJuan Ramirez, 11, and his brother, Erick, 3, visited a new Metro Community Provider Network clinic in Wheat Ridge on Tuesday.

Daniel SanJuan Ramirez, 11, and his brother, Erick, 3, visited a new Metro Community Provider Network clinic in Wheat Ridge on Tuesday.

Plenty of patients would be eager to get care here. There’s good bus service and easy access from Interstate 70. But the space remains empty.

For over a year, MCPN has been advertising for a geriatrician or an internal medicine doctor to oversee patients. Without one, CEO Dave Myers can’t open the space and so far, the response has been disheartening.

“Not even any nibbles,” Myers said, when asked if anyone has applied.

“We have been recruiting like mad. This building is part of a strategy for the entire western suburbs to create capacity and also to create a place where people want to come. This is a place I’d like to come,” he said of the airy, modern design, which is bathed in natural light.

Dave Myers, CEO of the Metro Community Provider Network, one of Colorado's 18 Community Health Centers, shows off space at a new Wheat Ridge Clinic. Hiring doctors has been so tough that Myers has not been able to open all the "pods" in the building.

Dave Myers, CEO of the Metro Community Provider Network, one of Colorado’s 18 Community Health Centers, shows off space at a new Wheat Ridge Clinic. Hiring doctors has been so tough that Myers has not been able to open all the “pods” in the building.

Colorado’s 18 Community Health Centers, which operate 167 clinics around the state, are thrilled that many of their previously uninsured patients now have Medicaid. For some, the majority of their patients used to be uninsured. Now that mix is shifting with more than half of patients covered through Medicaid. Colorado is one of the states that has expanded Medicaid and more than 160,000 newly eligible patients have gotten Medicaid coverage this year. The Community Health Centers operate in underserved areas across the state and care for one in 10 Coloradans and one in four Medicaid patients.

In the San Luis Valley, new access to public health insurance has been a financial lifesaver for a network of clinics there.

“The Medicaid expansion has been a blast of oxygen for Valley-Wide,” said Gigi Darricades, CEO of Valley-Wide Health Systems, which operates 12 primary care and seven dental clinics throughout southern Colorado. “It’s been a very emotional time. We’ve had patients in tears. It’s the first time they can get the health care they need.”

While patients can get care and Darricades can better pay her bills since more have insurance, she’s still struggling to find providers to care for all the patients.

“We employ 38 providers and are looking for four more,” Darricades said.

Attracting providers to rural Colorado is tough. Luring spouses or partners can be even tougher. And the salaries that providers want are loftier than ever since demand for doctors is so great.

The jump in patients who now have both private and public insurance is accelerating provider shortages around the state.

While the problem of too few doctors has long plagued rural Colorado, clinics in the Denver area are struggling now too. According to a 2013 study from the Colorado Health Institute, Colorado currently has 3,332 primary care physicians. The average age is 55 and many expect to retire within the next 10 years. (Click here to read Doctor shortages profound for Plains, Medicaid patients.)

The Metro Community Provider Network serves patients in suburbs on the western, eastern and southern borders of Denver. Today MCPN employs enough providers to cover 40 full-time positions, but the long-anticipated dearth of doctors has hit hard.

By the numbers
Colorado Community Health Centers
  • 18 Community Health Centers
  • 167 sites
  • serving patients in 60 counties
  • focus on underserved patients
  • 1 in 4 Medicaid patients gets care in a Community Health Center
  • 1 in 10 Coloradans gets care in a Community Health Center
  • Total patients in 2013: 504,595
  • Total number of visits in 2013: 2,015,224
  • Number of medical providers in 2013: 513

Source: Colorado Community Health Network.

“We have the capacity to add another 40 FTE…but there just are not enough providers coming out to meet the demand. It’s an important issue for us in meeting the need for our patients,” said Myers of MCPN.

In northern Colorado at Sunrise Community Health, the story is much the same with spikes in patient loads, new clinics under construction and worries about tapping enough doctors and mid-level nurses. In 2013, Sunrise cared for nearly 35,000 patients, more than triple the number that Sunrise served in 2000. The patient load that year was about 11,000.

“We have built new buildings each year…We are ready to accept new patients. We are poised to add 30 to 35 new FTE. We just opened our new Loveland Community Health Center,” said Mitzi Moran, Sunrise’s CEO.

Moran oversees nine clinics in Greeley, Evans and Loveland.

Community Health Center managers say they attract medical providers who have a “Peace Corps” mindset and who are attracted to the mission of caring for people in underserved communities. Many patients live in poverty and have complex health problems.

“For many, it’s ‘Do I pay the rent this month? Do I buy food?’ ” Moran said.

Those with diabetes may skip their medication or a visit to the doctor to buy other necessities instead.

“Then their diabetes gets out of control. It’s difficult to serve that population. You can’t just say, here’s a scrip,” Moran said. “It’s difficult serving people who are really ill, but it’s so rewarding.

“There is something unique about being in a safety net (system). You are serving people who, in many cases, have nowhere else to go. That appeals to a certain type of provider.”

In order to attract doctors and other providers, Moran and Myers said that rather than hiking salaries, they are trying to give providers what they want: more support staff and the hours they want.

“We want a competitive, fair salary. We try to offer a work/life balance,” Moran said. “As clinicians on our team, they get to be clinicians. They don’t have to run a business. All their energy can go toward patient care.”

For the moment, directors at clinics around the state say patients are able to get appointments if they need them.

In the past, some Community Health Centers have had waiting lists. Myers of MCPN said his clinics have plenty of spots for children and pregnant women.

“We can take all comers,” he said.

For adults who need care right away, MCPN has an adult walk-in center in Aurora and plans to open one in Wheat Ridge. The walk-in clinic is open until 8 p.m. on weekdays and from 9 a.m. to 5 p.m. on Saturdays. Patients might have to wait hours to be seen, but they can get same-day care.

At Sunrise, since the system has recently added providers, there are no waiting lists.

“Right now, we can see you,” Moran said. “Twelve months from now, if I don’t have another pod, maybe not.”

Moran said she’s managing to keep up with patient demand, but just barely.

In northwestern Colorado, the Northwest Colorado Visiting Nurse Association has just opened a new Steamboat clinic that doubled its capacity, said Lisa Brown CEO of the VNA.

In the San Luis Valley, a “Convenient Care Clinic” is open seven days a week until 7 p.m. Patients can get same-day service there. Those who need to see their primary care provider might have to wait three weeks or so to do that, said Darricades, CEO of Valley-Wide.

In this new era, as health reform takes hold, some patients are overjoyed, some safety net providers are overwhelmed, doctors are in great demand and managers are grateful for Medicaid.

“We don’t have to go into debt to make payroll this week. That’s a huge relief,” Darricades said. “Our model of care is expensive because we have so many sites.”

She’s hoping Valley-Wide can keep its remote locations open.

“It’s important. Otherwise people are going to end up in the hospital.”

For Moran of Sunrise Community Health, these are exciting times, but challenging too.

She said patients are “grateful and confused.”

Juan Gomez, 23, is a farm worker who recently earned his master’s in public health and serves on Sunrise’s board, where he has been a patient since 2000.

Gomez said people in his community don’t really understand health reform.

“They have been struggling a lot. They don’t know the system,” he said. “People don’t know how to start, who to talk to to get enrolled.”

Added Moran: “Just because someone becomes insured, that doesn’t mean other issues go away. Yes, (insurance) is helpful, but it doesn’t solve poverty.”


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