A national shortage of primary care doctors is felt in Belfair, with latest clinic closure

In late January, Carolyn McClain experienced something that is becoming all-too-familiar for those over 65 — she lost her primary care physician, seemingly overnight.

The Franciscan Medical Clinic in Belfair, where McClain received primary care, was a collaboration between Mason County Public Hospital District No. 2 and Virginia Mason Franciscan Health. VMFH contracted to provide primary care and urgent care to residents living in Mason County in exchange for payment collected through the hospital district. For the past 15 years, the Belfair clinic — the last unionized clinic in the VMFH system — has served its employees and its patients well. 

Dr. Raul Dominguiano, known as “Dr. D” to his patients, had been McClain’s primary care physician from the very beginning. “I was one of his very first patients. I did not know at the time; but I was also one of his last,” she told me.

It seems that Dr. D did not know either. After her afternoon appointment, he recommended following up with him in three months. She scheduled an appointment for early May. Just a few days later, she learned she needed a new primary care doctor because Dr. D was no longer working there.

The same thing happened to Ned Wright in early March, when he walked in for a 9 a.m. appointment. He was surprised to be told that his appointment had been canceled and his primary care physician for the past 12 years was suddenly gone. A few weeks later, more bad news followed: VMFH announced they would close the Belfair primary care clinic on June 28, permanently, impacting more than 3,000 patients who received care at that location. 

On a regular basis, I receive emails from patients across the nation who have suddenly lost their doctor. They are asking me how to find a new one. The numbers are staggering — today, up to 100 million Americans do not have access to primary care services — a number that has doubled over the past 10 years. Even though the Affordable Care Act was touted by many — and at times, by me, as well — to improve our health, it has not lived up to those expectations.

Americans are less healthy than they were 10 years ago. Life expectancy is decreasing, while rates of chronic disease, like obesity, hypertension, and diabetes, climb higher each year. The U.S. ranks dead last out of 11 nations, according to the Commonwealth Fund, in healthcare access, efficiency, equity and health outcomes.

In my opinion, the fatal flaw in our healthcare system boils down to one thing: misplaced financial incentives. American healthcare rewards specialty care and surgical procedures while discounting the preventive and diagnostic work done by primary care physicians. Today, there are far more patients than there are doctors, and neither the government nor insurers are willing to financially support the increased patient demand.

As a result of the ever-growing physician shortage, finding a doctor feels like searching for a proverbial needle in a haystack. Twenty-five percent of Americans will not be able to find a new family physician at all. And if they are lucky enough to find one, the soonest new-patient appointment will be months away. The same day Liz Wilkins learned that she and her 84-year-old husband needed a new primary care provider, she called clinics in the area. The earliest she could get an appointment was three months, to see a nurse practitioner, and five months to see a new doctor.

The interminable delay to secure an appointment is hardly the worst part. It is what can happen to you and your health during the wait that might kill you. According to a 2021 study published in the Journal of the American Medical Association, without the preventive care provided by a primary care physician, visits for specialty care surge by 10%, trips to the emergency department increase by 5%, hospitalization rates climb, and the mortality rate rises.

While Wilkins waited to see a new primary care provider, she ended up in the emergency department on Valentine’s Day with an abnormal heart rhythm. Over the last two months, she has seen three different specialists. Ironically, after discharge from the emergency department, a primary care physician called to check up on her as a part of routine follow up. When she inquired if he could accept her as a patient, he said he did not have space for new patients at this time.

What choice do patients have after losing their doctor? “Retail clinics,” like Amazon’s One Medical, Walmart Health, Kroger Little Clinic, and CVS Minute Clinic, are cashing in on the lack of primary care services. As a rule, these facilities do not employee physicians at all, preferring only nurse practitioners and physician assistants to see patients. And while urgent cares are popping up on every street corner, 75% of them do not require physicians on-site. It should come as no surprise that VMFH will keep the Belfair urgent care clinic open, while referring patients in need of new primary care to clinics in Port Orchard, Poulsbo, Silverdale and Bremerton.

More from Dr. Al-Agba: Why the trend toward quick and easy appointments may not be making us healthier

Unfortunately, the mismatch between physician supply and patient demand has reached the point of no return. And nowhere is the access gap more apparent than in Belfair. But they are not alone. In the future, primary care will be out of reach for many patients in many communities. After losing Dr. D, Mrs. McClain said, “it really knocked the wind out of me. My heart goes out to the whole county. The day will come when driving to the doctor will become too difficult. And then what?”

I did not have an answer. No one does. And I predict life expectancy will not improve until we do.

Dr. Niran Al-Agba is a pediatrician in Silverdale and writes a regular opinion column for the Kitsap Sun. Contact her at niranalagba@gmail.com.

This article originally appeared on Kitsap Sun: A Franciscan clinic closing in North Mason highlights national problem