When leaders in Bakersfield’s medical community discuss the issues they face in 2023 and beyond, it’s clear that a continuing shortage of doctors and other medical professionals is at or near the top of the list.
Daniel Wolcott, former president of Adventist Health’s Kern County network, in a speech he made last summer, described Bakersfield as a community of abundance that also suffers from scarcity. “We struggle with having enough medical professionals to serve the people of this community,” he told a crowd gathered in front of Adventist’s AIS Cancer Center.” He worried that Kern County has less than one primary care doctor for every 2,000 people. “If you look across the state of California,” Wolcott said, “that is nowhere near what is acceptable.”
He also noted that we, as a community, train too few specialists. ” That means we’re a net importer of other healthcare talent,” he said. According to “The State of California’s Physician Workforce,” a research report published by the Healthforce Center at UC San Francisco in 2021, “California’s physician workforce is not sufficient to meet the state’s needs.” Even more problematic is that medical doctors are not well-distributed across the state, with the lowest supply per capita in the San Joaquin Valley, the Inland Empire, and the Northern and Sierra regions.
The study divided the state into nine regions. The Greater Bay Area had the highest ratios of both primary care doctors and specialists per 100,000 people. The San Joaquin Valley had the lowest ratio of specialists and the third lowest ratio of primary care doctors per 100,000 population. “The topic of primary care physicians and how many we have in the community is extremely important,” said Dr. Ghassan Jamaleddine, a critical care pulmonologist and medical officer at Adventist Health Bakersfield. “It plays a role in the prevention and control of chronic illnesses,” he said. When patients don’t have a primary care doctor, often their diabetes is not controlled, their high blood pressure and cholesterol are not monitored. Then, rather than outpatient preventive care, these patients end up in the hospital with a stroke, heart disease or other preventable illnesses, Jamaleddine said.
According to a 2017 study by the California Future Health Workforce Commission, the state will need 4,700 new primary care clinicians by 2025 and an additional 4,100 by 2030 to meet the growing demand. At the same time, a wave of primary care physicians, many from the baby boom generation, are expected to retire over the next decade, further driving the shortage of physicians, according to the study. It can be difficult attracting primary care doctors, Jamaleddine said. It can also be difficult attracting med students to the primary care discipline.
“Primary care physicians are not paid as much as physicians working in the emergency department or as much as physicians working in intensive care, or as much as surgeons,” he said. “Their clinics are not supported as much as hospitals.” As Kern County climbs toward the 1 million mark in population, some wonder whether it might be time to establish a medical school here. Jamaleddine lauded Kern Medical, the county’s public safety-net hospital and renowned trauma center for shouldering the role of being Kern’s only teaching hospital, with residency and other programs that help attract physicians and future physicians to Bakersfield, many of whom stay to establish long-term medical practices. “This is a huge service that Kern Medical is providing,” Jamaleddine said, “and we really need to bring public attention to it.”
Scott Thygerson, CEO of Kern Medical, is proud of the hospital’s decades-long record of training young physicians. In fact, many of the east Bakersfield hospital’s top medical professionals honed their skills at Kern Medical. And in some specialty areas in Bakersfield, as many as one-third of practitioners came through Kern Medical’s programs.
But it’s not enough to fill the gap.
“We continue to have significant challenges in Kern County,” Thygerson said. “A lot of people get their primary care at an emergency department,” he said. “That’s the most expensive way. And so, emergency departments are always on overload.”
It’s simply not the way the medical system is supposed to work, he said. But when so many Kern residents face such steep challenges to access to consistent primary care, they have to go somewhere when they get sick.
Even patients with good insurance can’t always get what they need in Kern. For example, there are only about four endocrinologists in the entire county, Thygerson said, of those specialists who diagnose and treat health conditions related to problems with the body’s hormones and hormonal glands. That means some patients have to travel to get the medical care they need. Beginning one year ago, Adventist Health and Kern Medical created a strategic partnership to bring together their respective strengths in an effort to add to the choices patients have for treatment and create a cross-county network for patients and physicians. It’s not a merger — and there’s still much work to be done before it’s working as planned — but it’s an indicator of how important it is to hospital administrators and physicians to cooperate with entities that once might have been thought of as competitors.
“We have a dire, dire deficit in primary care and internal medicine,” said Cecilia Tomono, director of business development at Adventist Heath. “Our physician needs assessment shows that we are underserved by roughly 100 primary care and internal medicine physicians,” said Tomono, who works to recruit physicians to Adventist in Kern County. It means that many people in Kern are not getting the care they need, she said, the blood screenings and consultations necessary to provide basic preventive care. “It’s a trickle-down effect,” Tomono said. “Now you’re seeing stage 4 cancers coming through the door, so the patients are getting sicker.” The COVID-19 pandemic had a particularly detrimental effect on primary care doctors, she said. “It led to an increase in physician burnout, early retirement or physicians just leaving the profession as a whole.”
“The problem of recruitment already existed before COVID”, Tomono said. “The pandemic just exacerbated the problem. Not only that, it fundamentally changed the practice of medicine. I have been doing recruiting in Bakersfield for about eight years now, and there has definitely been a shift post-pandemic, to where the practice of medicine has just changed”.
The model today is hard to sustain, with strains in maintaining a work-life balance for physicians and other health care workers. One specialty, gastroenterology, for example, has been one of the most difficult specialty areas to recruit. “It is so hard to find one GI that is going to want to come to Kern County,” Tomono said. “I would say that is probably one of our biggest underserved physician populations that we have in Kern County. That is exacerbated by the fact that we don’t have a program. None of the hospitals have a program. So how do you start a program? It is tough to recruit that first physician who does not have the mentorship, the partners or the built program,” she said.
But she hopes the new partnership with Kern Medical will make recruiting easier as candidates see that a “critical mass” of support, mentorship and volume of patients is already in place. “In the past, we were competing for these candidates,” Tomono said. “But now they’re combining forces, each drawing on the strengths of the other.” “Meanwhile, medical residency and fellowship candidates are clamoring to come to Bakersfield,” Thygerson said. “We have 12 internal medicine residency spots,” he said by way of example. “We received 3,000 applications for those 12 spots.” Kern Medical has stepped up efforts to recruit new employees at every level and to fill the training pipeline with future health care workers — even creating a pipeline of future staff among local high school students. The pandemic has pushed some nurses and other medical staff as well to leave their professions altogether. Others have departed Kern Medical for lower-stress, higher-paid work.
“Hospitals across the city are making up the deficit by hiring traveling nurses,” Thygerson said. “I’m down to 130 today,” he said ” Friday. We’ve had up to 200. That’s very costly.” For Adventist’s Jamaleddine, and many others in the medical community, expanding the school-to-hospital pipeline is critical. “This is at the core of our strategic partnership with Kern Medical, to expand what we call graduate medical education,” Jamaleddine said. “But even deeper, is the need to reform, nationwide, the way medical professionals and patients think about health care. We have to move in the United States from what we call ‘sick care, Rather than being focused on intervention “downstream,” we need to focus on patients outside the hospital.”
“We have to keep our community healthy. We have to build a resilience in our community,” he said. “We have to build knowledge about healthy living.”