Santa Clara County could see an exodus of primary care doctors, as physicians say they’re at a breaking point after years of heavy workloads and dismissive leadership.
Primary care doctors at Santa Clara Valley Medical Center said they’re being asked to prioritize quantity over quality health care. All physicians in the division, roughly 75 people, signed a letter detailing their concerns to county leadership last summer. Doctors said their workload, which started increasing five years ago, coupled with reduced resources and a burned out workforce is hurting patient care.
Physicians asked the county to reduce their number of patients to improve safety and care quality in a letter more than a year ago. But doctors said, as of this month, county and hospital officials have not made any changes. VMC primary care doctors are required to see 11 patients per shift, while hospital systems in neighboring counties such as San Francisco and San Mateo have a goal of nine patients per shift, according to the letter.
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“When I went into primary care, I really enjoyed seeing patients, and I’ve had patients here that I’ve taken care of for (years),” a VMC primary care doctor of more than 15 years told San José Spotlight. “But this workload has made me question whether I want to keep going or whether I can keep going.”
San José Spotlight is not naming VMC workers due to their fear of retaliation. This news organization obtained the letter and talked to six primary care doctors who shared corroborating stories. The doctors are members of Valley Physician Group, which has been negotiating for a new contract for roughly 20 months. The union represents nearly 500 county doctors.
County Executive Jeff Smith deferred questions about primary care doctors’ concerns to VMC CEO Paul Lorenz. Lorenz said concerns are being addressed through contract negotiations with the doctors’ union.
“The quality of care provided to our patients is a priority for the county health system, and we will continue to work with our physicians and staff to this end,” Lorenz told San José Spotlight. “We are hopeful that we can reach (an) agreement with the physicians and move forward together.”
Santa Clara County’s five supervisors either did not respond or declined requests for comment.
Sounding the alarm
Concerns at VMC’s primary care division come as health care workers across Santa Clara County’s hospital system are sounding alarms over ongoing worker shortages, outdated equipment and tone-deaf leadership. Workers said the years-long issue is made worse by COVID-19, resulting in an average wait between eight and 14 hours for emergency services, a backlog of hundreds of patients and months-long waits for basic, non-invasive screenings. Many workers are doing the job of two or three people, workers said.
Each VMC primary care doctor also has a list of 1,800 patients, which means a patient is unlikely to be able to see their primary care doctor more than twice a year. Many residents with complicated medical conditions, including diabetes, need at least three visits per year, doctors said. The letter sent by the doctors noted no other neighboring county system assigns more than 1,350 patients to their primary care doctors.
Doctors want the county to cut their daily goal to the same criteria: nine patients per shift and reduce the number of assigned patients to 1,350. They also also want county leadership to listen, support and respect them.
VMC is one of three public hospitals operated by the county, and serves some of the most vulnerable, low-income residents in wealthy Silicon Valley—many of whom don’t have private insurance or other options for health care.
Primary care doctors said the county started increasing their workload in 2017—when they were already at maximum capacity, a doctor with a close to two decades of experience at VMC said.
“They came in saying we need to increase our bottom line essentially,” the doctor told San José Spotlight, adding the hospital promised it would provide support to accommodate the increased workload, but relief never came.
Under the currently workloads, VMC primary care physicians can only spend 15 minutes with each patient. They said the practice is unfair to patients, who often wait months for an appointment.
“Our patients are medically complex,” another doctor said. “They have a lot of social determinants of health which makes a simple medical issue far more complex than in other environments.”
San Jose resident Susie Bercier, 64, has relied on the county hospital system for primary care for the last two decades. Bercier used to wait two to three weeks for an appointment, but that has ballooned into waiting months over the last few years. When she saw her primary care doctor four months ago, Bercier said she didn’t even have a chance to bring up all her health issues.
“Because (the doctor) only has 15 minutes for each appointment, by the time she comes in and does the paperwork, we’ve got like six minutes left,” she said. “There’s no quality at that point. It’s shameful.”
VMC also requires primary care doctors to do preventative measures such as mental health screenings at each visit. While the physicians support the initiatives, they said the screenings make their jobs more impossible—especially without adequate support staff.
The backlogs in other divisions in the system, such as radiology, have also created more work for primary care doctors, as they often spend hours trying to schedule specialist appointments for their patients.
“It really takes us going above and beyond with almost every patient,” a doctor with 10 years of experience at VMC told San José Spotlight. “It’s not sustainable and it hurts knowing that sometimes we can’t give our all to every single patient. It adds up.”
Facing a mountain of work, physicians said they routinely work through lunch and bring work home to keep up.
“I basically work here until I have to go home for dinner and spend dinner with kids, then they go off and I get back on the computer working until it’s time to get the kids into bed. Then I get back on the computer until I’m exhausted and it’s dangerous for me to keep going, and then it starts back all over again the next day,” a doctor said. “It stresses me out beyond belief.”
Contact Tran Nguyen at firstname.lastname@example.org or follow @nguyenntrann on Twitter.
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