Area's low ratio of specialists to patients causes complications.

By Barbara Anderson / The Fresno Bee

A shortage of medical specialists is causing patients to suffer and become sicker while they wait for appointments, according to a survey of health clinics in the San Joaquin Valley.

In some cases, a delay in care may have led children with chronic infections to lose hearing and patients to die, said researchers at the Central Valley Health Policy Institute at California State University, Fresno.

"Health problems become more complicated or more costly or there's a worse outcome, whether it be more severe reaction to disease or sometimes death," said Deborah Riordan, health policy analyst and lead author of the study.

The survey of eight clinics that serve mostly Medi-Cal and uninsured patients found almost all had difficulty referring people to specialists.

The Valley's shortage of physicians could knock it out of contention as the location for proposed new medical and mental health prisons in the state. State officials said they want the institutions located where staff would be easy to recruit.

The Valley has the lowest rate of doctors of any region in the state at 173 per 100,000 residents. Statewide, there are 302 doctors per 100,000 people.

But it's specialists -- doctors who receive extra training in selected areas of study -- who are the most scarce. The Valley has 43 specialists per 100,000 people, according to the institute's report. The statewide rate is 87 specialists per 100,000 population.

The health professional shortage study, funded by The California Endowment, a statewide health foundation, found all but one of the Valley clinics surveyed rated medical referrals as difficult "most of the time" or "almost always." Only referrals for kidney disorders were not a routine problem.

Clinic administrators said Tuesday that they have patients waiting from weeks to months to see specialists.

"Recently, it took us five months to get a patient to see a urologist," said Dr. Patricia Quintana-Van Horne, chief medical officer for Sequoia Community Health Centers in Fresno.

At the Family Health Care Network in Visalia, the staff often has to refer patients to Fresno or Bakersfield for appointments with bilingual psychiatrists, dermatologists and general surgeons.

"A lot of them end up not receiving the necessary care," said Janet Paine, director of integrated services.

Some have no means to get to the out-of-town appointments, she said. "They don't have money so they don't receive the care they need. They come back to see us or end up in the emergency room."

Said Riordan: "What we know is we have a lot of folks who are uninsured. We have a lot of folks who are poor. We have a shortage of specialists, and we have an overburdened safety net system. You put that all together and we've got problems."

The institute was created in 2002 at Fresno State to conduct health policy research primarily in the San Joaquin Valley.

The clinics surveyed were in Fresno, Kern, Madera, Merced, San Joaquin, Stanislaus and Tulare counties. Kings County was not represented in the survey. The clinics, which serve about 300,000 patients a year, receive state and federal money to provide primary care to people in medically underserved areas.

Many of the clinics' patients are on Medi-Cal, the state-federal insurance program for the poor.

According to the report, clinic staffs had the most trouble finding specialists for patients on Medi-Cal.

In one case, a patient died in a hospital after a lung specialist refused to treat him, even when a primary care doctor offered to personally pay for the services, the report said.

One clinic said the lack of ear, nose and throat specialists for children had resulted in chronic illness and possible hearing loss. And another said a patient in need of chemotherapy had to wait for treatment because there was no local access to treatment.

The report did not identify which clinics or counties the problems occurred in.

The specialist shortage is affecting everyone, including people with health insurance provided by their employers, Quintana-Van Horne said.

"But it just more acutely is felt by those who are uninsured or underinsured," she said.

Valley clinic administrators said they understand specialists' reluctance to treat patients on Medi-Cal. The pay Valley doctors receive from Medi-Cal is too low, they said.

Assembly Member Juan Arambula, D-Fresno, said the state Legislative Analyst's Office has agreed to study funding inequities for social services and other programs. He hopes Medi-Cal will be included in the review.

"I think it is true that medical providers are reimbursed at lower rates in the San Joaquin Valley than other parts of the state," he said. "The same is true for Medicare funding from the federal government."

Quintana-Van Horne, a Valley native, hopes a proposed medical school at the University of California at Merced will ease the speciality shortage.

"I think when people come here, a lot of people stay," she said.

The Valley is fortunate to have a medical education program in Fresno operated by UC San Francisco, said John Zelezny, senior vice president and chief communications officer for Community Medical Centers.

"That right there is a big recruiting tool," he said. "If it wasn't for that, we'd really be in a tight spot here in the Central Valley."

The reporter can be reached at banderson@fresnobee.com or (559) 441-6310.

On the Web

"Health Professional Shortages in the San Joaquin Valley: The Impact on Federally Qualified Health Clinics" is available online at cvhpi.com.