As doctors age, small towns face critical shortage

Ukiah, Mendocino County— Californians are getting older and so, too, are their physicians.

In isolated places like this small, scenic community 110 miles north of San Francisco, fears are rising that as greater numbers of doctors retire, there won’t be enough to take their place.

The dilemma looms particularly large here in Mendocino County, whose 159 doctors, as a group, are among the oldest in California. A statewide survey conducted in 2009 by UCSF found that half of the county’s physicians were over 56.

Efforts to find replacements for aging doctors have produced mixed results at best in rural areas like Ukiah, where many health care professionals regard the looming prospect of too many patients and not enough doctors to treat them as nothing short of ominous.

“At this rate,” said Ukiah emergency room physician Marvin Trotter, 58, “what we’re looking at within the next five-to-seven years, if not sooner, is a full-blown health care crisis.”

Drawn to the higher incomes, broader cultural pursuits and diverse recreational opportunities commonly found in big cities, most new doctors in California today shun small towns to practice in and around the Bay Area, Los Angeles, and other urban centers. The result, many experts fear, will be less access to quality medical care in outlying areas—especially for baby boomers entering old age, and for the legions of new patients who will require attention under the mandates of national health care reform.

It is a fact of life in rural America that if you need highly specialized medical treatment, you find it somewhere else.

“Everybody here knows that if you need anything significant, you have to go out of town,” says Cindy Peroni, 59, a paraplegic who grew up in Ukiah and has been confined to a wheelchair since the age of 26, following a suicide attempt.

For residents of Ukiah, population 15,000, that can mean roundtrips of four hours or longer to Santa Rosa, San Francisco or Sacramento. But with the prospect of fewer local primary care physicians to refer chronically ill patients to those specialists, doctors say they worry that many people, rather than experience the inconvenience or discomfort of a long drive, will simply put off treatment.

“You’re going to see more complications and a lesser quality of life,” said Trotter, who puts in 12-hour days, three days a week, in the emergency room at Ukiah Valley Medical Center, the town’s only hospital. “You’re going to have your foot cut off more as a diabetic. You’re going to have more heart attacks because nobody’s taking care of your cholesterol. You’re going to have more people lose their vision because they can’t get in to see an ophthalmologist. That’s all a function of physician accessibility, and accessibility’s going away.”