The shortage of primary care doctors in Texas deteriorated sharply during the pandemic, and a rural family doctor pleaded with state legislators to take action.
Dr. Adrian Billings is the Chief Medical Officer of Preventive Health Care Services, which has clinics in Alpine, Marfa and Presidio. He is a primary care doctor, but there are not enough doctors near Big Bend.
“There is now a family doctor in the Big Bend area who can treat 5,000 patients. This is a delay in care,” Billings told the Texas State Assembly’s House Public Health Committee this fall. "This means patients with worsening conditions, which means more expensive or higher care costs. This means lower productivity. This means more deaths."
The Federal Government’s Health Resources and Services Administration classifies areas with less than one primary care provider for every 3,500 residents as areas with a shortage of health professionals or HPSA.
Big Bend is definitely a kind of HPSA, but according to research done by the American Public Media Research Laboratory, Big Bend is not unique in Texas—the pandemic is not helpful.
“In 2019, 129 of the 254 counties in Texas were identified as areas with a shortage of primary care providers. Katherine Sypher, a data journalism researcher at the APM Research Laboratory, said: “As of July 2021, this number has jumped To 228. As a result, 99 counties were added. "
Sypher said: "There are only five counties in Texas that have not experienced a major shortage of primary care doctors, four of which are metropolitan. Therefore, it is also important to note that many counties in Texas are experiencing these shortages. It’s in the countryside, and there was a shortage of healthcare providers from the beginning."
Back in the Alps, Billings said that before the COVID, the shortage of primary care doctors was difficult to solve, but the epidemic was a heavy blow.
“Since February of this year, this area has lost five doctors; four family doctors are the only pediatricians in the area. We have lost a nurse practitioner, we have lost a doctor’s assistant,” he said. “As a result, there are seven primary care providers in the region, which account for more than 50% of our doctor’s workforce and cover a vast area of 12,000 square miles that we serve approximately 25,000 people.”
Billings said that providing medical services to areas like Big Bend is a team effort, but they don't have a deep bench. When the team is overwhelmed, none of them can substitute.
"Sometimes, we have to close our behavioral health service hotline, dental service hotline and primary health care service hotline in order to focus on mass vaccination days because that workbench is empty," he said.
This has implications for people who need to ask a doctor for a COVID test or anything.
"We have now made an appointment for three weeks. As the next available appointment in our practice, some patients need to see a doctor, they need to see a doctor today. And you know that we are doing our best to try to squeeze them in, and we tend to overbook ourselves ."
On July 5, due to a shortage of delivery nurses, the Big Bend Regional Medical Center had to temporarily close the only delivery department between El Paso and Del Rio—they were more than 400 miles apart.
Billings said that it is this pressure that has driven some primary care doctors out of this field-the pressure to work so hard and still not be able to provide the care needed by the community.
He said: "The primary care system in our health care system is currently under tremendous pressure trying to deal with COVID, but in the next few years, the epidemic of these chronic diseases may have unintended consequences." "Not to mention our health care. Staff burnout."
Rural Texans’ access to medical care is also reduced by the lack of medical insurance. According to data from APM Research Laboratories, Texas has the highest uninsured rate of any state, and nearly one-fifth of its residents are uninsured. One reason is that Texas is one of only 12 states that refuse to expand Medicaid under the Affordable Care Act. This has led to the closure of rural hospitals, which Billings said has exacerbated the shortage of primary care doctors.
"I think the lack of an expanded Medicaid program in Texas is one of the important reasons why doctors-especially your primary care (physician)-left the state or just retired," he said.
Billings proposed what he called the Texas Rural Health Education Center
"The center will become an excellent training center for educating rural healthcare students, nurses, doctors, senior clinicians, pharmacists, social workers, behavioral health workers, and public health professionals that are sorely lacking in rural communities," He said.
If something does not change, the outlook will be bleak. In May 2020, at the beginning of the pandemic, the U.S. Department of Health Services predicted that the number of family doctors in shortage may increase from just over 1,000 in 2018 to nearly 2,500 in 2032.
However, Billings does not believe that these numbers are set in stone. Or at least they shouldn't, as he told the Texas State Assembly House Public Health Committee in October.
"Because of the inability to obtain medical services in their own communities, the rural zip codes of Texans should not be a risk factor for their health."