Local hospitals finding ways to maintain patient care amid physician shortage

Over the past two years, the number of patients Dr. Daniel Armbrust sees each day has increased greatly.

Amid the seasonal “tripledemic” of the coronavirus, influenza and respiratory syncytial virus, known as RSV, Armbrust said he’s been booked solid with patients every day for months.

Many new patients who wish to see Armbrust, a family medicine physician at the Northwestern Medicine Regional Group in Geneva, have to wait about a month to get in. Doctors who have been with the practice longer than him have even longer wait times to see new patients, he said.

“It’s been a very challenging viral season since October, so that’s also increased our volume,” he said. “That has made us be extra efficient with our time with patients. We save same-day slots for acute visits, and my clinic has been filling up daily.”

It’s not just there. Throughout northern Illinois, residents may have noticed that it’s becoming harder to get an appointment to see their primary care doctors, which are defined as internal medicine physicians, family practice physicians and pediatricians.

A nationwide physician shortage – depending on various factors, including location and type of care – has led to longer wait times to be seen in both doctor’s offices and in hospital emergency rooms. And it could get worse in the coming years.

According to the American Medical Association, a recent study from the Association of American Medical Colleges projects that by 2034 there could be a shortage of between 17,800 and 48,000 primary care physicians and a shortage of between 21,000 and 77,100 specialty physicians nationwide.

Dr. Jonathan Song, vice president and chief medical officer for Northwestern Medicine Delnor Hospital in Geneva, said one reason contributing to the shortage is that people are living longer, which increases the demand for physicians.

Another reason? The stress associated with the job, which has led to more physicians leaving the field.

“The stress level for physicians is really high, and adding the impact of COVID, that led to physician burnout,” Song said. “A concentrated, elevated mortality rate seen by doctors during the pandemic can leave emotional scars that can’t be easily forgotten. The suicide rate [among doctors] went up, as did early retirements.”

Song also pointed to the often-grueling process of going through medical school, followed by sometimes lengthy residency programs.

“It’s that investment of time that goes into schooling. If you went through med school, you would be almost 30 before you get a paycheck,” he said. “You’re graduating with a six-figure loan. Certainly, you have to go into medicine for all the right reasons, not just financial reasons. All these things contribute to a decline.”

At Delnor, Song said in addition to primary care physicians, they’re also feeling the effects of the shortage in the ER. They’re finding different ways to alleviate the problem so patients are seen sooner, Song said.

“Patients are waiting a prolonged period of time, but that’s everywhere,” he said. “We’re asking our outgoing doctors to stay an hour later and our incoming doctors to come in an hour earlier. And we have midlevel providers [such as nurse practitioners and physician’s assistants] in the triage area who can order labs or imaging rather than having patients wait until they’re seen [by a doctor]. That will make wait times shorter.”

Dr. Jeremy Silver, medical director for Northwestern Medicine Kishwaukee Hospital’s emergency department in DeKalb, said that the primary care shortage could affect the growing number of flu and COVID-19 cases this season. He said it’s unfortunately a problem that’s not new.

”Everybody has that issue,” Silver said. “[Kishwaukee Hospital] is unique in that Kish has gone out of its way to create physical space, and it’s one of the outliers that I’m aware of that actually has run out of space – and probably relevant to the nursing staff – is doing as well as expected.

“It’s the physical limitation that we’re up against. I’ve been fairly impressed with what we’ve utilized in the existing plan to help. Kishwaukee’s ER recently underwent some upgrades as well. You can’t have enough.”

Kishwaukee Hospital in March began a $12 million renovation to its emergency department, adding a new ambulance bay and more trauma rooms to cater to its growing patient needs.

But there is reason for optimism. Song said that medical school applications actually increased during the pandemic. That will lead to more doctors entering the profession in the next few years. One way Delnor is working to recruit more physicians to the area is Northwestern Medicine’s family medical residency program.

“We have a great relationship with young physicians-in-training, and we’ll be graduating eight residents who we hope will help our communities,” he said. “Some of them are from different states, so there’s a concerted effort to keep them here.”

Armbrust also pointed to Northwestern’s family medical residency program, which he said has been helpful in addressing the shortage of primary care doctors.

“Northwestern has an emphasis on primary care, and they’re trying to bring in more primary care doctors,” he said. “We’re the backbone of health care, and our population is growing as life expectancy increases and we’re seeing more patients. Family medicine is humbling because you’re the jack of all trades, and we have to know a little bit about everything.”

But if patients are diagnosed with a serious illness, such as cancer, they won’t have to wait long to get an appointment with an oncologist.

“For those patients who are gravely ill, they’ll be able to be seen earlier. That happens often. We do prioritize our patients based on the gravity of the illness,” he said.

Northwestern Medicine also has implemented a wellness program for physicians in hopes of keeping the staff that’s already in place, Song said.

“Physicians are stressed, so we need to address that now,” he said. “Northwestern Medicine has appointed a wellness director whose job is to help reduce anxiety and stressors experienced by physicians. There’s a dedicated executive to tackle these issues, as well as forums, counseling and a peer-to-peer outreach program. We want to make sure we’re retaining the physicians we have now. It’s not just recruitment but helping to retain.”

Sue Hovanes of Joliet is frustrated that she can’t see specialists and get certain tests done without long waits between appointments.

Hovanes said she recently – and finally – was diagnosed with a pinched nerve in her lumbar area after battling pain for six years.

However, it took three weeks to see an orthopedic specialist for the first appointment and another three weeks for the second, she said. The electromyography test that found the pinched nerve was easier to schedule, she said.

But now Hovanes, who’s been going to a pain clinic, needs adjustment in her treatment. So she took the first available appointment: Jan. 18. In the meantime, Hovanes has pain that drops her to her knees, she said.

“I’m going to see my primary tomorrow and see if I have any other options,” Hovanes said.

Hovanes has a second worry. Two weeks ago, she had her annual mammogram and was told she needed more tests: a diagnostic mammogram and an ultrasound. But Hovanes can’t be seen until after the holidays, she said.

“So in the meantime, I’m going, ‘Great. What’s wrong?’ ” Hovanes said.

The Will County Health Department said in a written statement that’s it’s aware, anecdotally, of the doctor shortage, but it has no way of providing specific information.

The health department said it doesn’t track numbers in medical schools’ graduating classes, so it’s difficult to say what might be “coming down the pipeline.”

“While our doctor-to-population ratio has traditionally been a little bit low in Will County, and we can’t speak for area hospitals or medical providers, we are not currently seeing a doctor staffing issue at our Will County Community Health Center,” the Will County Health Department said in a written statement.

U.S. Sen. Dick Durbin, D-Illinois, earlier this year secured $1 billion for the National Health Service Corps in the American Rescue Plan for scholarship and loan repayment awards aimed at recruiting more physicians, doctors and behavioral health providers for underserved areas.

In January, Durbin sent a letter to Illinois health care providers, clinics and hospitals, as well as schools of medicine, nursing and dentistry, urging them to encourage health care workers to take advantage of the National Health Service Crops and Nurse Corps scholarships offering loan repayment.

Despite the sometimes longer wait times for appointments, Song reiterated the importance of primary care physicians and urged patients to keep up-to-date with their annual checkups.

“Primary care is your bread and butter,” he said. “They can take the time to understand your medical history and be a partner for long-term health goals. A good primary care doctor will oversee the big picture and improve preventative care that can curtail chronic health problems that, left untreated, can turn into serious problems. They’re also conductors to find out if a specialist needs to get involved.”