PRIMARY CARE: Much needed, but not so easy to come by
The health care industry in Idaho is robust and firing on all cylinders.
However, physician shortages, long wait times and other factors are stressing the system.
"What I’m hearing from patients is it is hard to find a primary care provider, a primary care doctor or provider in the area," said Dr. Anthony Rehil-Crest, chief clinical officer for Heritage Health, a regional provider of integrated medical, dental and behavioral health services.
He said even though patients live in North Idaho, many have to go to Washington because of the lack of available doctors in Kootenai County.
"As a primary care clinic, we have a lot of experienced providers who are retiring or leaving medicine or primary care and we’re having to replace them with new physicians right out of training," Rehil-Crest said. "It takes a long time to get those providers up to speed."
The COVID-19 pandemic, along with "The Great Retirement" of long-tenured physicians and a population boom in Kootenai County, have taken their toll on medical professionals, patients and access to care.
"The pandemic, at least in medicine, has also kind of accelerated some of that retirement," Rehil-Crest said. "They're deciding to retire early and they're replacing those providers with less experienced providers. And there’s this huge influx of people into North Idaho in the last two years, and there are not enough primary care providers to take care of those patients."
Idaho has a shortage of primary care physicians, with only 86.6 primary care physicians per 100,000 people in the state, according to data from the Idaho Department of Health and Welfare. This is lower than the national average of 92 primary care physicians per 100,000 people.
The population of Kootenai County in 2021 was 179,789. That same year, Kootenai Health, the region’s largest hospital and health care system, had a total of approximately 127 family medicine and internal medicine doctors, nurse practitioners, physician assistants and 23 pediatricians.
Wait times for appointments with primary care physicians in Idaho vary, depending on the location and demand for services. A survey conducted by the health care consulting firm Merritt Hawkins, found the average wait time for a new patient appointment with a primary care physician in Idaho is 31 days. This is higher than the national average of 22 days.
Kootenai Health told The Press the average wait times to see an existing primary care physician, assuming a patient has already established care with that doctor, are typically four to six weeks for follow-up appointments. In an urgent situation, most primary care physicians will find a way to see patients the same day. Average wait times to see a new doctor are typically three to four weeks. Some practices may have limited access for new patients.
Across all its services including psychiatric, Heritage Health reported an average wait of 23.51 days for new patients to receive care in 2022. Specifically, new medical patients waited an average of 28.5 days. The wait was slightly less for existing patients, who waited an average of 21.16 days to see their doctors. Medical visit wait times averaged 22.18 days.
The average out-of-pocket cost for a new patient with no insurance to see a Kootenai Health primary care physician is $202. This does not include extra services, such as tests and imaging. This also reflects the 25% discount Kootenai Health facilities offer uninsured patients.
"It is also important to keep in mind that Kootenai Health will always help uninsured patients see if they qualify for Medicaid or Medicare," Kootenai Health Communications and Marketing Director Kim Anderson said. "And it offers financial assistance and interest-free payment plans to those who need them."
Emergency departments are staffed and equipped to provide fast, life-saving care for a wide range of emergencies such as major traumatic injuries, heart attacks and strokes. Equipping and staffing these departments to respond to medical emergencies is more expensive than operating a doctor's office or urgent care clinic, meaning emergency room visits will most often cost more than care received elsewhere.
The average emergency room visit at Kootenai Health is $768. In 2022, Kootenai Health saw 53,113 patients in its emergency department, with 53,960 patients in 2021, 48,551 in 2020 and 52,976 in 2019.
Kootenai Urgent Care visits are similar in cost to regular doctor visits. Kootenai had 55,000 urgent care patient visits in 2022, which is considered an extremely high utilization.
"The best course of action people can take is to establish care with a primary care provider," Anderson said. "This allows you to establish a relationship, have a provider who gets to know you and your health history, and creates the best option for accessing health care. This is something we should all do before we have a situation that requires care."
