Few primary care doctors, older population leave SWFL ‘medically underserved’

There are not enough primary care doctors to go around, and that’s just one piece of the puzzle for why all of Southwest Florida is considered “medically underserved.”

It’s been this way for years, and at the rate we’re going, Florida is projected to have the second-largest physician shortage in the country by 2030.

According to the most recent data from Lee Health’s Community Health Needs Assessment, stacked up next to the state and the country, Lee County technically had a higher number of primary care physicians per 100,000 people before the pandemic. But add that we also have an older population, and supply is not meeting demand.

Karen Smiley and her husband moved to Cape Coral three years ago.

“I made a phone call at the end of September,” she said. “They told me it takes six months to get an appointment. I said I could be dead by then.”

She called around and finally found a doctor who could see her, but it would still take three months. She says she has felt like she has had to put her health at risk because of this.

“I did when I started looking for a doctor. And when I found some health issues, it was like, this is crazy,” Smiley said.

The U.S. Health Resources and Services Administration designates nearly all of Southwest Florida as a “Medically Underserved Area” or MUA. That’s 100% of households from Punta Gorda down to Marco Island defined by “having too few primary care providers, high infant mortality, high-poverty, or a high elderly population.”

“Establishing the doctor is terrible down here. And I’m sure everybody else is having the same problem with everybody moving here,” Smiley said. “It’s just gonna get worse, I think, before it gets better.”

Lee Health President Dr. Larry Antonucci says the nationwide physician shortage is likely to get worse.

“There’s been an imbalance for many, many years,” he said.

But he says they’re bringing in doctors as quickly as they can and plan to hire 100 this year alone.

“As the number of medical schools has increased, the number of residency positions have not. So, many young men and women will go to medical school, but then they’ll leave the state to do their residency,” Antonucci said.

In 2014, Lee Health partnered with Florida State University to train and keep physicians here to practice family medicine. Since then, Antonucci says about half have stayed in Lee County.

Next year, Lee Health will start an internal medicine program in Cape Coral, training 12 new doctors a year.

“We’re doing a lot of things to bring physicians to the community,” Antonucci said. “It’s a great community to live in. It’s a great community to practice in. And we’re doing everything we can to improve access.”

In Collier County, the Neighborhood Health Clinic tries to fill the gap too.

“We’re sort of your last stop,” said CEO Leslie Lascheid. “If you come to our door and you’re sitting on our steps, it’s because you are now at the safety net of the safety nets.”

The clinic serves low-income working adults – many in the service industry – without insurance who fall outside the criteria for government programs like Medicaid or Medicare.

Lascheid says that’s roughly 50,000 people in Collier.

“All 50,000 don’t need us today, thank goodness, but we’re here for them,” Lascheid said.

With more than 250 volunteer doctors across several fields of medicine, the clinic specializes in chronic disease management.

“I may come in and say my shoulder hurts because I carry heavy trays. But in examining them, we find out that they have hypertension, diabetes,” Lascheid said. “You know how important meds and food and exercise and the education piece, how important that is. Can you imagine trying to navigate that with no help and no medical facility?”

The organization, entirely funded by private donations, is growing. Lascheid says their services take some weight off overwhelmed emergency rooms.

“The more we can take this burden, people who don’t know where to go for health care, and get them directed here, the better for all the communities,” Lascheid said.

Smiley will soon trade her private insurance for Medicare, but getting an appointment isn’t so hard anymore now that she’s established.

“I think they need qualified doctors around here. And another hospital in Cape Coral.”

Antonucci said Lee Health is advocating for improvements to telemedicine, and it regularly assesses what the community needs to figure out which areas are underserved and work to open clinics there.

The federal government has also tried to incentivize doctors to choose primary care through scholarships and loan repayment. Over the last decade, it has also increased Medicare reimbursements for primary care and lowered it for higher-paid specialty positions.