The physician shortage has been driven primarily by demographics. Estimates indicate that by 2033, the number of Americans over age 65 will grow by 45%. Because seniors are the population with the greatest health care needs, in both primary and specialty care medicine, the supply of doctors must increase to keep pace. The Association of American Medical Colleges projects there will be a shortage of between 21,400 and 55,200 primary care physicians by 2033, making it difficult for millions of people to get preventive health care services. Equally troubling is the projected shortage of between 33,700 and 86,700 specialists, leaving patients with debilitating neurological, pulmonary, cardiac, gastrointestinal, orthopedic and other medical ailments without any immediate access to necessary primary or specialty medical care.

In response to the growing physician shortage, medical schools have increased their enrollments. However, without raising the federally imposed funding cap on support for graduate medical education (GME) — which has been effectively set and unchanged since 1997 — and without expanding training capacity, the increase in medical school graduates will do little to help the growing demand for physician services, especially in rural cities not able to offer the pay scale and lifestyle that larger cities can offer. Where does this leave cities like Porterville, Visalia, Tulare, Exeter, Woodlake, Orosi?

With regards specifically to anesthesia services at Sierra View the following is a generalized outline of how these services are rendered. Anesthesia groups vying for the contract to provide anesthesia services bid for the contract to provide anesthesia services to Sierra View Hospital. After the contract has been granted by the hospital to a group each practicing member of that group must be credentialed, vetted, and given the right to provide anesthesia medical services for the hospital. In the effort to meet the bid guidelines anesthesia groups have used non-physician nurse anesthetist to provide anesthesia services WITHOUT physician supervision. This is because of laws passed over a decade ago in California which stated “Because they are highly trained specialists, California, like many other states, allows CRNAs (certified registered nurse anesthetists) to administer anesthesia WITHOUT physician supervision. That practice is supported by the fact that CRNAs are independent practitioners who are legally responsible for their own actions and mistakes. September 21, 2009”

Thus today Sierra View Hospital like many other hospitals has had to seek out medical providers from a shortage of a limited number of providers that are available. As hospitals are turning to other alternatives: nurse anesthetists and foreign medical graduates the healthcare consumer must be aware . As the market for providers gets more competitive with larger cities and metropolitan regions attracting more US trained physicians rural cities like Porterville will be subjected to not only the budgetary restraints of what hospitals can afford to competitively pay physicians in rural areas but who will be ultimately in charge of your healthcare.

To conclude, the medical care provided all of the patients of Tulare County should be driven based on scientific evidence and clinical science. Patient safety should ALWAYS take paramount to any other force guiding medical care. A few things any patient can do on their own is ask their healthcare provider these simple basic questions that should always be answered openly by providers.

1. Have you had any to litigation brought against your medical license? Have you had any restrictions or limitations brought against your license? If yes, how many?
2. Have you had any adverse complications arising from medical care you provided? If yes, what were the complications.

3. Where did you complete your training and how long have you been practicing?

4. Are you a doctor or nurse? Are you board certified?

Lastly individuals who are responsible for making any healthcare decisions that impact a community should be of the community from which they represent, with a sense of how their community works and what things may help that community to provide the safest, most up to date medical care available. In Porterville where the city that has large Latino and Native American communities it would be prudent to have people that truly represent those communities at the table as well as women from the community when decisions guiding the healthcare for Porterville are being made.

Furthermore, it should be key to forge alliances with major training medical centers to introduce medical students to the Central Valley for exposure to rural medicine. Establishing strong alliances between Stanford, UC San Francisco, USC, UC Irvine, UC Davis with support from local communities to introduce medical students from these schools to the San Joaquin Valley would be a good start for any rural community looking to attract the next wave of the best and brightest.