High cost of living and aging doctors contribute to Monterey County’s physician shortage.

When Carol Hutchings’ primary care doctor retired in May of 2021, he gave each of his patients a list of other doctors to contact for continued care. Hutchings started calling around and got an initial consultation with a potential new doctor scheduled for October 2021. A bit of a wait, but at least she was on someone’s calendar. But then she got a jury duty summons that interfered with the appointment date and when she tried to rebook, she was told the doctor was no longer taking new patients.

That became a familiar refrain when she went back to the list provided by her now-retired doctor and started calling every office. No one was taking new patients. Eight months later, Hutchings, who lives in Monterey, is 66 years old, self-employed and uses Medicare insurance, has yet to find a new primary care physician. She’s frustrated and blames the impact of the Affordable Care Act, which expanded access to primary care to millions more Americans. But while studies do acknowledge the changes the ACA brought to healthcare delivery, the national physician shortage pre-dates this law.

There isn’t one single answer as to why Monterey County residents are having trouble finding new primary care physicians, or waiting months for that eye exam or dentist appointment. But it boils down to supply and demand.

Demand is strong among the county’s 439,000 residents, 14 percent of whom are over the age of 65. Supply is where things get tricky. Data from the Association of American Medical Colleges estimates that the United States will see a shortage of 37,800 to 124,000 physicians (both primary care doctors and specialists) by 2034. There are various reasons why we have fewer doctors than we need – a growing, and aging, population means more demand, putting pressure on existing doctors. And the high cost of medical school (in 2019, the median medical school debt was $200,000) could have a dampening effect on the number of people looking to become new doctors. It’s far from just a local issue.

But Mark Carvalho, CEO at Montage Medical Group, says there are some specific local reasons that contribute to the pinch too. According to a Montage study two years ago, 41 percent of the doctors in the community are over age 60 – what Carvalho calls a “disproportionate” aging population. When a doctor retires, like Hutchings’ did, hundreds of patients are suddenly let loose on the hunt for a new physician.

Meanwhile when it comes to attracting new, early-career doctors, the high cost of living in Monterey County makes this a difficult place to hire.

“We’re recruiting like crazy,” Carvalho says. But the cost of living is a tough sell. “If you come out of medical school with a very heavy debt burden, and you come into a community with a very high cost of living, it’s really a tough choice.”