Insurance hurdles, long wait times prevent SLO County patients from seeing specialists. Why?
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SLO County’s doctor shortage: A 5-part series
This series examines the shortage of both primary care and specialty physicians in San Luis Obispo County, what it means for patients and doctors and what can be done to improve the situation.
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Many SLO County residents can’t find a primary care doctor. What’s causing the shortage?
Insurance hurdles, long wait times prevent SLO County patients from seeing specialists. Why?
Struggling to see a doctor, SLO County patients turn to ER, urgent care — and even Mexico
Some SLO County doctors offer an alternative to basic primary care — but it comes at a price
SLO County doesn’t have enough primary care doctors. What could fix that?
Editor’s note: This is the second in a five-part series exploring health care access in San Luis Obispo County.
Allen Root has battled late-stage prostate cancer for nearly nine years.
Through six rounds of chemotherapy and radiation therapy, Root said one of his biggest struggles has actually been simply scheduling his appointments with local doctors.
“These systems are not designed to be client-patient-centric,” the 71-year-old San Luis Obispo resident told The Tribune. “They’re designed to be expeditious for the people that design these systems, the programmers and the administrators; the patients are on the far end of that spectrum.”
Root was first diagnosed with cancer in 2016.
By the time a doctor caught it, Root said, it was already stage four, metastasized cancer. Root’s Gleason score — a measurement of advancement and aggression of prostate cancer — was 9 out of a max scale of 10.
Root, the current president of the SLO County Arts Council, said that since his diagnosis, managing his own care has been practically a full-time job. Between the hassle of scheduling appointments and then actually attending them, he said it’s been hard to find time to work, let alone finish a major five-year art installation project he’s been working on.
Though Root said he sees his primary care provider about three times a month, it took time to get into a “rhythm” of scheduling appointments.
He’s also had difficulties getting scheduled to see an oncologist.
Last February, Root was admitted to the emergency room because of pain and complications with a previous surgical operation.
Then when he ended up losing a kidney in March as the cancer spread there, he felt like his doctors finally acted with more urgency. The doctors told him he needed treatment stronger than chemo, so he started having more frequent visits with his oncologist.
Through it all, one of his chief complaints has been as simple as getting a human on the phone when he’s trying to set up an appointment.
“There’s no way for me to directly access the staff of my doctor’s office,” Root said.
Root said during these calls, he has spent hours on hold and fears hanging up since there’s no way to leave his phone number or receive a call back.
When the time comes to finally see his provider, Root said, it was “boom, boom, boom — rapid fire,” with the physician asking questions as fast as possible. By the time he leaves, he’s forgotten to ask his physician about other concerns.
In light of this, Root — like many other San Luis Obispo County residents — has had to adopt a “pretty proactive” stance as a patient to take control of his own care.
“If a patient is not willing to advocate for themselves, there is no one else that’s gonna step in and do that,” Root said. “No one in the medical profession is going to oversee their entire medical program and coordinate specialists.”
The Central Coast region, which includes San Luis Obispo County, has 109 specialist physicians per 100,000 residents, according to a UCSF 2021 research report on California’s physician workforce. This ratio was slightly lower than the Bay Area and other regions including Orange County, San Diego, Los Angeles and Sacramento.
Depending on the specialty, the Central Coast has lower ratios of patient care in internal medicine, pediatrics and gynecology compared to these same regions.
In this five-part series, The Tribune is examining access to health care in San Luis Obispo County, which includes finding both a primary care doctor for basic needs and specialists for more serious issues.
Delays in care worsened SLO County woman’s shoulder injury
Cases like Root’s aren’t isolated.
San Luis Obispo County residents responded to a survey sent by The Tribune about difficulties accessing primary care here in the county. Ninety-three people responded, listing concerns like insurance requirements and getting a referral from a primary care provider to see a specialist.
For one patient, 67-year-old Jill Turnbow, the delays she faced actually ended up making her injuries worse.
In August 2023, Turnbow injured her shoulder while exercising. She later learned she had torn her rotator cuff.
Turnbow — who was on Medicare — told The Tribune she had to overcome numerous hurdles to access an orthopedic specialist or MRI imaging. One of the obstacles was requesting a referral from her primary care provider.
FIrst, she was told by her insurance she would need a primary care referral to get an MRI.
Then, Turnbow said it was challenging finding providers in the area who would take Medicare. She finally found someone in Morro Bay, but Turnbow said she went in circles trying to schedule an appointment.
“The upside — great (insurance) plan,” Turnbow said. “Downside? Nobody in this county took it.”
Turnbow said it was like “begging for a referral” to see a specialist.
When she didn’t hear back from her primary care provider for weeks, Turnbow turned to urgent care as she began to experience debilitating pain that worsened over time.
Ultimately, her physical therapist told her she had torn her rotator cuff, Turnbow said. Turnbow received an MRI order from a different sports doctor who had happened to share office space with her previous primary care provider— but it was still up to Turnbow to figure out where and how to schedule imaging.
Turnbow said she was told by every imaging center she contacted — from San Luis Obispo County to Los Angeles — that the wait time for an MRI was at least three months.
Desperate, Turnbow walked into French Hospital Medical Center in San Luis Obispo and saw someone she recognized sitting at the front desk. Because of that chance personal connection and her MRI request from her sports doctor, Turnbow got an MRI within the same week.
Ultimately, five and a half months passed from the time Turnbow injured her shoulder to having surgery on Jan. 31, 2024.
Turnbow said her pain and the seriousness of her torn shoulder increased with the delays in MRI scheduling. The diagnosis changed from a torn rotator cuff to a “massive” tear.
“It did get a lot worse by the time I could have it fixed,” Turnbow said.
Why is it difficult to find a specialist in SLO County?
For San Luis Obispo County residents who need specialized medical care, delays from primary care providers or a shortage of available specialists can leave them vulnerable to further injury or illness.
The Tribune spoke with doctors who discussed the hoops patients must jump through to see a specialist. They spoke about delays in care and the walls that must come down to enable patients to get imaging done or see a specialist sooner.
Dr. David Bolivar is a general surgeon who has practiced for 22 years in San Luis Obispo County. His office is in Templeton, but he also performs surgeries at other hospitals around the county.
Bolivar described the medical field in the county as “a little bit of an island.”
If a patient has a really complicated care routine, the closest hospital is in San Francisco or Los Angeles.
“There are some things with certain procedures and surgeries that are needing to have university-level care, and so that does make it challenging for the patients,” Bolivar said.
In terms of primary care access, Bolivar said patients often tell him they don’t have a regular primary care doctor or are trying to find one but can’t find a provider accepting new patients.
“That’s a challenge,” Bolivar said. “Then they utilize the emergency department, which backlogs the emergency department. Getting into the primary care doctor, to get in to see a specialist — I think that’s the bottleneck that we’re seeing.”
Bolivar said the patients who “fall through the cracks” often end up with an unclear diagnosis.
A classic example is when a patient has abdominal pain. Without a primary care physician or medical history, it’s unclear whether they should see a gastroenterologist, surgeon or rheumatologist.
“That’s where that patient kind of gets in this limbo, and sometimes they might feel like they’re getting ping-ponged around and not having a specific direction,” Bolivar said. “I can see that that can be really frustrating for some people.”
Dr. Nelson Yamagata, meanwhile, has practiced neurology in the North County for 24 years.
Yamagata treats an array of neurological conditions, from subtle ailments like migraines to brain diseases like multiple sclerosis or dementia.
Yamagata said he can think of only a few other neurologists besides himself who serve the entire county.
He said he requires patients to have a referral from their primary care physician and is restrictive about what types of insurances he accepts. This can present more hurdles for patients — but it also alleviates his administrative costs and hassles.
One such burden is dealing with prior authorizations, which require providers to get approval from a patient’s insurance company before certain medication, procedures or imaging requests can be covered, he said.
“It’s just a hassle to try to get things approved, and it’s just not worth the effort,” Yamagata said.
The upside is that his wait times are not that long. Most patients can set up an appointment with Yamagata within a month.
Nevertheless, the lack of neurology in the county overall could have “potentially fatal or chronically damaging consequences for people who weren’t able to get neurological care in time,” Yamagata said.
In Part 3, The Tribune will look at membership models of care — including concierge medicine — to understand how doctors are filling the care gap, a solution that comes with additional costs.
This story was originally published February 9, 2025 at 5:00 AM.
