Struggling to see a doctor, SLO County patients turn to ER, urgent care — and even Mexico
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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 part third in a five-part series exploring health care access in San Luis Obispo County.
Yesenia Molina, 29, has lived in San Luis Obispo County her whole life — the same as her 6-year-old daughter Luna. Molina was born in Santa Maria and has worked in each of the Five Cities.
In February 2024, Molina first noticed her daughter having troubles breathing while sleeping. She sounded congested.
“She would have disruptive breathing, almost like if she had a cold or something like that, where she sounded stuffy,” Molina said.
Molina would try to give Luna cold medicine, but nothing was “doing the trick.”
Molina realized after three weeks that this wasn’t just a typical cold. So she called Luna’s pediatrician.
That call kicked off three months of back-and-forth between various specialists, an ill-fated trip to the emergency room and eventually a $5,000 trip to Mexico, where Luna would finally receive the care she needed in order to breathe at night.
It’s an extreme example, but many San Luis Obispo County residents reported experiencing some form of difficulty accessing local primary care — difficulty that often pushed them into the area’s overcrowded emergency rooms or urgent care desperate for help.
In the third installment of its ongoing series on health care access in San Luis Obispo County, The Tribune looked into where patients who can’t see a primary doctor turn — and the issues those establishments face.
SLO County mother took child to Mexico to get surgery after months of delays
Two weeks after reaching out to her pediatrician, Molina finally got a call back to schedule an appointment for Luna. Then the doctor herself was sick, so the appointment was pushed back another week.
Eventually, Molina learned her daughter was having issues with her tonsils.
The pediatrician told her she would need to set up an appointment with an ear, nose and throat doctor.
“But it turns out that they had a two-month wait, and so at this point, we’re just trying to find other doctors,” Molina said.
They ended up seeing another pediatrician in March for a second opinion.
Molina said that as time went on, Luna’s symptoms worsened. She would stop and restart breathing in her sleep.
“I just felt kind of a little stressed out about how long of a wait it was, knowing that my daughter’s breathing just stops in her sleep,” Molina said of those long weeks.
At a consultation in Santa Barbara in April, the doctor looked at Luna’s airways and noticed the problem wasn’t just the tonsils but also a gland in the back of her throat.
“What would end up happening is that, since both of them were so enlarged, when she’d go to sleep, her muscles were relaxed, and they were physically pushed up against each other, and that’s what was disrupting her breathing,” Molina said.
The doctor told her that because of how enlarged they were, Luna would have to get her tonsils and gland surgically removed.
But the earliest appointment Molina could find for surgery was June. Then, the appointment was canceled because the doctor himself needed back surgery. Luna’s operation would have to wait until the end of July.
“It had gotten to the point where my daughter would wake up gasping for air,” Molina said. “She would ask if we could take her to the emergency room.”
One night, Molina decided to do just that. But upon arrival, the ER told her Luna would need to wait for an ENT doctor.
“It was just a recurring issue,” Molina said.
Meanwhile, Molina’s mother, who is from Morelia, Mexico, was talking to her family there who “thought it was strange” that Luna had to wait all these months just be seen, let alone schedule surgery.
Molina’s mother asked her how she felt about taking Luna to Mexico for surgery. Molina was hesitant but said she would look into it.
At the end of April, her mom scheduled a pre-operative appointment for Luna to meet the ENT doctor in Morelia on May 16. Luna had surgery eight days later.
After the surgery, Molina said Luna could sleep again and she was no longer stressed out.
“Her color was coming back in her face,” she said.
In total, the cost of Luna’s surgery and appointments in Mexico was about $5,000, Molina said.
“It was totally worth it for me. I can’t put a price tag on my daughter’s health,” she said.
But the whole experience left a sour taste in Molina’s mouth. As she traveled from one doctor’s office to another across San Luis Obispo County, Molina said she felt as if her daughter was treated as a number.
“They’re like, ‘OK, we hear your case. We’ll see you back in 60 days,’” she said. “And so it just felt like we were just another number that we had to wait to be processed.”
In an ideal world, Luna should have been seen earlier by an ENT doctor, long before having to go to Mexico, her mother said.
The Tribune spoke with emergency department and urgent care providers who said they want to help patients like Luna, but it’s often difficult when emergency resources aren’t necessarily what the patient needs as a first step in care.
The other obstacle is when there’s no available specialist to diagnose a problem, and the patient’s condition can worsen — which is what happened to Luna. Then the cycle of patients having nowhere to turn continues and can lead to overuse or misuse of emergency facilities.
Patients turn to emergency departments for primary care needs
Dr. Margaux Snider, an emergency medicine doctor at Arroyo Grande Community Hospital, said oftentimes, people come to the ER and don’t know if what they have is urgent or emergent — meaning they would pose a significant threat to a patient’s health.
Snider said she sees “a lot of stuff” that could be instead addressed in an urgent care clinic.
Take blood pressure medication refills, for instance.
Patients often can’t get in to see their primary care doctor for three or four months because they’re either new to the area or their physician retired, Snider said.
“I had a lady who her primary care doctor died unexpectedly, and then she went to see a new primary care doctor,” she said. “But the appointment was six months away, and she took three different blood pressure and cholesterol pills and had nowhere else to get that refilled. So she came to the emergency department.”
Snider said the overuse of ER for primary care needs isn’t because primary providers aren’t trying to see patients. The problem arises when patients don’t have a regular primary care doctor or those with complex medical problems need more frequent checkups.
“I mean, we used to see 75 patients a day in a row, and now we see 96 to 100 patients a day,” Snider said.
Dignity Health expanded Arroyo Grande’s emergency department space in 2021 due to rising need in the community. The original department, built in 1990 to serve 15,000 patients annually, had seen up to 27,000 emergency room visits per year in the outdated facility, according to a news release from the health care company.
Snider said patients’ inability to access primary care doctors directly affects the ER’s ability to take care of other emergently ill people. The ER doesn’t normally have access to a patient’s full medical history, which can also dampen the quality of care the ER is able to deliver.
Those problems extend to urgent care facilities as well.
Snider said she knew of one patient who went to urgent care while on various medications for diabetes. He didn’t disclose he was a new diabetic. He was put on oral medications for something that should have been treated with insulin and ended up being hospitalized.
“This happens a lot, and it’s not because the urgent care (workers) are not qualified to be in urgent care,” Snider said. “It’s because they’re being asked to be everything, just like we are.”
‘The primary care doctor is really like the team captain’
The Tribune also spoke with two Adventist Health emergency care providers, who weighed in on how emergency use has changed over time.
Dr. Cinnamon Redd is in her 20th year of practicing emergency medicine in San Luis, Obispo County. She has been at what are now Adventist Health hospitals her entire career and currently serves as the chair of Adventist Health Twin Cities Emergency Department and vice chief of staff of the hospital.
Redd said over the years, ER use has branched out to serve not just emergency needs but also social and psychiatric needs.
“We’ve definitely seen more primary care coming into the emergency room,” Redd said. “We’ve seen a lot more psychiatric emergencies coming into the ER, a lot more social issues like homelessness or people unable to care for themselves due to great disability coming into the ER, addiction problems — those have all increased.”
Redd said the ER has become more of a safety net for addressing issues like homelessness or addiction.
But in other cases, the ER fills a primary care gap.
Redd added that medicine is a team sport that starts with the primary care provider.
“The primary care doctor is really like the team captain to help navigate their patient through the different specialists they might need,” Redd said. “And when you work somewhere (where) you don’t have a cardiologist or a pulmonologist to refer them to, and you have to refer them out of county, you get really disjointed care.”
Samantha Sams, 39, has practiced as an emergency room nurse for 24 years. A native of San Luis Obispo County, Sams worked in a Monterey County hospital from 2008 to 2015, when she started working at Twin Cities.
No day is a slow day for Sams. A day before speaking with The Tribune, Sams said the ER had a patient in respiratory distress who would have died if she hadn’t made it to the hospital when she did.
When The Tribune asked Sams if she felt primary care needs were being met in San Luis Obispo County, Sams said, “absolutely not.”
“Primary care is the absolute backbone of medicine,” Sams said. “You can have 1,000 specialists, but you need a person overseeing the management of various specialists, and someone who’s looking at the patient holistically.”
Sams said blood pressure or diabetes medication management, for instance, belong in the wheelhouse of primary care but can often end up in the emergency room.
“A lot of times, patients just look at me and laugh, because they’re like, ‘I called my doctor about this and they said it’d be four months,’” she said.
Patients come to urgent care with long-term care and chronic needs
Brian Roberts, the owner of Med Stop Urgent Care Center in San Luis Obispo’s Madonna Plaza, said the lack of access to timely primary care service is at a critical stage.
“It is getting worse, and I’m unaware of any viable fix on the horizon,” Roberts said. “We’re in a difficult situation.”
Though it’s hard to track how urgent care use has changed over time, Roberts said the number of urgent care facilities has increased in the last few years.
In San Luis Obispo County, there are at least nine urgent care facilities, either operated by hospital affiliates like Dignity Health or companies like Carbon Health and Med Stop, Roberts said.
Though urgent care clinics don’t offer expertise in medical management of chronic disease like diabetes or heart problems, they can address challenges like congestion, new rashes or unfamiliar pain — some of the “missing services” brought on by healthcare shortages, said Roberts.
The problem is, many patients come in with health issues that need more acute, long-term care.
Roberts said most of the time when people come in with chronic diseases, they have an acute exacerbation of some part of their illness, like extremely high blood sugar.
“They have a worsening of a baseline problem, and we’re happy to be part of that care process, if that fits within our expertise,” he said.
Roberts told The Tribune that it’s not that urgent care clinics don’t care for chronic diseases, but more that they aren’t equipped to provide long-term care management.
Roberts said Med Stop providers have seen how primary care doctors have grown more inaccessible to patients. Med Stop will even call primary care facilities to know which are still in business and who is no longer practicing.
“Every few months, we recall them to make sure, ‘Have you hired somebody new? Are you still doing this? Are you taking these insurances?’” he said.
Dr. Julie Fallon, who works in family medicine at her private practice in Templeton and who spoke with The Tribune about having to close her practice to new patients to accommodate existing ones, said it doesn’t make sense for the ER to bear the burden of non-urgent medical conditions.
“ER doctors do not have time for that, but unfortunately, people who don’t have primary care doctors are going to the ER because they have no one to take care of themselves,” Fallon said. “It’s a sad thing, but that’s not what the ER doctors were really meant to be doing.”
In Part 4, The Tribune looks at how some local primary care doctors are turning to membership models and concierge care.
This story was originally published February 10, 2025 at 5:00 AM.
