Forty percent of the primary care providers in the Glens Falls Hospital network have left this year, and they have not been replaced.
The departures have delayed appointments to the point where some of the remaining providers are now booking for November.
One patient had to take her granddaughter to urgent care for an ear infection, during normal office hours, because her pediatrician was too busy to see her. Urgent care is much more expensive for patients than a regular sick visit.
She has also had to switch doctors three times this year, as each provider decided to leave the hospital’s primary care system.
“I don’t think the hospital realizes. Here you’re losing all these people, causing so much anxiety,” said patient Natalie Fido-Kennedy of Salem. “My doctor restored my faith in the medical profession. She listened. She cared. It’s hard finding someone like that, and someone your kids like and trust.”
The hospital lost $38 million in 2017 when a new billing system did not function. As the problem persisted through much of 2018, hospital officials cut positions, services and reduced some salaries in an effort to get into the black. The losses had a delayed effect on providers, since it often takes months to collect from insurance.
Providers and patients contacted The Post-Star to report on the departures. Providers would not agree to speak on the record, out of fear they would hurt future employment prospects if they were seen criticizing an employer.
But they are speaking with their feet. In the last six months, 16 of the hospital’s 40 primary care providers — doctors, physician assistants and nurse practitioners — have left or turned in their resignation letter. Most have gone to similar primary care systems run by hospitals, including the Ellis, Saratoga and Southwestern Vermont systems.
The 24 providers that remain must cover the Glens Falls Hospital primary care system’s entire caseload.
Several providers are now working at two or more locations, and most locations have far fewer providers than last year.
The Glens Falls primary care center on Broad Street had four providers. Now it’s down to one physician, who also works at the Hudson Falls office. He’s so busy that patients with a non-urgent issue have to wait six weeks for an appointment.
The Wilton primary care office run by Glens Falls Hospital lost all of its providers, so two from Broad Street were relocated there.
Likewise, Whitehall lost two of its five providers, Granville lost three of its seven providers, and Cambridge primary care lost two of its seven providers.
Most of the providers leaving are physician assistants or nurse practitioners, but six physicians also left or are leaving.
Lack of information
As providers leave, patients might as well. They have choices in the area: Hudson Headwaters Health Network operates a growing system of primary care offices, and so does Saratoga Hospital.
Most patients have been sent letters, telling them that their provider left, or that their provider was moved to another location. Many have been told that they must switch to another location as well. Some patients a reporter encountered at primary care offices were taken aback to learn from the reporter that their provider had left.
Getting a new primary care provider has caused them difficulties — they must have one to approve refills of regular prescriptions, for example. One patient needed to meet with her doctor to get pre-op approval for cataract surgery, but her new primary could not see her until the end of July. Eventually, she was able to see another provider, at a different office, for the approval.
In February, when hospital CEO Dianne Shugrue said the hospital was in the red, she also said it might be time to get out of the business of primary care. No hospital official has confirmed that is occurring now, although the hospital is not advertising to replace any of the departing providers.
The Post-Star emailed Vice President of Planning Tracy Mills with a list of providers who had left, as reported by providers and patients. She declined to comment on the list, so a reporter called every primary care office in the hospital’s system and asked to make an appointment with the providers listed on the hospital’s website. Office workers responded by explaining which providers had left or were leaving and which were still available for appointments, as well as how long the wait would be for an appointment.
None of that information was communicated through hospital press releases or its website.
The shrinking of the system, intentional or not, is causing major problems, according to doctors and patients.
Patients complain about long waits to get an appointment and providers say they have to rush from patient to patient. One provider said he has submitted his resignation, because so many others had left without being replaced.
“With the attrition of both providers and ancillary staff, the burden on those remaining is unhealthy,” he said, speaking on the condition of anonymity because he still works for the hospital. “I stayed because these are my friends, neighbors and community that I provide care for.
“Unfortunately, there is no aspect of the system that is not ‘broken,’ with no answer for a fix ... I still see these people daily, and I feel like I’m abandoning them. I will always be concerned for their well-being. For now, I have to take care of myself,” he said.
Hospital officials would not admit the primary care system had gotten smaller.
“If there are changes in physicians or locations for services, that information will be communicated to patients and the community in a timely manner,” Mills said in an email on May 14.
While primary care providers have left, the hospital has added providers in other specialties.
“Since 2018, 38 new providers — physicians and physician assistants — have joined our team,” Mills said in an email on May 15. She did not respond to two further emails and refused to speak by phone.
Mills also said in her May 15 email that losing 40% of primary care providers this year was not unusual.
“There is nothing that indicates our staffing trends in the last year differ from years past or from the national average,” she said. “Those who have left our staff, much like any industry, have done so for a variety of reasons. We’re proud of the work done by all 2,700 of our employees, including the 180+ providers, who work together to provide the quality care that our patients deserve.”
Can’t phone it in
Mills did say, however, the hospital’s primary care may be changing.
“It’s no secret that health care is changing. Primary care is being delivered — and will continue to be delivered — in increasingly non-traditional settings. We will remain focused on identifying the very best ways to provide affordable primary and specialty care in locations that are convenient for our community,” she said.
The most common non-traditional setting for primary care is tele-medicine.
But for many issues, a doctor must physically examine a patient. Ear infections, for example, cannot be diagnosed by telephone, because the physician can’t see into the patient’s ear. Tele-medicine software will alert patients to that limitation before the call is placed, so they don’t have to pay for a useless call.
On those issues, patients who want to avoid the higher cost and wait time at an urgent care must see a primary care provider.
Fido-Kennedy’s family switched from their Wilton provider, who left, to two providers in Greenwich. Recently, she got a letter saying that one of those two — Frank Westad — was leaving, so her granddaughter will have to switch providers again. Of the medical center’s remaining four providers, one is there only two days a week and one is about to depart temporarily for maternity leave.
“They were overbooked before,” Fido-Kennedy said. “And now that Frank’s leaving, I can’t imagine the madhouse.”