In California, the wave of unemployed and uninsured is breaking on hospital emergency rooms, over-taxing staff and resources, and putting a dangerous load on hospital finances. The overload situation is having increasing impact on seniors.
But Musielewicz, the emergency department's medical director, doesn't mean that in a bad way. In fact, he's angry about the rising numbers of Medicare patients who are forced to rely on the ER or urgent care clinics to treat common problems that should be monitored by a primary care physician.
"One is too many if there is even one senior citizen who doesn't have access to a primary care physician," said Musielewicz, who has worked at Dominican for 10 years.
The problem: Fewer primary care doctors are opening practices in Santa Cruz County because of low reimbursement rates compared to counties over the hill. Those who have patient openings are likely to accept the privately insured over retirees bearing Medicare cards. Even seniors who have regular doctors sometimes are forced to wait weeks to get in.
Given all this, "We're the safety net for everyone," Musielewicz said.
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At San Joaquin General's emergency room, Dr. Richard Buys has seen a marked increase in volume, while at the same time, hospital admissions from the ER have been flat.
That tells him that people who normally would have gone elsewhere for care, such as a physician's office or same-day clinic, are seeking out the ER because it does not require payment upfront.
"On a personal note, I've noticed more often that when I ask a patient if they need a note for school or work, the answer used to be 'yes' or 'no.' Now it's, 'I just lost my job.' The number of times I used to hear that was virtually nil. It puts a more human touch on what is going on, and they don't say it with a smile," Buys said.
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Urgent care clinics also see a wave of seniors who can't get into their doctor or can't find one. The Santa Cruz Medical Foundation, which is part of the nonprofit Sutter Health network, has a freeze on all new Medicare patients who are not part of an HMO network, but will continue to see seniors in its urgent care areas.
Dr. Lawrence deGhetaldi, the foundation president, said urgent care doctors in his six clinics are seeing older patients for high blood pressure, diabetes and medication refills. But when the seniors seek ongoing general care, they are shut out because the clinic's primary care doctors are at capacity for Medicare patients.
And that is a shame, Musielewicz said.
"Our health care system is breaking," Musielewicz said. "The fact that the elderly have difficulty finding primary care is something the community, the county, the state and the nation have to work on as a whole."