Table 2

Sample Quotations by Primary Care Physicians in Underserved and Nonunderserved Settings

Theme and SubthemeSample Quotations
Physicians in Underserved SettingsPhysicians in Nonunderserved Settings
Changes to local and regional health care system capacity
  Inpatient care over capacity“Now everybody has to be transported who needs to be admitted, because we don’t have any inpatient facilities per se.”
  Emergency department overcrowding“…we don’t have emergency room, we only have the urgent care that is very limited.”“You’re seeing more uninsured patients that are affected…. They tend to be sicker because they’re not getting any care anywhere. You know, an emergency room is an emergency room.”
  Decreased access to specialists“And even though the hospital here is now called a multiambulatory care center, especially in pediatrics, some of the specialty services we were providing we’re not providing anymore, because they moved them out of the hospital.”
  Decreased access to elective surgery“I mean, even before closures, sometimes elective surgery, you’d have to wait a year before you had your surgery, so I don’t know that it’s worse than that now. I mean, that’s pretty bad.”“I said I didn’t have access of some specialty and somebody made the comment to me, well, you can just refer them over to UCLA. I though, what a naïve comment. Many of these people don’t have cars. They walked to the facility because that was their community backstop.”
Difficulty for patients in navigating system of care
  Greater delays in care“That’s because they’re coming to [clinic] into emergency care. They’re coming to us bleeding and they’re coming to us where they should actually be going 911 and going to actual emergency rooms but they prefer to come to us lots of times.““…waiting times, so people are getting put off longer and longer times before they actually get authorized for surgical care. They just wait longer and then they get sicker.”
  Poorer access and lower quality of care“The fact that [the hospital closed] is also going to affect in terms of whether these people get their care. I mean where are people going to go? So, it’s going to be these ‘safety-nets’ that actually take them. The problem is the safety-nets are bursting….”“What we have seen has been a sharp increase in our volume because with County services—not just hospitals, but County services in general being cut back—a lot of [patients] have a lot fewer resources…. And there’s fewer places for them to go.”
Workforce and training changes
  Loss of training sites and faculty“There’s no teaching. Recently they cut off even teaching to medical students.”“The residents are maybe a little bit busier because they’re taking a few more patients… the patients always present learning opportunities for the residents, so I don’t think that it’s a negative thing.”
  Workforce relocated“Then, when the hospital closed last summer, there was a huge exodus. Charles Drew University’s faculty, the practicing faculty completely disappeared…. I don’t think anybody appreciated… how valuable that medical staff was.”