Healthcare Access Crisis Deepens in San Diego as Wait Times Soar and Primary Care Becomes Scarce

San Diego residents face unprecedented delays for routine medical care as physician shortage reaches crisis levels

SAN DIEGO — What should be a routine medical appointment has become an exercise in patience and persistence for San Diego residents, as the region grapples with a severe primary care shortage that is forcing patients to wait weeks or months for basic healthcare services.

The crisis has reached alarming proportions: only 20% of San Diegans can see a doctor within two days, down from more than half a decade ago, according to data from the California Health Care Foundation analyzed by NBC San Diego in 2023. For many residents, securing a routine appointment now means waiting until mid-November for care they need today.

National Survey Reveals Mounting Crisis

The local shortage reflects a broader national emergency. A comprehensive 2025 survey by AMN Healthcare found that physician appointment wait times have surged 19% since 2022 and 48% since 2004, with patients now waiting an average of 31 days to see a doctor across 15 major metropolitan areas, including San Diego.

"Average physician appointment wait times are the longest they have been since we began conducting the survey in 2004," said Leah Grant, president of AMN Healthcare's Physician Solutions division.

The survey included data from 1,391 physician offices in cities with some of the highest per capita concentrations of doctors in the country, suggesting conditions may be even worse in underserved areas.

California's Statewide Shortage

The San Diego crisis is part of a statewide healthcare emergency. California faces a shortfall of approximately 4,700 primary care clinicians in 2025, with an estimated 7 million Californians living in provider shortage areas.

Many regions in California fall below the federally recommended threshold of 60 primary care doctors per 100,000 residents, with some neighborhoods having ratios half that number. In San Diego County, which now has over 3.3 million residents, the shortage has moved from anecdotal to well-documented.

Specialists Face Extended Delays

Specialty care faces even greater challenges. Dr. Paul Schalch Lepe, an ear, nose, and throat specialist with practices spread throughout San Diego County, reports wait times "upwards of four to six weeks" despite having a large practice network.

The AMN Healthcare survey revealed stark differences by specialty:

• Obstetrics/gynecology appointments now take an average of 42 days, up 33% since 2022
• Gastroenterology appointments require 40 days on average
• San Diego had the longest orthopedic surgery wait times among surveyed cities at 55 days in 2022

Emergency Rooms Bear the Burden

As primary care becomes increasingly inaccessible, emergency departments are absorbing much of the overflow. California emergency department visits grew by 23% between 2011 and 2021, while the number of emergency departments and hospital beds declined.

California emergency rooms have seen a 17% increase in non-emergency visits in the last three years, many driven by gaps in access to primary care. This trend places additional strain on an already overwhelmed healthcare system and drives up costs across the board.

Pandemic Impact and Workforce Challenges

The COVID-19 pandemic significantly worsened existing shortages. Dr. David Bazzo, interim chair of family medicine at UC San Diego, noted that the pandemic made the ongoing doctor shortage much worse by burning out healthcare workers and causing some to leave the industry.

A survey by the Physicians Foundation estimated that 8% of all physician practices nationally—around 16,000—closed under pandemic stress, while 7% of primary care practices were unsure whether they could stay open past December 2020 without financial assistance.

Disparities in Access

The crisis disproportionately affects vulnerable populations. Latino, Black, and Native American populations make up the majority of residents in health professional shortage areas. Additionally, just over half as many doctors accept Medi-Cal as those who accept private insurance, creating additional barriers for low-income patients.

While 82% of physicians in 15 major urban markets accept Medicare, only 53% accept Medicaid, further limiting options for vulnerable patients.

The Primary Care vs. Specialist Imbalance

The healthcare workforce crisis extends beyond simple numbers to the fundamental structure of American medicine. In 2024, only 24.4% of US physicians are in primary care specialties of Family Practice, General Internal Medicine and Pediatrics, while 50% is considered the ideal ratio. This represents a dramatic shift from 1931, when 75.3% of American physicians were in primary care.

The ratio of primary care physicians to specialists in 2012 was 0.70 and had remained stable from 2002 to 2012, meaning specialists consistently outnumber primary care physicians. Of the 624,434 physicians in the United States who spend the majority of their time in direct patient care, slightly less than one-third are specialists in primary care.

The imbalance stems partly from economic factors. After World War II, surgical fees rose rapidly compared to the fees charged by generalists for office or home visits, creating financial incentives to specialize. Today, procedures performed by specialists are reimbursed at much higher rates than the "cognitive services" provided by primary care physicians.

Alternative Models: Direct Subscription Care

As traditional healthcare becomes increasingly inaccessible, San Diego residents are turning to alternative models that promise timely access to primary care. Direct Primary Care (DPC) and concierge medicine have emerged as subscription-based solutions that bypass traditional insurance hassles in favor of direct doctor-patient relationships.

DPC practices operate on a membership model where patients pay a flat monthly fee, typically ranging from $50 to $150, directly to their physician. In exchange, patients receive unlimited office visits, extended appointment times, same-day or next-day scheduling, and often 24/7 access to their doctor via phone, text, or email. Unlike traditional insurance-based care, DPC practices don't bill insurance companies, eliminating copays, deductibles, and administrative overhead.

Several San Diego area practices have adopted this model. Prospera Internal Medicine & Aesthetics offers DPC membership for $99 per month with a one-time $100 enrollment fee, promising "unlimited access to quality primary healthcare services for a predictable monthly fee." Dr. Deepti Mundkur's practice emphasizes personalized care where "all communication goes through her" rather than getting "lost in an endless labyrinth of inbox messages."

Concierge medicine represents a higher-tier subscription model, with UC San Diego Health and Scripps Health both offering membership-based programs. UC San Diego Health's concierge medicine program provides "24/7 access to doctors, same-day or next-day appointments, minimal wait times, and comprehensive wellness evaluations" for patients willing to pay an annual membership fee in addition to their regular insurance.

The appeal is clear: while the national average wait time for a primary care appointment has reached 31 days, DPC and concierge patients typically see their doctors within 24-48 hours. The model allows physicians to maintain smaller patient panels—averaging 400 patients for DPC practices compared to 3,500 for traditional primary care physicians—enabling longer appointments and more personalized care.

However, subscription-based care isn't without limitations. These models typically don't replace health insurance entirely, as they don't cover emergency care, hospitalizations, or specialist visits. Patients often need to maintain high-deductible health plans alongside their DPC memberships for comprehensive coverage. Additionally, the monthly fees can add up to $1,200-$1,800 annually for basic DPC membership, potentially creating a two-tiered healthcare system where timely access depends on ability to pay.

Despite these challenges, the DPC model has shown significant growth. According to the Direct Primary Care Coalition, more than 2,300 DPC practices now operate in 48 states, serving over 300,000 patients. The model has proven particularly attractive to employers seeking to control healthcare costs while providing better access for employees.

The Rise of "Doc in the Box" Clinics

To fill gaps left by the primary care shortage, retail health clinics—often colloquially called "doc in the box" clinics—have proliferated nationwide. CVS MinuteClinics, Walgreens VillageMD locations, and similar retail health centers promise convenient, accessible care for minor ailments and routine services.

CVS's MinuteClinics currently serve about 5 million patients, with data showing that about half do not have a primary care provider or have not seen one in years. The clinics are staffed primarily by nurse practitioners and physician assistants rather than physicians, and offer services to address wait times that can stretch from three months to a year for primary care appointments.

However, the retail clinic model has faced significant challenges. Walmart recently announced it would shutter its 51 in-store full-service healthcare centers, while Walgreens announced the closing of 160 VillageMD locations. According to Timothy Hoff, a Northeastern University expert on retail health clinics, primary care is "a very low margin business" with low reimbursements, making the retail model economically challenging.

Despite these setbacks, CVS is expanding its MinuteClinic model into comprehensive primary care services. CVS recently partnered with Mass General Brigham to provide in-network primary care at MinuteClinic locations in Massachusetts, representing what the company calls "a strategic evolution of MinuteClinic's care model — from episodic, urgent care to comprehensive longitudinal primary care".

Training New Providers

San Diego is taking steps to address the shortage through expanded training programs. Point Loma Nazarene University graduated its first class of 28 physician assistants in December 2023, representing a crucial step toward increasing the healthcare workforce.

Physician assistants, along with nurse practitioners, are seen as key to addressing increasing demand for healthcare that has led to long wait times and emergency department overflow. The American Association of Medical Colleges projects a shortage of between 21,400 and 55,200 primary care doctors by 2033.

The Human Cost

For patients, the shortage translates into delayed care, worsening conditions, and difficult choices. Many are forced to self-diagnose, delay care and ration their worry, telling themselves it's probably nothing and they'll seek care if symptoms worsen.

The situation has created what some residents describe as "civic gaslighting"—the assumption that because San Diego appears prosperous and well-functioning on the surface, its healthcare infrastructure must be adequate as well.

Looking Forward

Healthcare experts warn that without significant intervention, the crisis will likely worsen as California's population continues to grow and age. AMN Healthcare attributes the physician shortage to population growth, an aging population and corresponding aging physician population, pervasive ill-health, limited physician training capacity, physician burnout, and physician maldistribution.

The convergence of these factors has created what healthcare leaders call a perfect storm: increasing demand meeting decreasing supply at a time when the healthcare system can least afford it.

As one San Diego resident recently wrote, describing the months-long wait for a routine appointment, "We deserve to stop treating health care like a scavenger hunt." For millions of Californians, that sentiment captures the frustration of a healthcare system under unprecedented strain.

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Sources

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