Fewer people pursuing a career in primary care and an aging population — both in terms of the people needing health care and those working in health care — are to blame for a shortage of primary-care physicians nationwide and in the Midcoast.

"It's a perfect storm sort of situation that we are trying to address," said Erik Frederick, chief operating officer at Pen Bay Healthcare.

Laurie Doran, 54, of Camden, found herself looking for a new family doctor after her physician of 30-plus years, Dr. McKim Peterson, retired in September. She quickly learned it was not as simple as making a phone call or logging onto the Find a Doctor page on the Pen Bay Healthcare website.

Prior to retirement, Peterson practiced out of Midcoast Medicine in Rockport. When Doran received a letter from Midcoast Medicine asking patients to submit paperwork to transfer their files to the practice's new Camden office, Doran assumed this meant she was still a patient with Midcoast Medicine.

It was not until she tried to make an appointment that she discovered the practice was not absorbing all of Dr. Peterson's patients.

"I'm thinking they've got my forms, they've got my files, I should be all set, but that is when the nightmare began," Doran said.

Doran, who is retired, spent almost three days calling various doctors she found on the Find a Doctor page on the Pen Bay website. She called nearly 50 doctors and very few were accepting new patients — some had waiting lists in the hundreds and others could not take on any new patients until at least March 2016.

Doran's situation is not unusual, according to Frederick. "We definitely hear it all the time [and] in all settings. Not a day goes by that one of us does not hear from a consumer; an employee will hear it at the supermarket," said Frederick.

Maine has the highest median age, 42.7, of any state and Knox County has the third-highest population (22.4 percent) of residents above the age of 65, behind Lincoln (25.3 percent) and Piscataquis (23.6 percent) counties, according to the latest data from the U.S. Census.

With the aging of the baby-boom generation, there has been a surge of people accessing the health-care system. At the same time, nationwide, fewer doctors are pursuing primary care as a career, choosing instead to go into more specialized fields, Frederick said.

"Because of this, what happens nationally, locally, and in the state is that everyone wants these physicians, so the competition is fierce," Frederick said.

Concurrently, the few practicing primary-care physicians available are seeing their patient population grow significantly. Frederick said doctors have what he called a “panel,” which is the largest number of patients a medical provider can be accountable for and still ensure good care in a timely way. When the panels grow, there is less time with patients, Frederick said.

And, as Doran discovered, one way providers control the size of their panels is to stop accepting new patients.

Doran said she found one doctor taking patients, but not until May. Another practice told her to fill out some paperwork and they would interview people early next year to decide which patients they would accept. "So now I have to audition?" she said.

Since she is on management medications that must be taken daily, she could not wait that long to be seen.

In frustration, Doran took to social media to vent about her situation. She found she was not alone. In just a few hours, more than 50 people had sent her private messages and another 28 people had openly commented on her post, many with similar stories.

After seeing her Facebook post, a representative from Pen Bay contacted her, attempting to help, but later called back and said she also could not find her a doctor, she said.

"Imagine if you didn't have a computer or if you were elderly [trying to find a doctor]," Doran said. "Imagine, imagine, imagine."

Frederick said Pen Bay has seen a few people come into the emergency room who lost their primary care provider and have run out of their medications. During the summer, the Pen Bay Medical Center emergency room saw an increase in visits, but so far projected visits versus actual visits for the entire year are not far off from what was anticipated, he said.

"I absolutely understand the fear … we are working on this very situation," he said, noting hospital management has been meeting with the ER director to discuss the problem.

At Pen Bay Healthcare, officials have been using physician assistants and nurse practitioners in place of traditional family doctors. However, since there is a nationwide trend toward the use of PAs and NPs, the competition for them is also very high.

"Although that is becoming a more popular model and people are beginning to pursue those options, everyone wants them because it is another option," he said. "It's driving competition, but it's also driving cost."

Pen Bay is also pursuing locum tenens, or temporary, physicians that serve a three- to six-month stint.

"They can be very helpful, but in primary care it's not the most ideal situation because you're not really building that relationship you expect with your primary-care provider," he said.

Frederick said locum tenens physicians also are in high demand and Maine currently has 11 requests out for temporary internal medicine doctors.

Since 2014, Pen Bay Healthcare has experienced changes in several of its practices, which has further compounded the situation, he said. In some offices, doctors have left unexpectedly and left patients without physicians.

At Pen Bay Internal Medicine, Dr. Archibald Green left in 2014 and staff shuffled to figure out how to absorb his patients while Pen Bay Healthcare began the recruitment process. Then, this summer, Dr. Denise Anderson made the decision to leave the same office and move into hospitalist services.

Frederick noted Anderson is a great doctor and the hospital is very grateful she made the switch because it was a needed service, but it left a hole of two physicians in one office. Dr. Lori Tobler was then recruited to take on some of those patients, but she also decided to leave. Nov. 20 was her last day.

On the family medicine side, Peterson closed his practice in September and Dr. Brian Pierce, who also worked at Midcoast Medicine, also left to open his own cash-only practice.

"The other reality is, in our region and many others, we have a number of our primary-care providers looking at retirement," Frederick said. In September, Drs. Ted Mohlie and Jack Waterman, who work at Waldoboro Family Medicine, started scaling back and decreasing their patient loads so they can eventually retire.

"So it's kind of coming from all angles,” Frederick said. “It's internal and some of the things we are doing, it's external practice environment and what people are doing out there. It's folks just saying, 'hey, it's time to retire.' It's the diminishing pool of resources," he said.

Pen Bay Healthcare is actively recruiting for internal medicine and family medicine physicians, and family and adult nurse practitioners, he said.

The organization also is looking at establishing a clinic in Rockland, with the former MacDougal School lot on Broadway and a site on Tillson Avenue as possible locations. The idea is for a clinic that would include pediatric and general practice doctors' offices, as well as a dental care office.

Frederick acknowledged it is often challenging to find a building suitable for health care because there are a lot of regulatory requirements related to things like the level of air conditioning and fire safety. Often there is so much work to be done to an existing building, he said, that the work exceeds the value of the building and constructing a new building is more affordable.

Pen Bay Healthcare is also trying to help its current staff of medical providers. One initiative is consolidating the various practices scattered around Rockport into a new primary services building on the Pen Bay Medical Center campus. “The vision is to better support staff by being co-located, getting some efficiencies by being in one place, which would give employees better work flow," Frederick said.

Frederick said the hospital is in the design phase and also looking at funding options for the new building.

Doran was eventually able to find a spot at Seaport Community Health Center in Belfast, but cannot be seen until January.

"I did find someone. I do have to drive and I do have to wait eight weeks. That's the best I can do," she said. "I think what is most disheartening is, I've lived here 54 years, four generations, and never left town and I can't find a doc?"

Courier Publications Editor Kim Lincoln can be reached at 236-8511 or by email at klincoln@villagesoup.com.