If you're going to the doctor's office, you can almost always expect a long wait -- and that time in the waiting room is about to get longer.
The nation is expected to see a shortage of about 120,000 doctors in the next decade, with primary care physicians in extremely short supply. That healthcare crisis is especially severe in parts of the Coachella Valley.
For Louise Nussbaum, a baby boomer battling cancer, the difficulty was apparent during her diagnosis.
"There were 49 tumors," said Louise Nussbaum, who needed a neck specialist but could not find one in the desert area. "It's very frustrating. It's terrifying."
Nussbaum eventually had to go to Loma Linda University Hospital, which translated to a grueling two-hour drive for each checkup.
Her experience isn't uncommon; our dry valley is a healthcare desert.
"Coachella Valley is particularly hard pressed," said Dr. John Stansell, the director of medical education at Eisenhower Health. "The average number of patients per physician should be 1500 to 2000. Okay, literally within one mile of here, it's a one to 6000 7000."
California is facing a massive doctor shortage and, according to state officials' latest report from the California Future Health Workforce Commission, it's about to get worse in the next decade.
More than a third of the state's doctors and nurse practitioners are reaching retirement age.
With an aging baby boomer population living longer than ever — and battling all the health problems that come with it — there aren't enough physicians to go around.
And becoming a doctor in the first place isn't that easy.
The potentially staggering debt is enough to turn off even the brightest from the profession. Medical school loans can be astoundingly high.
The average cost of private medical school tuition is about $246,000, according to the Association of American Medical Colleges (AAMC). Loans may also include cost of living while the student completes the four years of medical school. For California, the average cost of living is $52,000 per year, according to USA Today and 24/7 Wall Street, resulting in around $454,000 of debt already.
And it can be tough to make a dent on those loans out of medical school. After graduation, new doctors have to do a three to four-year medical residency, making a yearly average of about $56,000, according to AAMC. During that time, doctors-in-training can pay as high as 8 percent interest each year on the loan. In this case, if the student chooses to pay off the interest each year, that leaves just $20,000 before taxes to live on during residency.
The deep debt from medical school might explain why we have such a shortage of primary care doctors, who receive one of the lowest-paying salaries in medicine. Many choose to go into specialties, like gastroenterology or surgery, which have higher salaries.
On top of that, there aren't enough medical schools and residency spots producing doctors to keep up with our exploding population. Each year, thousands of successful medical school graduates can't find residency spots. For the 2018 year, per the National Resident Matching Program, around 37,000 applicants applied for about 33,000 residency positions.
New doctors can also face burnout from working such brutal hours. Physicians, according to Medscape, have the highest suicide rate of any profession.
"The hours are long, very intense," said Dr. Adam Roberts, a resident physician at Eisenhower Health. "It's very competitive. In order to get through it, you really have to have a sense of compassion that wakes you up everyday and doesn't prevent you from burning out."
Then there's attracting young doctors to come to the Coachella Valley, which is known for being a retirement community. It doesn't make for the best dating scene.
"Young physicians are particularly problematic because this is not Los Angeles," Stansell said.
"Women doctors that I had said there's no lifestyle for them here," Nussbaum said.
It's a hard problem with no easy fix, but Eisenhower Health is doing its part to help, by starting a huge residency program, with UC Riverside's medical school, hoping new doctors will train here, love the desert, and stay.
"It's a passion that you have to follow. Medicine is not something that you just decide on the spur of the moment that you stick your finger in and see and judge the temperature," said Stansell. "Really, it is almost always a lifelong desire to pursue the care of people."
The medical education system and resulting debt is only one facet of a very complex healthcare issue.
Rural areas have always had a tougher time convincing doctors to set up shop.
Healthcare reimbursement by Medicare pays more to doctors living in more populated cities.
Separately, nurse practitioners have argued to work independently of doctors to fill the need, a proposal that's seen as a controversial.
The California Future Health Workforce Commission, a state task force, has recommended a $3-billion plan to address the state's doctor shortage.