Not long ago, a friend told me, “I switched insurance and can’t find a doctor who will take me.” Another said, “I left Kaiser after going on Medicare and now no one will see me.” These aren’t isolated complaints. They’ve become the new reality in Silicon Valley: It’s easier to buy a multimillion-dollar home than to find a new primary care doctor.

I saw this problem firsthand before I retired from full-time practice at the end of 2020. At my Palo Alto Medical Foundation clinic in Daly City, only two of us out of more than a dozen internists and family physicians had “open panels,” meaning we were allowed to accept new patients. Everyone else had closed their doors, maxed out with 1,200-1,500 patients each.

In my old solo practice, I never turned anyone away. If someone was sick, I squeezed them in. Same-day care built trust, spared ER visits, and kept people healthier. But that old model doesn’t exist anymore.

Now, most Bay Area primary care doctors are employees of giant health systems: Stanford, Sutter, and Kaiser. On paper, this should work: Doctors get a salary, fewer administrative headaches, flexible schedules, and no hospital rounds or midnight phone calls. But here’s the catch: Many work part-time, often by choice. Younger physicians, especially those balancing family responsibilities, understandably opt for lighter schedules. The result is fewer available clinic hours, longer waits, and fewer open panels.

I experienced this from the patient side when I tried to find my own doctor after retirement. I wanted to join Stanford’s network for access to their specialists. Despite searching for months, I couldn’t find a single open primary care physician anywhere on the Peninsula. My only option was a video visit with a brand new internist 30 miles away 6 weeks out. Recently, I tested access across major systems in Silicon Valley. The results were discouraging:

• Sutter/Palo Alto Medical Foundation: Four doctors in San Mateo and Santa Clara counties were taking new patients, with waits of 4-6 weeks.
• Stanford Primary Care: Zero availability on the Peninsula, even with a six-month search window.
• Kaiser Permanente: About a dozen doctors open to new patients, with waits up to 4 weeks.
• One Medical (Amazon-owned): Same-day visits were available, but unclear if doctors were accepting long-term patients.

That’s slim pickings for millions of residents.

Why is this happening in one of the richest regions on earth? Several reasons:

• Recruitment is tough. Housing costs are astronomical. Primary care salaries can’t keep pace. Kaiser has helped with home-loan forgiveness, but others haven’t.
• The workforce is aging. Many doctors have retired in the past decade. Too few young physicians are replacing them.
• Concierge medicine is growing. More mid-career doctors are switching to boutique practices with only a few hundred patients who pay $3,000-$20,000 a year. Everyone else is left scrambling.
• Substitutes fill the gap. Nurse practitioners and physician assistants now handle much of primary care. While they are capable providers, many patients still prefer a physician for complex care.
• Medical students aren’t choosing primary care. The field pays less, carries heavy workloads, and looks less appealing than specialties.

The irony is painful. Silicon Valley, home of cutting-edge medicine and unimaginable wealth, is experiencing the same doctor shortages long associated with rural America. Patients wait weeks for routine visits, rely on urgent care for acute needs, and struggle to build lasting relationships with a doctor who knows them.

Unless something changes (better incentives to recruit and retain physicians, creative housing solutions, or bold new care models) this shortage will only deepen. Concierge medicine will expand, part-time work will rise, and fewer new doctors will enter the field.

The Bay Area may lead the world in technology. But if we can’t guarantee something as basic as access to a primary care doctor, what does that say about our health care system?

George F. Smith is an internal medicine physician and author of Tales from the Trenches: A life in Primary Care.