At Northeast Philly’s only city-run primary care clinic, patients wait up to a year to get an appointment

At Health Center 10, the only city-run primary care clinic in Northeast Philadelphia, people wait up to a year to get an appointment.

It’s easy to see why, stepping inside the unassuming office building on Cottman Avenue: Demand at this low-cost clinic is so high that every square foot has been optimized for space. Narrow hallways are lined with lockers and cubicles double as clinic rooms. Exam rooms are not much bigger than closets. The massive reception desk has nearly a dozen staffers answering constantly ringing phones.

Uninsured and underinsured people have few options to get primary care in the Northeast, where demand far outstrips the city’s capacity to deliver such care. Wait times for appointments at Health Center 10 are the longest in the city. The health department recently announced plans to open two new clinics in the neighborhood, but the first will not open until at least 2025.

“This health center is filled to the limit,” said Yelena Galkin, the city’s medical director of ambulatory health services. “There’s no corner where we can put additional staff to serve people. We do everything we can.”

Seeing a doctor regularly is crucial to preventing and treating health conditions that can spiral into serious chronic illnesses. But for people without insurance, or the “underinsured” who still have a hard time affording health care bills, primary care is often unaffordable or inaccessible. Health Center 10 and other city-run clinics, which accept patients regardless of their insurance status or ability to pay, aim to fill those gaps.

“It takes forever to get seen,” said Eliane Da Silva, 57, a North Philadelphia resident who doesn’t have health insurance, speaking in Portuguese through a health department translator.

Once after an appointment, she said, her doctor asked her to return two weeks later for follow-up care. But the earliest appointment Da Silva could get was months later.

Poverty rates have risen over the last 30 years in Northeast Philadelphia, home to about 425,000 people. In the Oxford Circle and Castor area, where Health Center 10 is located, the number of residents living in poverty jumped a staggering 352% between 1990 and 2017. The Northeast has some of the highest rates of uninsured patients in the city, said Cheryl Bettigole, the city’s health commissioner.

It’s also home to the highest concentration of people who immigrate to Philadelphia, said Bettigole, who ran Health Center 10 before she became the city’s top public health officer. By law, immigrants cannot quality for government-funded Medicaid health coverage for five years after they obtain a green card. Until then, many are unable to afford private insurance and rely on Health Center 10 for care.

“It’s an incredibly diverse, vibrant area of the city, but it doesn’t have health care access,” Bettigole said.

Patients at city-run health centers pay on a sliding scale if they don’t have insurance, which Bettigole said typically runs about $5 to $20 a visit. About 40% of Health Center 10′s patients are uninsured.

Besides primary care, the clinics offer dental care, pediatric primary care, women’s health care, vaccinations, and testing for sexually transmitted diseases, tuberculosis and other conditions. There is also a pharmacy on-site. The idea is to provide patients with a one-stop shop for primary care needs.

Typically, new patients are offered an appointment within nine months, Galkin said; returning patients usually get an appointment within six. The staff leaves some slots open for urgently needed care, but the high demand and staff shortages make it difficult to offer prompt service. Across the city-run clinic system, about 30% of staff positions are unfilled, said Chanel Conley-Bacon, Health Center 10′s director of operations.

Patients receiving care at Health Center 10 said they appreciate many of the services it provides. But because it’s in such high demand, they’re also forced to wait much longer for care than someone with private insurance might. And many patients here simply don’t have another option.

On a recent weekday afternoon, Tajkera Perdous sat in the waiting area at Health Center 10, helping her mother to an appointment. Formerly a patient there herself, she explained that she had liked the care that she personally received at the clinic, but opted to find a doctor elsewhere when she could.

“They don’t do anything on time — that’s the main issue,” said Perdous, 23, whose family is originally from Bangladesh but has lived in Parkwood for 10 years.

Recently, her brother-in-law, who is uninsured, moved to the city and tried to make an appointment. He was given a date a year away.

Across the room, a line of patients waited to see the in-house pharmacist. Downstairs, the pediatric waiting area was packed with parents and children. The clinic sees about 300 to 400 patients a day, and its regular patients speak 40 languages between them. Some translators work at the center, but other patients must call in to a telephone translating service during appointments.

Speaking in Portuguese through a translator, Da Silva spoke glowingly of her primary care physician at Health Center 10, but said she doesn’t always receive adequate or respectful care from other staff at the clinic. Because she is uninsured, she said cannot go elsewhere.

She recalled leaving in tears after a difficult appointment during which she felt belittled and mistreated by a doctor. But she wasn’t sure who to tell about the experience, and didn’t believe that she had any options to be treated elsewhere. (Asked about the episode, clinic directors said they are investigating and declined further comment. In a statement, health department spokesperson Jim Kyle said the department “takes these types of complaints very seriously, and strives to maintain a welcoming, safe environment for all patients.”)

In the pediatric unit, a young mother who also speaks Portuguese arrived with her son for his first appointment at the clinic. She had requested the appointment in October — seven months ago.

The woman had resigned herself to the long wait, she told health department translator Yorhanna Costa. “It’s a different country,” the patient said. “I figure it might just be like this here.”

Bettigole said that it’s crucial the city offer more primary care to its most vulnerable residents. A 12-year veteran of the city’s health centers, she recalls treating middle-aged patients whose life expectancies were “dramatically shortened” because they hadn’t been able to address health concerns early.

“If I had seen them at 30, we could have had them on medications that cost pennies per month,” she said. ”This is devastating to communities — and it’s completely preventable.”