This is Albuquerque, which is a three hour drive. There used to be a couple of these specialists in a closer, smaller city, just two hours away. They have all gone. Along with more than half of the rural general practitioners in the surrounding 100 miles. One closed his practice entirely after completely failing to find a replacement. I recently went to an appointment with a specialist in Albuquerque that took me six months to get ... and spoke only with a nurse. No doctors are available even after that long. This was after six months of waiting while in pain and bleeding out of my ass daily.

Shortly before Obamacare I went to the same variety of specialist in that closer city. I called on a Monday and was in to see him on Thursday morning. Now, the three closest clinics to me have no doctors at all between them, just nurse practitioners and physician assistants. If your condition isn't on their short script you get an appointment in six months with a different nurse, or directions to the emergency room. I'm not claiming this is the general experience, but my experience has vastly enshittified.

The specialist nurse that took me six months to see? He ordered a test and scheduled me to come back and discuss it with him in another six months. Maybe I'll get another five minutes of his time then.