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California Builds Clinics Under Federal Health Law, But Hiring Doctors May Be A Challenge

Apr 22, 2013

Clinica Sierra Vista in Arvin, CA - (file photo)
Credit Joe Moore / Valley Public Radio

Starting next year, millions of people will gain new health coverage under the federal health law.  In California, dozens of clinics are gearing up for the expansion, with new funding to build clinics and expand old ones.  But as Pauline Bartolone reports from Sacramento, it may be a challenge to find the physicians to staff the new centers.

Just north of downtown Woodland, the Peterson clinic runs out of what used to be a one-story county hospital, built after world war two.  Low income and uninsured people come here for health care. But not for much longer. The county wants to demolish the building. And that’s just fine for Communicare CEO Robin Affrime.

"It would be so expensive to make it work, the way that we would like to present a community health center. We’ve been growing a lot over the last number of years, and we also expect a surge in the number of patients that are eligible for health coverage. So we, we need to be ready,” says Affrime.

Affrime says they expect a 25% increase in patients at their Woodland site starting next year under the Affordable Care Act. So she’s been working on a grand plan for a facility to serve them.

Communicare recently broke ground on the construction of a brand new clinic. It’s right across the street from Peterson. Affrime is standing on the sidewalk, looking at tractors moving around dirt and debris on an empty plot of land. 

 “The first time I came on the site, the sound of the tractor was like music to my ears,” says Affrime.

More than half the money for the new clinic comes from a 5 million dollar federal grant made available through the federal health law. 

"A year from now, this site’s going to have a beautiful new, 21,000 square foot building," says Affrime.

The new clinic will not just be bigger – it will have a different model of care. Affrime says it will be like ‘one-stop shopping.’ Many services – dental, medical, substance abuse treatment – all in one building.  This idea - of a “patient-centered medical home”- is being advanced under the Obama administration. Dylan Roby with the UCLA Center for Health Policy Research says it’s part of a push to improve the quality and efficiency of care.

"Health information technology, developing these team based approaches to care, getting more national health service corp slots, so you can meet the primary care needs of the population.  So there’s a little more funding designed to enhance the health centers we already have," says Roby.

Nationwide, the Affordable Care Act allots eleven billion dollars to expand or build new health centers to serve the nation’s poor.  Roby says these centers help reduce health costs in other areas of the health system.

"So investing $1 in a federal qualified health center might end of saving you $2 or $3 in Medicaid claims and in-patient and ER visits because they’re allowing patients to avoid those high dollar more significant acute care," says Roby.

Community clinic advocates are thrilled by the federal investment. But there’s a problem. 

"California has a very significant workforce crisis and this challenge is only going to be augmented by healthcare reform," says Carmela Castellano-Garcia, who directs the California Primary Care Association. 

She says a limited supply of family physicians in the state already has community clinics struggling to get the doctors they need. Soon, the problem will get worse.

"Community health centers are really feeling this in they are having challenges with recruiting physicians; they are having challenges with retaining physicians as there’s increased competition now because everybody’s trying to expand and gear up for healthcare reform. Not just the community health centers, but the entire healthcare industry is facing the impact of this crisis,"  says Castellano-Garcia.

The Affordable Care Act does offer financial incentives to primary care doctors who work in underserved areas. Some may want the stability of a clinic setting as opposed to starting their own private practice. But either way, Castellano-Garcia does expect a bumpy start next year.

"In Massachusetts when the healthcare reform happened, quite frankly the community health centers were overwhelmed. There was a tremendous demand on them. I actually believe that the community health centers will be quite popular in 2014 as well, and that we will probably be struggling to keep up with the demand," says Castellano-Garcia.

The federal government says half a million more Californians will be served in the new or expanded clinics. How many physicians will be working in them remains to be seen.