State Loan Repayment Help Not Enough to Solve Doctor Shortage
California’s health care system is expected to face an influx of millions more patients as new insurance requirements start next year. But experts are worried that a limited number of doctors in the state will mean health care consumers will have an insurance card but no doctor to see them. Health Care Reporter Pauline Bartolone has more from Sacramento.
Dr. Glen Villanueva has known he wanted to be a doctor since he was five years old.
"A lot of children are afraid of going to the doctor. I looked forward to going to the doctor. I liked how clean the office was; I liked the lab coat," says Villanueva. "It just impressed me that it was a place where people got help when they were hurting."
Now, at 46 years old, Dr. Villanueva sees up to three dozen patients a day at a clinic in a rural area outside of Modesto.
His patients are poor. Many have chronic diseases, mental health problems or addictions. But Dr. Villanueva knew he wanted to serve the underserved.
"Being Filipino myself and being an immigrant myself, it seemed kind of a natural fit," says Villanueva. "There’s something to be said from a social justice standpoint to help take care of the folks that need the most amount of help."
California has a shortage of primary care doctors in many inner cities and rural areas. Dr. Villanueva knows that from experience.
"We have been attempting to recruit physicians for 2 ½ years and we have been unsuccessful and have made at least seven physician offers and we’ve been unsuccessful with all seven of them. And of the seven, five have stated our compensation is too low for the work that we do relative to what they can make elsewhere," says Villanueva.
The State of California tries to offset economic or other drawbacks of working in an underserved area by helping primary care doctors repay their loans. Every year, around 50 family doctors have part of their medical school debt paid off this way. Doctors get the financial benefit for a maximum of six years.
“We find that even 15 years after that physician has received a loan repayment, more than 50 percent have stayed in those areas,” says Lupe Alonzo-Diaz with the California Office of Statewide Health Planning and Development.
She's talking about one of two state loan repayment programs for family doctors. She says they have made it possible to recruit top medical students to take jobs in underserved areas. And the program tends to attract people who come from diverse backgrounds.
“It’s the concept of growing your own. It’s this idea that individuals that are coming from for example, a rural agrarian area are likely to understand what that population looks like in the same way that an individual from an inner city urban area understands that population, understands that community and is more likely to be better at understanding that community,” says Alonzo-Diaz.
Callie Langton with the California Academy of Family Physicians says some doctors would not make the choice without the loan repayment.
"I think there are a number of people that are on the fence, and the loan repayment programs as well as other incentives can help push people over the fence," says Langton.
But Langton would like to see more family doctors benefit from loan repayment. And that alone wouldn’t solve the problem. She says there are many reasons for the shortage of family doctors. Specialists make more money, medical schools don’t encourage general practice, and a cap on residencies has created a bottleneck. So Langton says creating more primary care will take a multi-faceted approach.
"Procedures are much more high-valued than counseling. Talking to somebody about their diabetes problem is much less profitable than a similar procedure down the road. And so until our reimbursement strategies focus on providing preventative care and incentivizing physicians to provide preventative care, we really are not going to have enough people to provide those services," says Langton.
Dr. Villanueva benefits from one of the state loan repayment programs, and says it provides huge relief. But that’s not why he practices outside Modesto.
“The loan repayment program will never help the graduating physician that wants to live on the coast. It will never help the one that wants to be in the big city. It won’t ever affect that, that demographic of physician. And to think otherwise, I think, is folly,” says Villanueva.
His patient load is full right now, and they’re still looking for two physicians. Next year, the patients with insurance cards under the new federal health law may be more than his clinic can handle.