California Faces Shortage of Primary Care Doctors

By Susan Valot

At a Los Angeles hotel meeting room dozens of medical students mill around booths set up by residency programs. They pick up literature and stop to ask questions.

It's the California Family Medicine Residency Fair, put on by the California Academy of Family Physicians. Its goal is to bring more general practice doctors into the fold. Dr. Jeff Luther runs the family medicine residency program at Long Beach Memorial Medical Center.

"There are benefits to living in California," Luther says. "That’s why so many people do it and a lot of people want to come to California for training. It can be harder to attract people to practice in ... the more developed parts of California, because it’s expensive to live there. And if you’re coming out of medical school with $200,000 in debt off the ground and then thinking about trying to buy a home and raise a family, that part of it can be a little more difficult."

In general, specialists make a lot more money than general practitioners. A study three years ago by the California HealthCare Foundation found that only 16 of California’s 58 counties had enough primary care physicians, based on standards by the American Medical Association. Areas like San Bernardino and Riverside counties and the San Joaquin Valley fared the worst.

UC Riverside next year plans to open California’s first new medical school in 40 years. That's a first step. Once medical school is completed, Dr. Luther says residency slots are key to keeping doctors in the state’s underserved areas.

"People often go to train in an area where they hope to settle eventually or where they have some ties to begin with. And when you’re finishing training, it’s very comfortable to stay where you trained. You know the community. .. And to pick up and leave where you trained and go to a new community, it’s a little scarier."

Callie Langton of the California Academy of Family Physicians says the state government limits the number of family medicine residency slots, which also contributes to the shortage of family docs.

"If you’re a new patient and you’re moving into the area," Langton says, "it’s really hard to find somebody. And that shortage is only expected to get worse as more and more people become insured under healthcare reform."

Tucked away in a corner of the residency fair, Dr. Robert Allen is trying to attract medical students to a new family medicine residency program in the Central Valley town of Visalia. He’s in charge of it at Kaweah Delta Healthcare District Hospital, in an area that until now has had no general practice residency program.

"We currently have an estimate of between 30 to 50 percent underserved in the area of primary care," Allen laments. "If you look at the number of docs that are going to retire, we could probably place the next ten years of graduates of our program. We think we’ve probably got positions for about 50 to 60 doctors in the area."

Dr. Raul Ayala chose to do his residency at UCSF Fresno. Ayala this year created a networking program to help doctors share resources in his underserved area. Ayala says President Obama’s healthcare plan is another step in the right direction, but it won’t work without enough primary care physicians.

"You have a great blueprint," Ayala says "but you also forget about, okay, do we have enough wood? Do we have enough nails? Do we have enough sheet rock? ... It's a great monument, but if you don’t have the raw material, then I’m sorry, you’re not going to be able to build something with a great foundation."

Some state lawmakers want to strengthen that foundation by expanding the roles of lower level healthcare providers, such as pharmacists and nurses. Democratic State Senator Ed Hernandez of LA's San Gabriel Valley also wants to reintroduce a bill that died during the last legislative session to increase the number of California’s residency slots.

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