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Primary Care Physicians - A Medical Emergency

New America Media, News Report, Viji Sundaram Posted: May 18, 2009

Editors Note: An aging population and a state in financial crisis are aggravating a severe shortage of primary care physicians and medical technologists. As more doctors seek to become specialists to pay off medical school debts and the government cuts health and human services programs the shortages are becoming more difficult to fill. NAM Health editor Viji Sundaram reports.

BERKELEY, Calif. Marty Lynch has been trying unsuccessfully to hire primary care physicians and nurses to his clinic to linguistically and culturally match his patient population, who are primarily Latino and African American.

It doesnt matter which ethnicity you are looking for but its very difficult to find primary care providers, said Lynch, executive director of LifeLong Medical Care, a not-for-profit primary health care facility that operates nine health centers in Berkeley, Oakland and Marin County.

Primary care providers, in short supply nationwide, are the main source of health care for most Americans.

Why the shortage?

Students graduating from medical school typically owe about $140,000 in loans. They are looking to quickly pay off their debt.

The pay differentials between primary care physicians and specialty care physicians is wide, noted Dr. Mark Doescher of the University of Washington School of Medicine, at a recent Association for Health Care Journalists conference in Seattle.

How wide? In specialty care, physicians can make two to three times as much as primary care physicians, said Serena Kirk, senior policy advocate of the California Primary Care Association (CPCA), a membership organization of over 700 not-for-profit community clinics and health centers in the state.

Historically, reimbursement rates for procedures performed by specialists have increased, while reimbursement rates for primary care physicians have not even kept up with inflation.

According to a new survey of community clinics, there is not only a shortage of primary care physicians in community clinics, many vacancies in the allied health care sector -- which represents over 200 types of positions -- are becoming increasingly difficult to fill. Allied health professionals are health care practitioners like medical technicians with formal education and clinical training who are credentialed through certification, registration and/or licensure.

Community clinics represent the front lines of our health care system, observed Carmela Castellano-Garcia, president and chief executive officer of CPCA. The economic situation is putting a further strain on our collective safety net.

The survey, conducted online by Goodwin Simon Victoria Research, focused on 108 community clinics, between Nov. 25 and Dec. 8, 2008. It was funded by a grant to Fenton Communication from The California Wellness Foundation.

According to the most recent employment numbers available from the California Labor Market Information Division and the Federal Bureau of Labor Statistics, California, for example, only has 73 percent of the pharmacists of the national average per 100,000 people.

At LifeLong, which serves around 20,000 patients a year, 40 percent of them being either uninsured or underinsured, Marty Lynch said he is also experiencing difficulty in finding nurses and social workers to fill vacancies.

Unless drastic steps are taken to find a solution, the situation is only going to worsen in the years ahead, say health care providers. In 2030, it is projected that there will be around 70 million people over the age of 65 nationwide.

Their demand for health care services is going to go up, said Jane Garcia, chief executive officer of La Clinica de la Raza, which for 38 years has been dispensing health and dental care to the largely uninsured population in the Bay Area through its 27 satellite clinics.

Concerned that the aging population will put more strain on an already economically beleaguered health care industry, the Obama administration is looking for ways to increase primary care physicians and other health care providers.

Federal officials are considering a plethora of proposals, including one that would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants.

Susan Chapman of the Center for the Health Professions at UC San Francisco said allied health workers will become even more crucial as the states population ages.

"You can't run a hospital or a clinic without these positions," she is quoted as saying. "Not having enough people to fill these jobs compromises our overall ability to maintain the system in California."

In California, there will be more than one million people over the age of 85 by 2030, according to the U.S. Census. And with more and more health care workers retiring, the California Labor and Workforce Development Agency believes there is a need to educate over 206,000 additional health care professionals by 2014.

The scarcity of workers is driving community clinics to find innovative ways to find solutions. Some are striking partnerships with their neighbors. La Clinica de la Raza, for instance, is partnering with neighboring community colleges to train medical assistants, with the colleges providing the teachers and education materials and la Raza providing clinical training sites.

Were training our own community members, Garcia said of the project the clinic started two years ago.

On May 14, California Governor Schwarzenegger presented a budget plan that would direct the state to seek a federal waiver to permit $750 million in cuts to Medi-Cal, Californias Medicaid program. The waiver is needed to avoid violating provisions of the federal economic stimulus package that would make the state ineligible for some funds.

Other programs that would be affected under the governors budget plan include cutting Medi-Cal reimbursements to private hospitals by 10 percent.

The cuts are meant to help the state deal with a $15.4 billion budget deficit that is likely to occur if voters approve some of the propositions in the May 19 special election.

If voters reject those propositions, the governor outlined $800 million in cuts to health and human services programs, including one that will eliminate Healthy Families coverage for some 225,000 children. Healthy Families is Californias version of the federal Childrens Health Insurance Program.

Garcia said that bad though the recession is, there is a silver lining in it. Health care is one of the few sectors that more people will be choosing careers in, she said.

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