A Clinical Trial To Lure Doctors Where They're Needed
Finding a place in the Chase Avenue Clinic in El Cajon to conduct interviews was a little tricky.
Doctors share offices the size of walk-in closets. The conference room doubles as a break room. The hallways are too narrow for a traditional camera tripod. And the waiting rooms are so small the clinic added a playground in the courtyard to shift some of the crowd outside.
I settled on a busy nurse's station for my interviews, conducted piecemeal between loudspeaker announcements, phone calls and relentless appointments.
The Family Health Centers of San Diego facility is clean and efficient, if not a bit scrappy. Government and Public Relations Director Jennette Shay prefers a different word.
"I think it's just a lot of chutzpah," Shay said of the private network of low-cost clinics. "That's sort of a characteristic of Family Health Centers, where we're just here to make it work. We're here to make sure our patients get access to care."
That chutzpah makes clinics like Family Health Centers a cornerstone of the Affordable Care Act, which will grow the ranks of insured patients by about 30 million nationally. They're good at doing a lot with little. The federal office that researches health care quality says community health centers like Chase Avenue deliver the same quality of care as hospital systems and private doctors' offices while spending about a third less.
What they're not so good at is attracting doctors. New doctors' elephant-sized medical school debt often forces them to shy away from primary care positions that pay less than specialty care positions. The federal government estimates the nation is short about 16,000 primary care physicians.
But Dr. Chris Gordon, assistant medical director of Family Health Centers, said there's something else at work.
Doctors tend to stay in the settings in which they train, and that setting is typically a hospital. Finding a community clinic accredited to take on resident physicians is rare.
In San Diego, the need for clinic-tracked physicians is especially acute. The areas documented as having too few primary care doctors (the government recommends there be one per 2,000 residents) are some of the city's poorest neighborhoods, where low-cost clinics are commonly used.
In addition to rural San Diego County, mid-city, downtown and southeastern San Diego are considered health provider shortage areas.
The health reform law has set aside $230 million to help flip the residency model on its head. A program called Teaching Health Center Graduate Medical Education would base residencies in community clinics, rotating doctors through hospitals periodically.
Locally, Gordon and Family Health Centers are leading the charge. They're applying to open six residency slots at their new City Heights facility next year. They're betting on the idea that if doctors begin their careers in community clinics, they'll stay in community clinics.
That was Gordon's experience. He came to Family Health Centers four years ago after training at Texas A&M University, which specializes in primary care, and completed his residency in Riverside County's health clinics.
He insists he doesn't mind that his chair bumps up against his colleague's in the office they share.
"I think the reason most of us work for Family Health Centers is because we believe in the mission," Gordon said. "We want to take care of the underserved. We're interested in assisting with bridging the gap between those that have had insurance all of their lives and those that don't."