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State Loan Repayment Help Not Enough to Remedy California Doctor Shortages

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(Sacramento, CA)
Sunday, April 7, 2013

Dr. Glen Villanueva has known he wanted to be a doctor since he was five years old.

"I looked forward to going to the doctor," Villanueva recalls. "I liked how clean the office was, I liked the lab coat. 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 Ceres Medical Office, 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. "So 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."

0408PB Ceres patient

Not many doctors are choosing this kind of practice.

California has a shortage of primary care doctors in many inner cities and rural areas. Doctor Villanueva knows that from experience.

"We have been attempting to recruit physicians for two and a half 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," he says.

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 an individual has received a loan repayment, more than 50% of our practitioners still remain in those areas, " says Lupe Alonzo-Diaz with the California Office of Statewide Health Planning and Development.
Alonzo-Diaz is referring to 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, from 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 community, and is more likely to be better at serving that community," says Alonzo-Diaz. 

Primary care associations applaud the loan repayment model.

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 highly-valued than counseling," says Langton. "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, we really are not going to have enough people to provide those services." 

0408PB Ceres nursing station


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," says Villanueva. "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."

Dr. Villanueva's 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.  


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