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."
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.
"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.
"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."
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.