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Doctor Shortage Hits Rural California

Shellie Branco
Valley Public Radio

Children and parents crowd the waiting room in the United Health Centers clinic for low-income patients in Parlier. It's a busy morning, and Dr. Rogelio Fernandez is seeing patients one right after the other. At this moment, he's treating 35 year old Yesenia Campuzano of Reedley. The birth control implant in her arm caused acne, so Dr. Fernandez is surgically removing the tiny, tube-like device. She's feeling the incision, so she needs more of the local anesthetic.

Dr. Fernandez practices family medicine in his hometown, in a clinic just outside the fields where many of his farmworker patients make their living. He knows it's difficult to attract doctors to rural areas with poor residents. That's why the Valley faces a shortage of primary care doctors and specialists. In the Valley, there are 173 doctors for every 100,000 residents. The Bay Area has more than double that number of physicians. Fernandez says most doctors want to live in urban areas.

"That was one of the reasons that I went to medical school 20 years ago. I wanted to help in these areas that didn't have enough physicians… and that's still the problem now."

A new program through UC Davis and UC Merced will create more homegrown physicians like Dr. Fernandez. The schools have created the UC Merced San Joaquin Valley Program in Medical Education, also known as PRIME. And it's the first step in creating a medical school at UC Merced. Medical students will spend their first two years at UC Davis. They'll spend their last two years in rotations at Valley clinics and hospitals. The students have to demonstrate their commitment to providing primary care to underserved patients in the Valley.

PRIME classes are now in session at UC Davis. Randell Rueda of Fresno is one of the five pioneering students of the new program. When he was in high school, he recognized the lack of specialists when both of his parents became sick at the same time. His father had a borderline heart attack and didn't get the best care possible.

"My mother had her hysterectomy in the hospital, which was different…but my father, as far as follow-up treatment to check on his heart…he didn't get access to services as quickly as I felt he should have been able to," said Rueda.

This semester Rueda and the other students will take part in seminars about health disparities in the Valley. In the future, Rueda wants to practice internal medicine and possibly specialize in infectious diseases. His fellow PRIME students come from Modesto, Fowler, Salinas and Bakersfield. Each of them received a $10,000 scholarship.

PRIME is funded by a $5 million dollar grant from the United Health Foundation, and officials hope to raise more money. Dr. Frederick Meyers is the executive associate dean of the UC Davis School of Medicine. He says the state doesn't have the money to support the new program, or to sustain a medical school at UC Merced. But Dr. Meyers looks to financial support from philanthropists and programs like PRIME to bring the school to life.

"Most new medical schools in this country are developed incrementally, starting with smaller programs and building up to a full-fledged medical school. That continues to be the plan," said Meyers.

Money is also one of the reasons doctors don't come to the Valley. They leave school with massive loans and they believe Medi-Cal reimbursements for low-income patients don't pay enough. California offers a loan repayment program for doctors who serve in needy areas, but state legislators are trying to create more incentives. A current Assembly bill sponsored by Democrat Henry Perea would provide scholarships to medical students who will practice in underserved locations.

Culture is another roadblock. Dr. Meyers says many doctors don't see the Valley as a sophisticated place to live.

"Physicians are really no different than anyone else. They want to raise their families in places that are safe, good schools, cultural activities, etc."

Back in Parlier, Dr. Fernandez says he would welcome PRIME students to work with him.

"Those are the people that are going to stay. You're not gonna keep someone from an urban area who wants to stay in an urban area…You can bring 'em here, but they're not gonna stay."

The recession has made it harder to secure support for such programs, just as it's made it difficult for patients to afford health care. Doctors and academics say those challenges have motivated them to make this Valley medical program a success.