Training for the frontline of U.S. medical care
Third year resident physician Dr. Trina Hurley, left, and new resident physician Dr. Sarah Murphy check on one-day-old Zephaniah Russell on Monday in the labor and delivery department of Sutter Medical Center of Santa Rosa.
CHRISTOPHER CHUNG / THE PRESS DEMOCRATPublished: Monday, June 28, 2010 at 6:57 p.m.
Last Modified: Monday, June 28, 2010 at 6:57 p.m.
Anthony Lim, 33, is training to become a family practice physician, the lowest paying job in American medicine.
The rewards transcend money, said Lim, who speaks Mandarin Chinese, holds a law degree and previously worked as a management consultant in Boston.
He also taught math as an Americorps volunteer in Boston's hardscrabble Dorchester area and counseled low-income clients during his studies at Harvard Law School.
“There's a crisis in primary (medical) care,” Lim said. “That's where I want to be. The cause I identify with.”
Lim, a San Diego native, is one of the 12 medical school graduates — freshly minted MDs — who started work last week in the Santa Rosa Family Medicine Residency sponsored by Sutter Medical Center.
In three years, they will emerge as certified family practice doctors, with the prospect of making perhaps $175,000 a year.
Medical specialists, such as dermatologists, anesthesiologists, radiologists and surgeons, typically make two to three times more money.
Medical school grads are jamming the residency programs for specialties that earn $300,000 to $500,000 a year and command prestige in the medical profession.
Meanwhile, 16 percent of family practice residency positions go unfilled, and many primary care physicians regret their career choice.
A survey of about 9,000 primary care doctors found that 41 percent would, if they had it to do over, chose a surgical or diagnostic speciality. Only 28 percent would stick with primary care, and 27 percent wouldn't even go into medicine, according to a 2008 survey by Merritt Hawkins, a consulting firm.
But addressing the shortage of primary care providers — exacerbated by the health care overhaul — is now a national priority.
The U.S. Department of Health and Human Services last month announced the allocation of $168 million to train more than 500 new primary care physicians by 2015.
“Primary care providers are on the front line in helping Americans stay healthy by preventing disease, treating illness and helping to manage chronic conditions,” said HHS Secretary Kathleen Sebelius, a former public health nurse.
In 2014, the new health care law will sweep about 30 million people, now uninsured, into the system. It's a major step toward improving the nation's health, experts say, but thousands of new health care providers will be needed to handle the sudden influx of insured patients.
The Association of American Medical Colleges estimated that the nation will have a shortage of about 21,000 primary care clinicians by 2015.
In Sonoma County, about 45,000 people will become insured under the law, and officials are now assessing the medical system's capacity to treat them.
“It is critical that our community have an adequate supply of primary care providers,” said Dr. Mary Maddux-Gonzalez, the county public health officer.
Good primary care promotes better outcomes and prolongs life, she said. “It's one of the few situations where you get better quality at a lower cost,” Maddux-Gonzalez said.
With 337 primary care physicians, Sonoma County has 69 per 100,000 population, within the recommended range of 60 to 80 per 100,000 residents, according to a report last year by the California HealthCare Foundation.
(The ratio of specialists — 130 per 100,000 population — exceeds the upper end of the recommended range (105 per 100,000.)
Sutter's residency program, which has graduated about 570 family practice physicians since 1938, is a major reason why the county is well-supplied with frontline providers, Maddux-Gonzalez said.
About 150 program graduates are practicing family medicine in the county, said Dr. Jeff Haney, director of the residency program. Eleven of the 12 residents who will graduate from the program
While some family practice residency slots elsewhere go empty, the Santa Rosa program picks and chooses its participants. Nearly 300 medical school grads applied for the 12 positions in the class of 2013, Haney said.
The program admits just a dozen residents a year. It could apply for some of the federal money to expand, but Haney said the grants are for $80,000 a year per resident, enough to cover salary and benefits but not the increased costs for faculty and administration.
Grants last five years. “It's not a really great incentive,” Haney said.
Sutter Medical Center contributes $2 million a year to the residency program, and another $4 million comes from government reimbursements for medical services. Sutter's partners, including UC San Francisco, Kaiser Medical Center and Santa Rosa Community Health Centers, help support the program.
The new residents, ranging in age from 26 to 42, come from some of the nation's more prestigious medical schools, including Harvard, Brown, Georgetown, Boston University and UC San Francisco. They speak 11 different languages, and all but one is fluent in Spanish.
For three years, they will attend lectures, treat patients — in clinics, emergency rooms and obstetrics wards — and assist in surgeries, primarily at Sutter Medical Center and the Santa Rosa Community Health Center's Chanate Campus.
Residents work 65 to 70 hours a week and are paid about $50,000 a year. “It's a fairly strenuous job,” Haney said.
“You certainly don't go into it for the money,” said resident Cathryn Christensen, a Harvard Medical School grad. On her application to the Santa Rosa residency program, Christensen, 31, wrote that family practice was the place “where your joy meets the world's great need.”
Her commitment to family practice stemmed, in part, from working at a clinic in Burundi, an impoverished central African nation.
“You are invited into your patients' lives,” Christensen said. “You see the same people year after year.”
Kim said he was attracted by the gamut of human conditions that a family practice doctor sees, from newborns to elders, healthy to troubled. A specialist, in contrast, “sees the same problem over and over again.”
Haney, who graduated from the residency program in 2002, stayed on as a faculty member and also sees patients. “It's an amazing job,” he said, ranging from delivering babies to holding the hand of a dying person.
The financial sacrifice of going into family medicine is considerable, Haney said, noting that the average young doctor carries a $200,000 debt from college and medical school.
“It's a social decision,” he said. Specialists make bundles more money, but family practice physicians “still make a decent living,” he said.
The $175,000 average salary is more than other people make and who “don't complain about it,” he said.
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