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Reporting on health and quality of life in South LA

Primary care doctor shortage creates critical void, leaving field's future uncertain

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A recent Senate report said the country is short about 16,000 primary care doctors – and that shortage is only expected to grow.

That's especially troubling for people in the public health and medical fields, since a soon-to-be-enacted provision of the Affordable Care Act will extend Medicaid to millions of Americans – begging the question of who, exactly, will treat them.

A recent study in the Annals of Family Medicine estimated there are nearly 209,000 primary care providers in the U.S.

That's a big number, but with population growth, aging and the changes brought on by the Affordable Care Act, experts say today's shortage of 16,000 primary care physicians will grow to about 52,000 by 2050.

That's also a big number – but it's a bigger problem.

Why the shortage of primary care doctors?

Dr. Felix Aguilar, the president and CEO of UMMA Community Clinic in South Los Angeles, says the primary care physician is a "jack of all trades but master of none."

"The role of primary care is to provide comprehensive care that is affordable, prevention-based and that looks at all the faces of a human life – from babies to grandmas," he said.

Dr. Aguilar is a practitioner of family medicine – one form of primary care. He's worked in underserved South L.A. for about 10 years, and loves what he does.

But Aguilar says there are a few things about the job that keep a lot of young medical students away. For one, they have a heavy patient load.

"We have less support," he said. "We're not hospital-based and, of course, we get less money, so those are the drawbacks."

Primary care doctors typically earn less and and get less support than doctors who choose to go into specialized fields: cardiology, neurology, podiatry, oncology and other specialized fields. Specialists also tend to work with fewer patients.

Add to that an average medical school debt of more than $160,000, and it's easy not so hard to see why a more lucrative field – that is, one that isn't primary care – would be so attractive to medical students.

Uncertain – but optimistic – about the future

Lauren Wolchok, 27, is a fourth-year medical student at UCLA studying primary care. She says she wants to be part of the solution.

"We are the people who people think of as their doctors," she said. "And I think that is something that's really valuable to me. I want to be the one who is responsible for helping to make the diagnosis, but also to educate the patient about their health, keep people healthy and just help them out through life's challenges."

Wolchok says without enough primary care doctors, the Affordable Care Act "isn't particularly sustainable."

But she says it's an exciting time for the field – and she's not too worried about paycheck issues.

"Family doctors are still making a pretty comfortable income, although it might not be the same as our liver transplant surgeons," she said. "It'll be enough for me."

Michael Wolfe is another fourth-year medical student at UCLA – but he's studying to be an anesthesiologist. That means he'll manage surgical anesthesia, and make sure patients are ready for surgery. The 25-year-old physician-in-training has a genuine passion for anesthesiology.

"It's something where you're in the moment, one-on-one with a patient, taking care of the matter at hand," he said.

Primary care moving away from doctors?

As much as Wolfe enjoys one-on-one patient care, he says he's has to be open to changes in his field because nurses, physician's assistants or other mid-level providers often are just as qualified as he is when it come to administering anesthesia – and they're a whole lot cheaper.

"With the push to make things more affordable and cost-saving, the role of the anesthesiologist is kind of in question right now, as to whether it's still just going to be come, take care of the one patient, then go home," he explained. "So their expanding role might differ a little bit, and I think there's a pressure to embrace that, more so than primary care versus a specialty."

Mid-level providers could play a much bigger role in fulfilling the growing need for primary care – even bigger than the one they already play – because of the Affordable Care Act.

Dr. Aguilar put it succinctly: "Probably the future of primary care is not among physicians."

That's true, said Wolchok – but only to a point.

"I think these ancillary folks are going to be hugely important in meeting the primary care demand, but that physicians will still have a leadership role," she said. "That's one of the reasons that I wanted to go to medical school, as opposed to going the nurse practitioner route."

Which is good for Wolchok, because as soon as she – along with anyone else who's chosen to go into primary care – is done with medical school, she'll have plenty to do.

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