During a recent lecture at the UC Davis Medical Center, I had the opportunity to meet Moreen Lane. Moreen is a senior policy analyst for the California Workforce Investment Board, but she dubs herself as a “bureaucratic matchmaker.” In a follow-up meeting, Moreen and I exchanged our perspectives on addressing the maldistribution of primary care providers in California.
Moreen outlined an extensive inventory of state programs designed to incentivize recent resident graduates to practice in underserved areas, both rural and inner-city. Loan forgiveness for medical school debt is a prominent feature in many of these programs. Despite the state’s extensive funding of the loan forgiveness programs, Moreen inquired as to its muted impact in attracting physicians to practice in underserved areas.
I shared my observations of the medical resident’s mindset with Moreen. Most medical schools and residency programs do not dedicate time to teaching decision-making in a business context. Thus, there is no environment for residents to develop business acumen. This is correlated in a 2006 Family Practice Management article that reported more than 40% of community clinics were the victims of some form of financial fraud, including embezzlement, within a five-year period.
Nearly all of my residents freely admit that they lack the training to monitor the integrity of the hundreds of daily business transactions that accompany provision of patient care. California primary care residents are constantly exposed to the large group model of medical practice. These models promote the lack of financial administration as an inducement to join them. Recruiters tout that physicians are able to focus exclusively on their patient panels without the burden of running an office.
Most of the programs and resources involve the intermediary of a state or non-profit agency. However, I believe that communities should have a forum where a contingency of their leaders can meet and recruit physicians directly. The community will have an opportunity to express their needs for a physician they can call their own. They can put forth a proposal of partnership. They can appeal to physicians’ romantic and idealistic notions of a country doc or inner-city crusader. The basic message is that we want you in our community and we want to work together to build a common future. Some communities lack an established healthcare facility. In these instances, the physician has to assume the additional and unfamiliar responsibility of being a small business owner. The community’s business leaders can mentor the physician on the challenges, pitfalls, and rewards of establishing their own business. Basically, neighbors will be helping neighbors.
In an age of internet and speed dating, perhaps solutions to the shortage of primary care physicians may come from communities and physicians engaging in an old-fashioned courtship.
Dr. Fong is director of the UC Davis Family Medicine Residency Network. His opinions are his own and do not represent UC Davis.