Doctors reflect on the undervalued specialty of primary care

By Helen Afrasiabi

Second year family practice resident Dr. Ernesto Medina is happy with his specialty, despite the challenges of primary care.

“The value of primary care is found, quite simply, in the continuity of care you get for every member of your family,” Medina said, taking a break from his work at UCI Family Health Center in Santa Ana.

Faculty and residents see twenty or more patients daily at the center. The clinic, which serves 20 percent of the county’s safety net patients, provides the training environment vital to his preparation for serving low-income people, Medina said. He’s getting an understanding of their specific needs and learning how to navigate the system for them.

As an undergraduate, Medina volunteered with medical teams traveling to Tecate, Mexico, to administer care to the region’s poor. His experiences affirmed his desire to be a primary care practitioner, especially one that helped the underserved.

“Seeing physicians interact with and being able to treat the entire family, and seeing individuals from an underprivileged background be at ease with these doctors, showed me the value of being in this specialty,” Medina said.

But quantifying the effects of this work can be difficult, said Program Director Dr. Charles Vega. The program, which trains doctors like Medina in addition to providing care, is always in need of additional funds, and grants are hard to come by.

“There are ever-increasing financial pressures out there, and we’re feeling it too,” Vega says.

The program lacks the resources needed for the documentation and evaluation work that grants typically require.

“This takes a lot of effort and can sometimes be lost in the moment-to-moment care of very sick people,” Vega said.

And the pool of grant money is dwindling. The federal government is considering cutting programs like Small Community Health Grants, totaling $62 million, because it hasn’t produced health outcome measures that are scalable at a national level, according to the Office of Management and Budget.

The state has filled in a bit of the gap. UCI Family Health Center has gotten one grant this year from the Office of Statewide Health Planning and Development’s (OSHPD) Song Brown fund, which favors clinics in underserved communities that have diversity in their clinical staff. The grant was created for increasing the primary care workforce and will pay one resident’s salary at the health center, which totals between $45,000 and $52,000 per year.

But the money doesn’t help to meet other pressing needs.

One problem is that their patient population is 60 percent Hispanic, and few residents speak Spanish. The clinic has hired a language coach to help residents reach more patients.

A lack of preventive care is also common among patients.

“Ours are patients who don’t have a simple vaccination, mammogram or access to green open space or healthy food,” Vega said.

The lack of preventative care frustrates Medina. Some patients have difficulty affording primary care, but others will go straight to a specialist when they feel ill, forgoing a primary care physician.

Frequently, Vega finds himself dispelling the idea that family medicine is a chore among medical specialties. Nothing could be further from the truth, he said, especially considering that caring for those patients coming through the doors at UCI Family Health Center continues to present new challenges everyday.

For primary care to successfully address the poor community’s needs, it has to be kept innovative but simple, Vega said.

“We need simple technology because our patients are poor, even just things that help address problems with blood pressure and body weight. Once it gets too expensive, there’s nothing to pay for it.”

The bottom line, Vega said, is that the cost associated with running a Family Medicine training program such as his are unlimited, and the specialty is saddled with impediments such as proving outcomes and low reimbursement rates that just don’t go the distance. There is simply not that much money in talking to patients, Vega said.

That hasn’t deterred residents like Medina, who plans to continue working with the same population in Orange County after his residency.

“We’re not in it for the sports car,” Medina said.