Homegrown Program Addresses Inland Empire Doc Shortage

by Lauren McSherry, California Healthline Regional Correspondent

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PALM SPRINGS -- If all goes according to plan, college student Denise Barradas, 19, will be returning to the Coachella Valley in about 10 years as a full-fledged physician.

Barradas is one of 120 students participating in a pipeline training program through UC-Riverside's School of Medicine. The program is designed to produce more homegrown primary care physicians and, over the long term, address the Inland Empire region's shortage of doctors.

The Inland Empire has half the recommended number of primary care physicians, with only 40 primary care physicians for every 100,000 people, according to a 2010 California HealthCare Foundation report. Compared with other regions, that number translates to the worst shortage in the state.

In addition, the federal Health Resources and Services Administration has designated both Riverside and San Bernardino counties as Health Professional Shortage Areas.

The shortage is due to a number of factors. The region experienced rapid population growth during the housing bubble, and medical providers were not able to keep up with demand. Meanwhile, a number of statewide factors, such as an aging physician workforce, too few medical school slots in California turning out qualified local physicians, and compensation disparities for primary care physicians, have compounded the shortage, according to a 2011 report by the California Medical Association. While population growth in the Inland Empire has slowed in recent years, the region is still expected to experience significant growth, further exacerbating the physician shortage, according to the report.

The idea behind the Future Physician Leaders Program is to motivate high school and college students to become doctors who will be invested in remaining in the region. While the state's coastal regions have typically had no problem recruiting physicians, the Inland region has historically faced challenges in attracting and retaining physicians, experts said.

The program, which started in the Coachella Valley, expanded to Riverside and San Bernardino this year. Students shadow physicians and take part in community health projects that are intended to foster a sense of social responsibility and encourage students to see themselves as part of the long-term solution to the region's access-to-care challenges.

The program was created by Raul Ruiz, senior associate dean at the School of Medicine. Ruiz, the son of farmworkers, grew up in the Coachella Valley and at a young age vowed to become a doctor and return to help his community. After attending Harvard University, he accepted a post as an emergency department doctor at Eisenhower Medical Center in Rancho Mirage. Over the last few years, he has helped launch a number of medical programs targeting underserved communities in the region.

The Future Physician Leaders Program started in 2009 with Ruiz mainly traveling from high school to high school giving motivational talks. The program has since grown in structure and size. Each year, Ruiz makes sure to present students with the same two conditions for participation: They have to show up, and they must be involved in community service.

"Those two requirements are very profound," Ruiz said. "They demonstrate commitment, dependability, keeping your word. Those are all characteristics of leaders."

The chances are good that the students will choose to establish themselves in the region because doctors often decide to practice  where they have either grown up or were trained, Ruiz said.  

Because the state's physician workforce often does not reflect the population it serves, the program seeks diversity among its participants. Ruiz estimates 80% of participants are from underrepresented backgrounds and 55% are women, according to program data.

Once accepted into the program, students become members for life. They are tracked throughout their medical education and careers. They also will be invited to attend UC-Riverside's School of Medicine, whose application process will have an enrollment preference for students from the region. The school plans to begin enrolling students in August 2013 once it obtains accreditation.

Social Responsibility Takes Hold

Barradas, who grew up in Indio, is an example of an ideal participant, according to program officials. Currently a biology and pre-med major, she will be a sophomore at Santa Clara University this fall.

While many students who grow up in the Coachella Valley dream of getting out and never returning, she plans to devote herself to living and working in the community.

After watching both her grandparents die from cancer, she became motivated to become a doctor.

"It made me think, ‘What can I do to help people who face these struggles?" she said.

She liked the idea of making a difference through the field of medicine and learned about the Future Physician Leaders program when she applied for a Pathways to Success Scholarship. This is her second summer participating in the program. She's still deciding on what medical field to enter, but says she's interested in family medicine, obstetrics and gynecology, pediatrics, and oncology. 

As this is the second year Barradas has participated in the program, she has had ample opportunity to develop a feel for what these fields entail. Over 10 weeks, students shadow six physicians, attend lectures every other Thursday, and complete a community service project, which they design and implement themselves. Barradas is working on creating a prescription assistance resource manual for doctors serving low-income patients.

During her first summer in the program, she was shocked to learn from one of Ruiz's lectures about the dedication and sacrifices needed to become a doctor, but she wasn't deterred.

"It made me realize that it's something I want to do -- giving back to the community," she said.

Dedicated Mentors

The importance of community service isn't only instilled in students, the physicians who participate in the program also possess the same commitment, Ruiz said. The physician mentors volunteer their time, a difficult decision given most doctors' hectic schedules.

A central component of the program is creating nurturing mentor-mentee relationships, so that students remain inspired and dedicated to pursuing medicine, Ruiz said. This year the Future Physician Leaders program had 70 physicians who served as mentors.

Tahany Habashy, an assistant clinical professor at the School of Medicine, is a mentor. She also staffs the medical school's clinic in Palm Springs, where a rotation of students has shadowed her this summer.

The clinic opened in May and is the first of several that the School of Medicine plans to open. These clinics will be part of the medical school's out-patient clinical teaching platform. The school also is developing partnerships with a variety of community-based healthcare providers, including hospitals, county clinics, Federally Qualified Health Centers and multi-specialty group practices.

Habashy said these partnerships are particularly crucial for training homegrown physicians because students experience and become invested in working directly with the community. Through clinics such as the one in Palm Springs, students also learn firsthand about the implications of limited access to care.

"This area is severely underserved," she said. "We're talking about the people who live and work here, not the snow birds who can fly back."

For Habashy community service is integral to everything she does. She devotes her professional and personal time to not only mentoring medical students, but to volunteering her services abroad. She regularly returns to Cairo, her hometown, to provide free medical care to those in need.

Habashy said it takes a special combination of commitment and capability to become a doctor, and as a mentor she works to encourage those strengths.

If the Future Physician Leaders Program is a success, the hundreds of students who pass through its pipeline will be part of a long-term solution to the region's doctor shortage. Without an influx of more doctors, however, there will continue to be overcrowding in emergency departments, longer waits in primary care offices, difficulties finding physicians who are accepting patients, and more physicians working over capacity, Ruiz said.

Like Ruiz, Habashy believes that training physicians locally will be an effective strategy in combating the physician shortage. However, both agree it will be a decade or longer before an impact is realized.

"We cannot solve it in a year or two," Habashy said. "This is a long-term commitment to the community."


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