SALT LAKE CITY — When Michele Goldberg finished medical school in Los Angeles, she says she was burdened with “insane” debt.
But she still wanted to work with underserved populations, which the lower pay makes difficult for new doctors and other care providers exiting school. Recent graduates from medical programs often have massive loans to pay off on top of the several years of lost earning potential while they focused on their education.
Goldberg, however, found a path to follow her passion serving those most in need through a Utah program that incentivizes new providers to serve in urban or rural underserved communities by helping to pay off their loans.
It’s one way some states are fighting a provider shortage as longer lives and growing populations raise demand for more doctors, especially in communities where medical personnel can’t make as much money as they would elsewhere.
Four years later, Goldberg has remained at downtown Salt Lake City’s 4th Street Clinic, which treats the city’s homeless community. She now serves as the clinic’s medical director.
“It’s difficult at times, and they have other needs, but in general, the population is very gracious and very appreciative. And there’s a lot of education that you can do with this population. And when you’re really helping somebody in crisis just feel a little bit better, or even a lot better, it just feels really good,” Goldberg explained.
A national shortage in medical fields
According to the American Association of Medical Colleges, experts anticipate a shortage of 122,000 physicians by 2032. Health care delivery improvements, such as telehealth services, will reduce demand for doctors by a mere 1%, the association said.
“The nation’s population is growing and aging, and as we continue to address population health goals like reducing obesity and tobacco use, more Americans will live longer lives. These factors and others mean we will need more doctors,” AAMC President and CEO Dr. Darrell G. Kirch said in the introduction of the group’s report on the shortages earlier this year. “Even with new ways of delivering care, America’s doctor shortage continues to remain real and significant.”
The United States would need an additional 95,900 doctors immediately if health care use patterns were equalized across race, insurance coverage and geographic location, the study noted.
“The projected shortage of between 46,900 and 121,900 physicians by 2032 includes both primary care (between 21,100 and 55,200) and specialty care (between 24,800 and 65,800). Among specialists, the data project a shortage of between 1,900 and 12,100 medical specialists, 14,300 and 23,400 surgical specialists, and 20,600 and 39,100 other specialists, such as pathologists, neurologists, radiologists, and psychiatrists, by 2032.”
The report went on to note that “historically underserved areas may experience the shortages more acutely, (but) the need for more physicians will be felt everywhere.”
In Utah, the U.S. Department of Health and Human Services estimates there will be shortage of 600 primary care physicians by 2025.
According to Dr. Marc Babitz, medical director for the Health Clinics of Utah SLC and Ogden clinics and deputy director of the Utah Department of Health, communities that have 3,500 people or more and only one doctor classify as shortage areas.
But one doctor should see no more than 1,500 patients, Babitz told members of Utah’s Social Services Appropriations during a Tuesday hearing.
Of Utah’s 29 counties, 26 have shortage areas for medical providers. And 18 counties are underserved for dental providers, Babitz said. Davis, Summit and Sanpete are the only counties without provider shortage areas, he said.
The Los Angeles Times reported that one-third of California’s doctors and nurse practitioners are baby boomers who are reaching retirement age, further depleting the workforce. The care shortage led to the creation of the California Future Health Workforce Commission in 2017. The group proposed a $3-billion plan over the next 10 years to address the problem.
California, Utah among states seeking solutions
California this summer announced it will spend $340 million paying off doctors’ debt using money from tobacco tax revenue, the Los Angeles Times reported. Doctors whose debts are paid off by the state must devote at least 30% of their caseloads to Medi-Cal patients — California’s version of Medicaid — for five years.
But some costly and politically fraught recommendations by the commission will not be tackled this year, which could slow the state’s efforts to fix gaps in healthcare access. Among the commission’s recommendations was legislation to allow nurse practitioners, who undergo more training than registered nurses, to care for patients on their own without a physician’s supervision. A bill stalled in May amid pushback from the California Medical Association.
Utah advocates ahead of spring’s legislative session are asking for continuous funds for the state’s Healthcare Workforce Financial Assistance Program, which helps pay the loans of physicians, nurses, dentists, mental health professionals and others.
Draft legislation asks for an ongoing appropriation of $300,000 into the program. An equal fund match is available from the federal government.
In exchange for between $4,000 and $50,000 to pay off their loans — the amount depending on the type of provider — recipients serve for two years in approved clinics in federally designated Health Professional Shortage Areas.
People are chosen for the program based on how their abilities are needed at an approved site, past work at homeless shelters, public health clinics or other facilities for underserved populations, and similar experiences.
If they quit working at the site before the two years are over, they are required to pay back the award.
The program did not receive funding from the Legislature for this past fiscal year, and has existed on money awarded two years ago. If it doesn’t receive new funding during this upcoming session, it won’t survive, advocates say.
Goldberg also said she hopes the Legislature approves funds for the program because it’s needed to help encourage people to work for clinics like 4th Street.
Trying to keep professionals in underserved areas
When finishing medical school, “you’re really behind for saving, for retirement and for your future. And so you really have to be smart about financially, those steps you take. And so it was a huge part of my decision-making,” Goldberg said of her choice to apply for the program.
“Underserved clinics don’t pay as much as other clinics. And so that is really helpful when choosing, it makes it possible for people to choose federally qualified health centers and community health centers. If that money isn’t there, it makes it very financially difficult,” she said.
The hope behind the program is that providers will choose to stay in the rural or underserved areas after their two-year obligations pass.
“There are certain communities in the state that always have trouble getting health care providers come to serve them. It’s not a mystery,” said Rep. Ray Ward, R-Bountiful, who is also a doctor and drafted a bill for funding the program. “For rural communities, it’s always really hard to get health care providers there for a lot of reasons. And when we have urban populations like the homeless population, they can’t pay as much, so the physicians there don’t make as much, and there are more difficult circumstances.”
Clinics that do treat underserved communities often struggle to recruit and retain staff, he said.
“And so to me, this is just one of the ongoing tools that helps them do that. And I think it has a good track record of success in recruiting providers, and so I think we ought to keep doing it,” Ward said.
The goal of health department is for Utah to be the healthiest state in the nation, but right now, it’s ranked fourth, according to Babitz.
“It’s hard to be No. 1 when you leave a significant segment of your population without health care,” he said.