JUDY WOODRUFF: Now: the next in our series of stories on health reform and the challenges ahead.
Tonight, health correspondent Betty Ann Bowser reports from Northern California on the growing shortage of primary care doctors and one effort to fix that.
DR. ASHBY WOLFE, resident, University of California Davis: Hi, Mrs. Dieder. How are you doing? It's good to see you.
BETTY ANN BOWSER: Barbara Dieder has congestive heart failure, chronic obstructive pulmonary disease, osteoporosis, and arthritis. That's a lot for the 80-year-old homebound widow to manage all by herself. So, the frequent visits she gets from medical resident Ashby Wolfe are a big help.
BARBARA DIEDER, 80 Years Old: Yes, I think I'm healthier, because they catch things that are starting to go bad before they get too bad, yes.
BETTY ANN BOWSER: Do you think it keeps you out of the hospital?
BARBARA DIEDER: Yes.
BETTY ANN BOWSER: The University of California's Medical School at Davis brings Wolfe to Dieder's home in Sacramento as part of a unique program to increase the number of primary care doctors, by inspiring students to work in the real world in underserved communities.
DR. ASHBY WOLFE: I think, as a family doctor who is training now in the 21st century, it's becoming much more important for me to be comfortable managing a patient's medical conditions in a variety of settings.
BETTY ANN BOWSER: But the 21st century is not producing enough family doctors like Wolfe. U.C. Davis health economist Paul Leigh says the problem will get worse when the federal health reform law kicks in fully.
PAUL LEIGH, health economist, University of California Davis: So, we have more than 20 million Americans who now don't have health insurance who will have health insurance. And once they get health insurance, naturally, they're going to want to see a primary care physician.
The forecast is, however, that, in the next two or three years, there is not going to see a big growth in the number of primary care physicians. So, there is likely to be a crisis for not enough primary care physicians in a short period of time.
BETTY ANN BOWSER: Dr. Tom Balsbaugh, who runs the U.C. Davis resident program, says, if the problem isn't solved, health care reform will be in trouble.
DR. TOM BALSBAUGH, residency director, University of California Davis: I don't think health care reform can work well without a very robust primary care work force.
Here in California, we have about 60 primary care physicians per 100,000 patients. And that's pretty much the bare minimum to able to provide the care needed for those populations. If -- without a significant supply, there will be overcrowding of emergency rooms; patients will be diagnosed with problems later.
BETTY ANN BOWSER: One of the things driving the shortage is money. The average medical student graduates owing more than $200,000 in educational loans. So, having to pay all that back is usually a factor when med students pick a career.
A new study just released here at U.C. Davis in Northern California of 6,000 doctors nationwide found that the specialists, the oncologists, the radiologists, the orthopedic surgeons, made up to 52 percent more money than the primary care physicians, even though the family doctors saw more patients.
PAUL LEIGH: The disparity in wages between specialists and primary care physicians over a lifetime can be $2 million. So, that's a considerable incentive there for students to choose a specialty over primary care.
BETTY ANN BOWSER: There's nothing U.C. Davis can do to increase the salaries of family doctors, but using a $1.9 million grant provided under the new health care reform law, the med school will be able to train 10 new primary care physicians.
DR. TOM BALSBAUGH: That would be around 20,000 additional patients would receive a primary care physician from the money included in this grant.
BETTY ANN BOWSER: Community involvement is critical. Residents like Wai-Kui Lee go into high schools to talk to kids about nutrition, sex and drugs.
DR. WAI-KUI LEE, resident, University of California Davis: How many of your classmates do you think smoke?
BETTY ANN BOWSER: The population here at Sacramento High is overwhelmingly Hispanic, African-American, and Asian.
DR. WAI-KUI LEE: It helps us ground ourselves to why we became doctors in the first place. You know, here we are, at critical stages of these young people's lives, and we're able to make a huge impact on them.
So, if we're able to go and teach them some of the things that they need to do in order to go and become healthy and lifestyle changes that they need now, they won't be the 50-year-old that is coming into my clinic with diabetes who has to have their leg amputated.
BETTY ANN BOWSER: U.C. Davis also sends its residents to work in community health care clinics, like CommuniCare here in Sacramento, where 85 percent of the patients live below the federal poverty level. Nearly three-quarters of the 22,000 people seen here each year are also either uninsured or on Medicaid.
Dr. David Katz is the medical director.
DR. DAVID KATZ, medical director, CommuniCare: Most of the medical care that's practiced in the United States is not practiced in that academic university medical center. And, so, the importance is to give residents the experience of being out in the community and seeing that family practice can be intellectually stimulating and that it's really needed.
BETTY ANN BOWSER: Even though he still owes over $300,000 in education loans, Dr. Brenden Tu went to work as a family doctor at CommuniCare, because he likes the variety of patients.
DR. BRENDEN TU, CommuniCare: Some of them are homeless. There's a lot of psychiatric issues that we deal with, on top of the medical issues, family issues, single -- single-income parents, so the -- I mean, a whole range of social issues.
BETTY ANN BOWSER: There are provisions in the new health care reform law to encourage more medical students to go into primary care. One will pay off educational loans if young doctors agree to work in the National Health Service.
And there is money for pilot programs to experiment with the way doctors are compensated. Currently, most physicians get paid for each time they perform a service. But support is growing to pay physicians based on patient outcomes, in other words, based on how well the treatment works.
DR. TOM BALSBAUGH: We're starting to figure out what might be ways to start measuring value vs. quantity of services, and values quality of the care that's given. I think it will be very necessary to do that, because to provide
care to more people, we have to make our dollars go further. And the way that maybe we can start looking at value are things like comparative effectiveness, using...
BETTY ANN BOWSER: In other words, what works?
DR. TOM BALSBAUGH: Yes, researching what works and what works for the most affordable cost.
BETTY ANN BOWSER: And if that were to happen, most health care experts think more young people like Ashby Wolfe, Wai-Kui Lee and Brenden Tu would choose primary care.