Monday, Nov. 19, 2007

Valley has little to offer Doctors

The San Joaquin Valley has some of the worst rates of chronic disease in California -- and not enough doctors to deal with those problems.

The valley has fewer doctors per capita than any other region in California, and the shortage is especially acute in rural areas and small towns.

The state's metropolitan areas don't have a shortage, according to Debra Riordan, legislative analyst for the Central Valley Health Policy Institute in Fresno.

Why don't doctors want to practice in the San Joaquin Valley?

The answer is not a simple one, medical experts say.

Lack of job opportunities for a spouse, a perception that the schools aren't good enough, a lack of cultural opportunities and the lack of a medical school are among the reasons medical school graduates pass over the valley.

Dr. Richard Pan, an associate professor of pediatrics at the University of California at Davis, has studied pediatric residents' decisions about where to practice.

The biggest factor is not money, Pan said, it's family considerations. If there aren't career opportunities for a spouse, the doctor isn't likely to come. That's a societal change that has occurred over the past few decades, he said.

Years ago, doctors were men, and their wives were nurses, teachers or administrative assistants, Pan said. The wives could find jobs in the medical practice or with a school district.

Now the doctor is as likely to be a woman, and spouses of either gender have more specialized careers that may not be found in smaller cities, Pan said.

"If the spouse is a stockbroker or a specialized engineer, unless there is a job in the community, it is not going to fly," Pan said. "If the spouse is a mutual fund manager, it's New York, Boston or maybe Denver. There are just a handful of cities where they can work."

Even if the doctor is single, he or she may not feel there's an opportunity to meet a potential spouse who is on the same professional level in a smaller city, Pan said.

"You have to recruit the whole family, and we run into problems," said Mike Sullivan, chief executive officer of Golden Valley Health Centers in Stanislaus and Merced counties. "The community is too small, they are from an urban area and aren't comfortable here, they aren't sure the education system is adequate."

The perceived quality of education is a stumbling block, Pan agreed. Doctors may be willing to serve a rural area, but as soon as they have a child of school age, they want to relocate, he said.

And what is considered a small town can be surprising. Pan said Sacramento still suffers from the "cowtown" image, even though it no longer applies.

Specialists, in particularly short supply in the San Joaquin Valley, don't come here because they can't find a big enough patient base to support their specialty.

"In an urban area, there are a lot of patients for specialties," Riordan said. "They get more bang for the buck."

Pan noted that even Sacramento, with nearly a half-million residents, doesn't have a pediatrician specializing in rheumatology because the population does not provide enough patients. Multiple insurance carriers further split the potential client base, unless a doctor accepts all coverage, Pan said.

Culture, the environment, poverty and lack of academic support are among the barriers young doctors see in the San Joaquin Valley, Riordan said.

"Medicare rates are higher in urban areas. Doctors want to be by an academic area. There's a perception that the valley isn't a healthy place to live. They may not want to treat poor people. They don't perceive the valley as being a culturally stimulating place to live," she said.