Grassroots Efforts To Increase Florida’s Crop Of Primary Care Doctors

By Dalia Colón -

Florida is running dangerously low on a key resource. And we’re not talking oranges.

In much of the Sunshine State, primary care physicians – internists, pediatricians, OB/GYNs and others who work in preventative medicine – are in short supply. That supply grows shorter every day.

Meanwhile, as the population continues to grow, the state is heading for a crisis if residents can’t find doctors. HealthyState.org looks into the grassroots efforts in solving this physician shortage.

Gateway To The World

Any population with a citizen-to-primary-care-provider ratio of more than 3,500-to-1 is considered medically underserved, according to the U.S. Health Resources and Services Administration. On paper, Florida has a surplus of 9,096 primary care doctors.

But while metro areas and suburbs seem to have a doctor’s office on every corner, there’s a dearth of primary care providers in rural towns and inner cities. This maldistribution leaves the state with an overall shortage of 1,951 primary care docs.

Experts fear the ratio will only get worse. Florida’s population is the fourth-largest and third-fastest-growing in the country. Florida is also home to more older residents than the average U.S. state, and as Americans’ life expectancy increases, so does their demand for medical care. Then there’s the Affordable Care Act, which critics predict will further strain resources.

What’s bad for Florida is bad for everyone, says Cheryl Brewster, assistant dean for diversity at Florida International University’s Herbert Wertheim College of Medicine.

“Florida is one of the major gateways to the international world,” Brewster says. “And if our health isn’t in order for our population, then we can affect outcomes for the entire world.”

Here’s a look at some grassroots efforts to even things out.

The College Try

In 2008, primary care practitioners earned an average of $186,044, while specialists earned $339,738, according to the Bureau of Labor Statistics. Further, state budget cuts mean the only loan forgiveness opportunity for Florida’s primary care doctors is the National Health Service Corps’ Loan Repayment Program.

Bottom line: When it comes to attracting students to primary care, med schools know it’s not about money. Instead, Florida’s universities aim to show students the profession needs them and that primary care can make an engaging career – albeit without the gruesome surgeries, acerbic banter and on-call room trysts of specialist-centered dramas House and Grey’s Anatomy.

“Within the state, there really are lots of physicians," Dr. Maggie Blackburn says. "They just tend to be concentrated in our urban areas." (Photo courtesy of Florida State University College of Medicine.)

“There hasn’t been a Grey’s Anatomy for rural community health centers,” says Dr. Maggie Blackburn, director of rural health for Florida State University’s Department of Family Medicine and Rural Health.

But Blackburn and other administrators believe students can still gravitate toward primary care; they just need to be exposed to it through field work and mentoring.

Christine Matthews' interest in primary care makes her an anomaly among her med school peers. "Most of my friends, they admire that I want to do primary care. It’s just that they have an interest in something else," Matthews says. (Photo courtesy of Christine Matthews.)

Take Christine Matthews. Growing up in Miami, she was surrounded by specialists. But she’d never considered primary care until she enrolled in FIU’s college of medicine, where starting in their first semester, students are assigned a family to visit every month. Now a third-year med student, Matthews dreams of running a rural clinic.

“I found (specialties) limiting,” says Matthews, 25. “A lot of times, too, I’d want to know what happened next – what happened to (the patient)?”

To keep energetic young doctors like Matthews from burning out, medical schools also emphasize the need for support. For instance, during those monthly family check-ins, FIU medical students are accompanied by a nursing student, law student, social work student and others.

“This interdisciplinary approach lets them know that everything doesn’t have to solely be relied upon for a physician to fix,” Brewster says.

And gone are the days of one-doctor-does-all, Blackburn tells students. During her 12 years in family medicine in upstate New York, Blackburn focused on prenatal care but added obstetricians and midwives to her patient’s health team.

Still, the solving the shortage problem goes beyond inspiring college students. Regardless of how interested graduating doctors are in primary care, if they can’t find a residency, they’re forced to leave the state.

Training The Doctors That Florida Graduates

As teaching hospitals receive less federal and state funding for residency programs, they’re cutting back on the number of residencies they offer. Despite having nine medical schools that graduated 499 doctors in 2010, Florida ranks 43rd nationally in the number of medical residents trained.

At FIU, applications for the fledgling medical school’s next class have surpassed 5,000 applications for 120 slots, even though the originating class won’t graduate until 2013. But administrators know a program’s reputation rises or falls according to how successful its alumni are in finding residencies.

“I think 2013 will bring a whole new ball of wax for us,” Brewster says.

For Florida, the stakes are high. New doctors tend to plant roots wherever they complete their residency training. The challenge is that most residency programs tend to be in metro areas, not rural.

Sacred Heart Health System in Florida’s panhandle has three hospitals, two of which are in rural areas and one in Pensacola. The Pensacola location hosts three residency programs employing over 30 residents who divide their first year in each rotation of internal medicine, pediatrics and OB/GYN for three months each. There are no official residency positions located in Destin or Port. St. Joe, however they may spend a little time in those places getting to understand rural medicine.

“At first, they were like, ‘You want me to do what?’” said Dr. Paul Baroco, director of medical education at Sacred Heart. But so far, he added, they have come to really enjoy that work.

Starting Young: Florida’s “Best” Shot?

BEST students get homework help, learn CPR and attend an annual Health Exploration Day at the University of South Florida College of Medicine. (Photo from brainexpansions.org.)

Some say the job of piquing students’ interest in a health career starts much earlier than medical school or even undergrad.

While working in urban East Tampa, pediatrician and internist Dr. Dexter Frederick noticed a trend when he’d ask young patients what they hoped to become when they grew up.

“They would constantly tell me, ‘Well, I want to be a nurse, but I don’t know how to do it. I don’t know how to start’ or, ‘I want to be a dentist. I just don’t know where to begin,’” Frederick says. “I saw that there was a need.”

So in 2004, Frederick founded the Brain Expansion Scholastic Training program to prepare middle and high school students for medical careers. Several BEST alums are in the process of becoming medical professionals, including primary care and specialties.

Up to 90 percent of the students in BEST are from underserved urban populations, estimates program founder Dr. Dexter Frederick. (Photo from brainexpansions.org.)

Up to 90% of the students in BEST are from underserved urban populations, estimates program founder Dr. Dexter Frederick. (Photo from brainexpansions.org.)

“The goal is basically to supply the community, supply our country with culturally sensitive students who can fill the gap,” Frederick says. Many of the 165 students who’ve gone through BEST are themselves from underserved communities; most are black and live in Tampa’s inner city.

For Frederick, the effort is personal. He grew up in the U.S. Virgin Islands and recalls when his sister Dian had to fly to Puerto Rico to be treated for Bell’s palsy because there was no local neurologist.

In BEST, health professionals, retired teachers, college students and other volunteers take kids on field trips, tutor them in math and science and serve as mentors.

Students also learn chess and compete in a Medical Jeopardy! tournament. Because, when training up the next generations of primary care doctors, Frederick says, “We try to make it fun.”

This reporter can be reached at daliacolon@wusf.org.