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Bridging the gap

One doctor’s path to a career as a primary care physician.

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The Obama administration — and, arguably, the American health-care system — desperately needs more doctors to choose primary care. Decades of research have confirmed that more specialists lead to more specialty care, which leads to a more expensive system. Now, with the passage of the Affordable Care Act, tens of millions of previously uninsured Americans will be looking for a primary-care doctor. The success of health-care reform, then, rests on young doctors choosing a field where they will be paid less and work more. Who would sign up for that? Jacob Edwards, for one. He’s a 34-year-old resident in Washington, D.C. And he sees primary care as a way to “bridge the gap” between medical care and underserved communities. Here, he examines Lerner Medley, 1, at the Children's Health Center.

Jahi Chikwendiu / The Washington Post

Edwards grew up in a low-income, predominately African American neighborhood in Atlanta. Health care specialists were hard to come by, he said. Edwards had asthma as a child and remembers his mother driving him 20 miles to see his doctor. “I knew, from growing up, there are not a lot of African American doctors,” he says, “let alone access to doctors in underserved communities.” After graduating from Morehouse University, he settled on a primary care residency in the nation’s capitol. Here, he examines LeySean Blair, 5.

Edwards grew up in a low-income, predominately African American neighborhood in Atlanta. Health care specialists were hard to come by, he said. Edwards had asthma as a child and remembers his mother driving him 20 miles to see his doctor. “I knew, from growing up, there are not a lot of African American doctors,” he says, “let alone access to doctors in underserved communities.” After graduating from Morehouse University, he settled on a primary care residency in the nation’s capitol. Here, he examines LeySean Blair, 5.

Jahi Chikwendiu / The Washington Post

As a resident, Edwards sees patients weekly at the a community clinic on Martin Luther King Jr. Avenue. The surrounding area, east of the Anacostia River, has long had too few doctors to serve its residents. That correlates with striking disparities between the health of its residents and those who live across the river. Ward 8 residents are eight times more likely to die of heart disease than the Ward 3 Washingtonians of Georgetown. In Ward 3, 9.3 percent of adults are obese. In Ward 8, it skyrockets to 33.3 percent.

As a resident, Edwards sees patients weekly at the a community clinic on Martin Luther King Jr. Avenue. The surrounding area, east of the Anacostia River, has long had too few doctors to serve its residents. That correlates with striking disparities between the health of its residents and those who live across the river. Ward 8 residents are eight times more likely to die of heart disease than the Ward 3 Washingtonians of Georgetown. In Ward 3, 9.3 percent of adults are obese. In Ward 8, it skyrockets to 33.3 percent.

Jahi Chikwendiu / The Washington Post

Within Children Hospital’s residency program, Edwards is on the community health track, run by Kara Lichtenstein, left. The residency program takes a novel approach to medical education that often has residents outside the exam room. Residents teach sex education classes in local schools, take the bus routes their patients take and scope out local grocery stores to see what options are available. “A lot of what I gained was learning about the resources that are available,” says Julie Krueger, a first year resident pictured at far left. “We’re meeting with the foster program and other resources. A lot of times we tell patients to go do something. With this program, we know where they’re being sent.”

Within Children Hospital’s residency program, Edwards is on the community health track, run by Kara Lichtenstein, left. The residency program takes a novel approach to medical education that often has residents outside the exam room. Residents teach sex education classes in local schools, take the bus routes their patients take and scope out local grocery stores to see what options are available. “A lot of what I gained was learning about the resources that are available,” says Julie Krueger, a first year resident pictured at far left. “We’re meeting with the foster program and other resources. A lot of times we tell patients to go do something. With this program, we know where they’re being sent.”

Jahi Chikwendiu / The Washington Post

During his residency, Edwards has manned the clinic’s mobile van as it travels across underserved areas in Southeast Washington. “We get a really good following from those who can’t necessarily make it to the main hospital,” he says. “It’s such a medical desert.” Edwards has also taken advantage of his proximity to the Capitol: During his second year, he lobbied senators on increasing funding for graduate medical education. “One of the unique things about being in D.C. is you have so much potential to participate in policy discussions,” he says. “Congress is literally right down the street.”

During his residency, Edwards has manned the clinic’s mobile van as it travels across underserved areas in Southeast Washington. “We get a really good following from those who can’t necessarily make it to the main hospital,” he says. “It’s such a medical desert.” Edwards has also taken advantage of his proximity to the Capitol: During his second year, he lobbied senators on increasing funding for graduate medical education. “One of the unique things about being in D.C. is you have so much potential to participate in policy discussions,” he says. “Congress is literally right down the street.”

Jahi Chikwendiu / The Washington Post

More than a third of Edwards’s classmates came into the residency program with more than $250,000 in student loan debt. And when they graduate, they will have a choice. They can stay in primary care and earn $29.58 an hour. Or they can specialize and make $78.45. Over a lifetime, Edwards would earn $3.5 million more as a specialist than as a primary care doctor. “I have a lot of loans I need to pay off,” he says. “So for me, it’ll be a big step deciding what to do next year.” Here, he gets a jumping high five from patient LeySean Blair, 5, as LeySean's mother, Artavia Blair, sits nearby.

More than a third of Edwards’s classmates came into the residency program with more than $250,000 in student loan debt. And when they graduate, they will have a choice. They can stay in primary care and earn $29.58 an hour. Or they can specialize and make $78.45. Over a lifetime, Edwards would earn $3.5 million more as a specialist than as a primary care doctor. “I have a lot of loans I need to pay off,” he says. “So for me, it’ll be a big step deciding what to do next year.” Here, he gets a jumping high five from patient LeySean Blair, 5, as LeySean's mother, Artavia Blair, sits nearby.

Jahi Chikwendiu / The Washington Post

The gap between primary care and specialist salaries is wide. A radiologist earns, on average, just over $460,000. A family care provider takes home less than half of that. But with the health reform law passed, and implementation underway, Edwards is optimistic about the future of a primary care. For “pediatricians, speciality pediatricians,” he says, “I think there will definitely be a demand and a need for an increasing workforce.” A growing number of young doctors seem to agree with him: The number of American medical students matching into primary care residencies jumped 20 percent between 2009 and 2011.

The gap between primary care and specialist salaries is wide. A radiologist earns, on average, just over $460,000. A family care provider takes home less than half of that. But with the health reform law passed, and implementation underway, Edwards is optimistic about the future of a primary care. For “pediatricians, speciality pediatricians,” he says, “I think there will definitely be a demand and a need for an increasing workforce.” A growing number of young doctors seem to agree with him: The number of American medical students matching into primary care residencies jumped 20 percent between 2009 and 2011.

Jahi Chikwendiu / The Washington Post

Edwards is still sorting out his plans for when he finishes residency this year. “I want to apply for a health policy fellowship, so I’m in the process of doing that,” he says. “I probably will take advantage of programs with loan repayment, where I could serve in an underserved community a certain amount of time. Or a program that could help with loan assistance.”

Edwards is still sorting out his plans for when he finishes residency this year. “I want to apply for a health policy fellowship, so I’m in the process of doing that,” he says. “I probably will take advantage of programs with loan repayment, where I could serve in an underserved community a certain amount of time. Or a program that could help with loan assistance.”

Jahi Chikwendiu / The Washington Post

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