Renewed effort to lure doctors to rural areas faces obstacles

Young doctor is a test case for the Obama administration's goal to bring primary care doctors to underserved areas -- and keep them there.
Washington Post Staff Writer
Monday, August 9, 2010

ESMONT, VA. -- Sarah Carricaburu slipped her sleek new iPhone into her purse for the day. With no signal here deep in the woods, it's useless. She swiveled away from her desktop computer, which can't access the Internet, and glanced at the manila folders of patient records neatly stacked on a shelf by nurses.

"I grew up in the age of electronic medical records," said Carricaburu, 33, a primary care physician who was raised in the Washington suburbs. "Coming here was like stepping back in time. I would like to stay in a community health-care setting, but here I didn't feel like I had the resources to do my job. You're cut off."

Carricaburu's choice of whether to stay or go is not just about her own career satisfaction. Her 12 colleagues at the Southern Albemarle Family Practice have a vested interest in her staying on, as the clinic's director and its one full-time physician, beyond the three years that she is under a contract with the federal government that will help pay off school loans. She is also a test case for the Obama administration's goal, under the new health-care law, to bring thousands of young primary care doctors to underserved areas such as this unincorporated town of 1,200 -- and keep them there.

The administration recently invested more than $1 billion from the stimulus and the health-care law into the National Health Services Corps to beef up doctor recruitment. It's more money than the 40-year-old agency has ever had, said Rebecca Spitzgo, associate administrator for the Bureau of Clinician Recruitment and Service.

Nearly 5,000 recent medical school graduates accepted federal grants to pay off tuition and school loans averaging $150,000 per student. The awards come with contracts that obligate the young doctors to remain in what are typically rural areas for three to five years. The corps hopes to recruit another 2,800 students next year. A report by the corps' advisory council estimated that 27,000 primary care physicians are needed to meet the needs of about 45 million Americans in medically underserved areas.

But after facing decisions similar to the one Carricaburu is weighing, several young doctors who were interviewed said they are struggling with whether to spend a career in rural settings. Experts said they expect retention to be a problem.

Carricaburu embodied the traits that President Obama extolled in stump speeches about reform. She earned straight A's through Richard Montgomery High School in Rockville and graduated from Johns Hopkins University with a 3.7 grade-point average. She was one of two students in her graduating class at Northwestern University's Feinberg School of Medicine who chose to become a family practitioner rather than one of the high-wage specialists the school is known for producing.

Carricaburu made that choice despite the stigma that others attach to students who choose family medicine. "When I told one of my professors that it was what I wanted to do, he said, 'You're too smart for that.' "

But Carricaburu had a mission. "I just always felt that I really wanted to help people who wouldn't otherwise get help," she said. "It's like a cliche, but it's true."

Daily inconveniences

The Southern Albemarle Family Practice, where Carricaburu sees about 18 patients daily, sits a few miles from the real-life Walton's Mountain, made famous by the TV show about a homespun family that lived there.

It's surrounded by trees as tall as skyscrapers, emerald soybean farms and vineyards. To get there from her townhouse in Charlottesville, about 46 miles round trip, Carricaburu takes a two-lane highway that curves and dives on sloping hills, and a one-lane bridge where crossing cars are blind to oncoming traffic.

Carricaburu directs a staff of 12, including two part-time doctors. She said she enjoys the work. On a Thursday, she examined patient Edwin Denby, 70, who got careless while doing yardwork and poked his eye on a bush. Next, she played with Nikisha Woody's 1-year-old son Jordan as he romped through the examination room.

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