Ensuring There’s Doctor in the House

Raised on a sprawling coastal ranch at Point Mugu, Rocio Villasenor would tag along to translate when her Mexican immigrant parents drove to nearby Oxnard to see a doctor.

“I recognized that people need health care from someone who speaks their language,” said Villasenor, now 28 and a fledgling doctor. “And I have a desire to be of service.”

A graduate of Stanford University and UCLA Medical School, Villasenor is a new recruit to a type of medical practice that is as old as Hippocrates, but as threatened as the midnight house call.

She wants to be a family doctor -- a discipline that draws fewer young U.S. physicians each year because of relatively low pay, extraordinarily long hours, less professional prestige and the need to pay off huge debts from medical school.

New figures show that for the sixth year in a row the number of new doctors committed to family practice has declined: For 2003, just 76% of the 2,940 U.S. hospital residency slots were filled.

And the trend is similar in California.

But this new generation of physicians still has its family practice missionaries, its Villasenors, who want the satisfaction that comes with providing personal care for entire families for years on end.

And they don’t mind working where they’re needed the most -- in the blighted urban centers and dusty farm towns of America, where family doctors are scarce.

“I’m motivated most importantly by my parents’ sacrifices so I could have a better life and also to give back to the community I came from,” said Villasenor, the daughter of a farmhand and a homemaker. “I’m already living the American Dream.”

Family practice medicine still has its select training programs, too, and they’re still bulging with highly qualified applicants.

Last month, Villasenor joined one of them when Ventura County Medical Center chose 13 young doctors for its next three-year residency.

The Ventura program, which is affiliated with UCLA, is one of the nation’s oldest and most respected.

“It is one of the programs that does the best job training family physicians for rural community practice,” said Dr. Perry Pugno, director of medical education for the American Academy of Family Physicians in Kansas City.

So as medical school graduates opted for other specialties, the Ventura program drew 250 applicants.

Of the 13 selected, nearly all graduated from top medical schools, and all ranked at least in the top half of their class, said Dr. Thomas Dunlop, residency program director.

None were from foreign medical schools -- often in India, Pakistan, Mexico, Russia or Eastern Europe -- that increasingly supply family practice doctors to the U.S.

Of the top 10 candidates sought by the program, six accepted, Dunlop said. “They are very, very top students. And our residents come to the program dedicated to working with the underserved [population].”

Based at a public hospital in Ventura, the program is part of a medical safety net that delivers thousands of babies a year and provides care for local residents who have little money or no health insurance.

Potential patients account for one-quarter to one-third of Ventura County’s 780,000 people, studies have shown, including about 20,000 agricultural workers and their families.

The Ventura County residency program is very good partly because it has been around for so long, said Dr. Lanyard Dial, medical director at the county hospital.

A general practice residency was established there in 1928. And the hospital was one of the first in the nation to begin offering family medicine as a recognized specialty in 1969.

The allure of the program is obvious, Dial said.

“More work, less pay, sign me up!” he quipped. “We do not tend to attract doctors who want to open a boutique practice. Many of our people go to Indian Health Services sites, community clinics or missionary work.”

Locally, employers say family doctors make perhaps $120,000 a year. Nationally, Medical Group Management, a Colorado firm that compiles physician income information, reports that in 2001 family practice doctors averaged about $142,000.

By comparison, neurologists earned $180,000, obstetricians $231,000, general surgeons $258,000, ophthalmologists $261,000, oncologists $280,000 and anesthesiologists $282,000. Radiologists received even more.

“It’s lifestyle- and income-related,” Pugno said. “Being a primary care physician is a tough job. So [avoiding] it is not a tough choice for many young doctors with more than $100,000 of [university] debt.”

In brief biographies, all but one of the Ventura County program’s new doctors suggested income was not a key consideration: They said they want to eventually work in poor or underserved communities. Villasenor is on that list.

One of her earliest memories in Mexico, where she spent most of her first seven years, was watching a woman slowly waste away from illness.

“I remember thinking that if we could get some health care to her, she would not die. But she passed away,” Villasenor recalled. “That got me thinking about being a doctor. I was 5 or 6.”

Later, after her family moved into a house on Rancho Guadalasca, the historic ranch owned by the Broome family near Cal State University Channel Islands, Villasenor would go to the doctor with her parents: “I’d think that if I could be a physician, there would be a solid line of communication.”

She knows the need is overwhelming: According to a UCLA study in 2000, there is one Latino doctor for every 2,893 Latino residents in California. By contrast, there is one non-Latino doctor for every 335 non-Latino residents.

To help fill that void, Villasenor graduated as valedictorian at Channel Islands High School in Oxnard in 1993, before studying biological sciences at Stanford.

She was drawn back to Ventura County, she said, when she discovered the county hospital’s family practice program during her third year in medical school.

“It has a very good reputation, with very strong academics and especially good training because it is broad-based -- pediatrics, obstetrics, emergency medicine and a lot of time in the operating room.”

That scope of experience is not offered at many larger university hospitals, she said, because they have so many residents training in so many specialties that young family practice doctors don’t get enough opportunity to practice each skill.

“In Ventura, the family practice residents are the only ones in the entire hospital,” she said. “Ventura was my No. 1 choice.”

That decision was only reinforced last year when she served a training stint in a Moorpark community clinic associated with the Ventura County hospital.

“The experience was great,” she said. “It all comes down to what’s important in your life.

She never considered that she could repay $70,000 in medical school debt quicker in another specialty, said Villasenor, who’ll make no more than $36,000 annually during her three years of residency. “I love family medicine,” she said. “You’re able to see patients from even before their births during pregnancy until their deaths. You treat them within the context of their families and how they live. It fits me.”