Stimulus dollars to help primary care practitioners

BY ZHANRAN ZHAO | JUNE 11, 2009 7:33 AM

Incoming UI medical resident Lisa Zittergruen — who will specialize in family medicine — understands the reality of her decision to pursue a career in primary care.

“I never wanted to become very wealthy,” she said. “I chose family care because I like to interact with patients of all ages.”

The Obama administration is trying to get more residents similar to Zittergruen to work in community health centers, recently allocating $2 billion in federal stimulus money to fund community clinics and help medical-school graduates pay off their loans — hoping it will attract more graduates to primary care.

The government specifically targeted community health centers, lauding their cost-effective and high-quality care as part of the solution to the nation’s growing health problems.

Thirteen Iowa clinics are getting that financial boost, including Council Bluffs Community Health Center. Twenty-three percent of the center’s roughly 14,000 patients each year are below the poverty line, and 30 percent are uninsured. The center also serves more than 950 minority patients annually.

The stimulus money, which was awarded based on the number of patients per clinic, has helped the Council Bluffs clinic cope with a rise in uninsured patients.

“Over the last three to four months, we have seen 120 new uninsured patients,” Executive Director Cecelia Creighton said.

The center receives approximately half of its funding from the federal government. The rest comes from Medicare and Medicaid reimbursement, whose rates are determined by each state, but the economic crisis has put the sufficiency of those funds into question.

Particularly, the rise in patients who are unable to pay for their own bills has placed strains on the center’s operating budget.

All community health centers in Iowa received some aid from the bill. Ron Kemp, the director of Community Health Centers of Southeastern Iowa, said his clinic received $864,000 for renovating and building new facilities.

“It is a significant amount of money,” he said.

Creighton and Kemp said they were pleased with the stimulus money, but both centers are struggling with recruiting physicians.

“We are simply not comparable in the market with [large, national hospitals],” Creighton said.

Part of the reason is that not all medical-school graduates can afford to pursue primary care. On average, family doctors earn far less than specialists.

And, with arguably hefty medical-school loans, many new graduates are opting for specialist positions, leading to a national shortage in primary-care physicians. The stimulus bill tries to address the problem by providing loan repayment options for medical school graduates who choose primary care as their career.

The bill also gives funds to community health-care centers for recruitment. Kemp said his center received $270,000 for hiring new staff.

It’s not yet certain how much of an effect the bill may have in attracting more medical students to primary care. The government funds have not yet been distributed to current family-practice residents.

Zittergruen said the pending loan-repayment options could give her more choices to pursue her career without as many financial constraints.

“It would give me the freedom to practice where I want and where my family wants,” Zittergruen said.

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