Wanted: More Physicians to Serve in Community Health Centers

A recent article in "Modern Health Care" summed up the urgent problems of recruiting physicians for community health centers:

 "The limited supply of primary-care doctors and other clinical staff dedicated to the field has increased competition among healthcare providers to attract these key personnel. Federally qualified health centers often lose out in the scramble.

The larger health systems and hospitals have the wherewithal to offer lucrative signing bonuses and financial incentives to prospective employees. Community health centers do not.

“In any given market, whether it be small or large, there are at least 10 different delivery systems a family practitioner can practice in,” said Travis Singleton, senior vice president at physician search firm Merritt Hawkins. “That wasn't the world that we had 10 years ago.”

Many factors fuel the trend. One of the largest came with the implementation of the Affordable Care Act, as millions of newly insured Americans gained access to routine healthcare. Other causes include population growth, an increased elderly population and the likelihood that as many as one-third of the current physician workforce will retire over the next decade.

The confluence of factors has raised the possibility of a shortage of primary-care providers over the next decade. The Association of American Medical Colleges estimates the shortfall will reach between 14,900 and 35,600 physicians by 2025, according to a recent report.

A recent survey on physician recruiting by Merritt Hawkins showed family physicians are the most sought-after specialty for the 10th straight year. Urgent-care physicians, a growing alternative, have moved from 20th most requested in 2015 to ninth in 2016. Average starting salaries rose 13% to $225,000 in 2016 from a year earlier.

The nation's 1,200 community health centers are expected to be hit hardest by the shortage, experts say. The 10,000 primary-care physicians now at community health centers will need to be supplemented by an additional 15,000 providers over the next 10 years."

Here in San Francisco, recruitment is made more difficult because of the high cost of living and the fact that the scoring that is used to provide Federal Loan Repayment, traditionally a strong recruiting tool for doctors coming out of medical school with thousands of dollars in debt, disadvantages high cost, high density urban areas.

SFCCC is working with local, state and national partners on a series of initiatives to ameliorate this problem.  The California Primary Care Association (CPCA) has laid out the following priority recommendations and we will be adding local priorities and projects to address these issues.

CPCA Overarching Priority Recommendations

1. EDUCATE the public and key stakeholders about growing primary care access, quality, and cost challenges

2.  IMPROVE documentation and communication of emerging primary care workforce problems and consequences.

3. SECURE additional investment and partnerships to accelerate primary care transformation within CCHCs including pilot projects, training, technical assistance, and shared learning.

4.INCREASE the number of primary care residencies in California with a priority focus on residencies in community health centers and medically underserved regions.

5. EXPAND loan repayment funds and provisions to incentivize new and existing providers to practice in CCHCs.

6. ADVOCATE for funds to expand medical schools targeting candidates committed to primary care practice in underserved areas

7. DEVELOPformal ongoing relationships between CPCA and other key advocacy organizations and build an inclusive broad-based coalition to focus explicitly on primary care access and workforce-related policy solutions.

8. DEVELOP state level public-private entity with the necessary expertise, capacity, and relationships to advance collaborative primary care workforce solutions. Convene a process for development of a multi-year strategic plan for California to strengthen primary care capacity and access.

9. ACCELERATE and expand payment reform and pilot projects that align financial incentives and regulations with new team-based primary care models.


Facts About HIV/AIDS in San Francisco

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San Francisco has an estimated 15,979 people living with HIV.  In 2014, there were 302 newly diagnosed HIV cases, a decrease in number from recent years.

86% of new HIV diagnoses are among gay and bisexual men. In the past five years, the proportion of Latinos ( 27% in 2014) and Asian/Pacific Islanders ( 13% in 2014) who make up new HIV diagnoses has increased.   African-Americans are disproportionately represented among new HIV infections, with 11% of new diagnoses among African-Americans in 2014, while only 6% of San Francisco’s population is African-American.  Survival after AIDS diagnosis is worse for African-Americans than for other racial/ethnic groups.

The proportion of new diagnoses among people ages 25 to 29 years dropped from 21% to 17% between 2013 and 2014.  In 2014, more than 58% of those living with HIV in San Francisco were over fifty years old.

On average, 62% of people newly diagnosed with HIV achieve viral suppression within a year of diagnosis in San Francisco.  Among all people living with HIV—whether diagnosed or not—60% have their virus under control (are virally suppressed) compared to 30% nationally.

(Statistics and graphic from SF AIDS Foundation: http://sfaf.org/hiv-info/statistics/)



October is Domestic Violence Awareness Month

Interpersonal and domestic violence has a pro-found impact on the health of women and girls. Violence and trauma can result in serious injuries and death and can lead to chronic health problems.  Identifying current or past abusive and traumatic experiences can help prevent further abuse, lessen disability, and lead to improved health status. Because they are often trusted resources in their communities, health care providers are in a unique position to connect women who experience interpersonal and Domestic violence with support.

 Providers do not need to be experts on interpersonal and domestic violence to conduct screenings. Screening can occur during a well-woman visit with a primary care provider or as part of any other health care visit. Just as providers routinely screen patients for diabetes or high blood pressure and refer them to specialists as needed, providers can also screen for interpersonal and domestic violence and provide a referral to local domestic violence programs and services. If a woman discloses abuse, the provider can provide brief counseling to 1) promote the patient’s immediate safety; 2) discuss the possible relationship between current or previous interpersonal and domestic violence and the patient’s health concerns; and 3) link the patient to support services and resources.

.When a patient discloses abuse, providers can make a referral upon disclosure of abuse, including referrals in which providers give women information that the women can make the best decision for themselves. [i]

 Locally, San Francisco Domestic Violence Consortium (SF DVC) has a list of providers and other helpful information. Local Resources include: 

 APA - Family Support Services
Home visitation to at-risk Asian families with children 0-5; parenting education and victim support services.
10 Nottingham Place
San Francisco, CA 94133
ph: (415) 206-5450
fax: (415) 206-4778

Asian Pacific Islander Legal Outreach
Legal assistance to the Asian Pacific Islander community provided in a wide range of Asian Pacific Islander languages.
Domestic violence protective orders, divorces and immigration services; youth outreach and prevention education.
1121 Mission Street
San Francisco, CA 94103
Ph: (415) 567-6255
fax: (415) 567-6248

Asian Women's Shelter
crisis line (415) 751-0880
Counseling, advocacy, emergency shelter and support services for battered women and their children. Specialized services for non-English speaking Asian women and their children.
3543 18th Street, #19
San Francisco, CA 94110
ph: (415) 751-7110
fax: (415) 751- 0806

Bay Area Legal Aid
Civil legal assistance to low-income SF residents; training for welfare workers, police, judges, attorneys, advocates, clergy, media etc.; services for survivors of same-gender DV; outreach/education to youth and others.
1035 Market Street, 6th Floor
San Francisco, CA 94103
ph: (415) 982-1300
fax: (415) 982-4243

Community United Against Violence
crisis line (415) 333-HELP
Counseling and advocacy service for gay, lesbian, bisexual, transgender victims.
427 South Van Ness Avenue
San Francisco, CA 94103
ph: (415) 777-5500
fax: (415) 777-5565

Cooperative Restraining Order Clinic
Assists battered women in obtaining and enforcing restraining orders.
3543 18th Street, #5
San Francisco, CA 94111
ph: (415) 864-1790
fax: (415) 864-1082

Donaldina Cameron House
Counseling and advocacy services for Chinese and Vietnamese women; immigration and translation services.
920 Sacramento Street
San Francisco, CA 94108
ph: (415) 781-0401
fax: (415) 781-0605

Futures Without Violence
A national non-profit working to end DV through public education, public policy reform, model training, media campaigns and advocacy programs
100 Montgomery Street
The Presidio
San Francisco, CA 94129
ph: (415) 252-8900
fax: (415) 252-8991

GLIDE's Women's Center
Support groups and services providing survivors of domestic violence with education, prevention and intervention while healing and empowering.
330 Ellis St. (Main building)
San Francisco, CA 94102
ph: (415) 674-6000

Justice & Diversity Center
Intake (415) 989-1616
Legal assistance services utilizing volunteer attorneys in family law and other matters including dissolution, custody actions and restraining orders. Hold monthly advice/ referral clinics including a One Stop Women's Clinic. 
301 Battery Street, 3rd Floor
San Francisco, CA 94111
ph: (415) 982-1600
fax: (415) 477-2390

Intervention program plus community advocacy; programs for Spanish-speakers. 
474 Valencia, # 235
San Francisco, CA 94103
ph: (415) 552-1361
fax: (415) 552-1361

The Riley Center | Services for Survivors of Domestic Violence
St. Vincent de Paul Society of San Francisco

crisis line (415) 831-3535
Counseling, advocacy, emergency shelter and support services for women and children; transitional housing.
1175 Howard Street
San Francisco, CA 94103
ph: (415) 552-2943 x206
fax:(415) 552.0337

Shalom Bayit
(510) 451-8874
A grassroots organization dedicated to empowering battered Jewish women.
PO Box 10102
Oakland, CA 94610

Survivor Restoration Program of the Sheriff's Department
Supports survivors through their own process of restoration and empowerment, while creating counseling and opportunities for personal growth. 
120 14th Street
San Francisco, CA 94103
ph: (415) 734-2312
fax: (415) 734-2300

Victim Services Division of the DA's Office
Advocacy for victims in the criminal justice system; training for criminal justice personnel and community outreach and education.
850 Bryant, 3rd Floor
San Francisco, CA 94103
ph: (415) 553-9044
fax: (415) 553-1034

W.O.M.A.N., Inc.
crisis line (415) 864-4722
24-hour bi-lingual DV crisis line with citywide shelter availability info; Group and individual counseling; Lesbian DV program; Latina DV program; Outreach and education.
333 Valencia, Suite 251
San Francisco, CA 94103
ph: (415) 864-4777
fax: (415) 864-1082


 [i] Adapted from: Office on Women’s Health in the Department of Health and Human Services. http://www.womenshealth.gov/publications/our-publications/fact-sheet/ipv_screening_508.pdf


Deferred Action for Childhood Arrivals (DACA) Provides Opportunity for California Immigrant Families to Gain Medi-Cal.

Even though President Obama’s expanded actions on Deferred Action are currently on hold,  the original DACA program is still available.

The Children's Partnership and Georgetown University's Center for Children and Families recently released a report on the potential benefits of Deferred Action on health coverage and makes recommendations on how to prepare for new health coverage opportunities through Deferred Action in California. The research found that:

  • When fully implemented, immigration relief provides California, in particular, with an enormous opportunity to provide whole family health coverage.

  • As many as 1.1 million parents, young adults, and children living in immigrant families in California could gain health coverage, if granted immigration relief.

  • Immigration relief could also provide a welcome mat for parents to enroll their already eligible but hard-to-reach children in low-cost health insurance.

Right now more than 400,000 children in immigrant families are already eligible for full-scope or state-funded Medi-Cal health insurance but are not yet enrolled. This includes lawfully residing children in immigrant families and about 200,000 children and youth eligible for the 2012 DACA program.

For the full report, please go to http://www.childrenspartnership.org/storage/documents/Immigration_Relief_for_Parents_and_Youth_Whole_Family_Health_Coverage_in_California.pdf