When millions of Americans become eligible for Medicaid in 2014, the country's going to need a lot more health providers – doctors, nurses, medical directors.
That's particularly true for the safety net system – that network of community health clinics and providers that takes care of the uninsured. Clinics provide a lot of medical care to folks on the southside, which is why a recent trend has some local health officials concerned – about clinical care on the southside and beyond.
In short: Providers are leaving.
"There are quite a few number of folks that are getting recruited away," said Louise McCarthy, the CEO of the Community Clinic Association of Los Angeles County. That includes both medical directors and the care providers that work under them, she added.
Part of that has to do with financials: Safety net clinics simply can't compete with the salaries that providers like Kaiser can offer, and Kaiser is hiring. It wants to be prepared to meet the demand that will come with new provisions of the Affordable Care Act, too.
That leaves the clinics in a bit of a tough spot, not least because only one of several factors playing a role in employees' leaving.
"[Some are recognizing that] what it takes to be a community clinic doctor now is not the same as it was 20 years ago," said McCarthy. There used to be room for part-time medical directors – no more, says McCarthy. Medical professionals who worked in community clinics used to have a lot more flexibility than is feasible now – flexibility that allowed them more time to be with their families, for example.
"I actually just had one doctor say to me, 'I have kids at home and I want to be a part-time doctor'," said McCarthy. "And that just isn't possible."
Neither is it possible to be a part-time medical director, said McCarthy, and that's got them leaving, too. She says a lot of medical directors currently in the clinic system "forgot to duck when people were looking for a new medical director" – which isn't at all to say they're bad doctors.
"A lot of these people have never studied how to manage people," explained McCarthy. "They only know medicine."
McCarthy says historically, "clinics haven't done very well queuing leadership," meaning that when a medical bigwig leaves a clinic, there's a sudden vacuum of leadership – and a subsequent scramble to find someone to fill it. That person may not be actually qualified to be a chief medical officer, but in a pinch, clinics have to make do.
Which increases incidents of burnout and makes leaving the clinic system a lot more attractive – especially when transferring to a private medical practice comes with a pay raise.
Safety and security is also a factor, she said. "Some of the settings for clinics are uncomfortable," McCarthy pointed out. Add that to the facts that a large majority of clinic patients are 100 percent below the federal poverty level and most are uninsured with chronic conditions, and you'll have the making of a very difficult workday – all day, every day.
"It's rare for a clinic doctor to get to see a lot of well babies," said McCarthy. Instead, providers are often just trying to stabilize people so they live through the year – and that's stressful. If you want to make a difference, she said, "you might end up working elsewhere."
Dr. Felix Aguilar is the chief medical officer at South Central Family Health Center, and he calls this "growing pains." His clinic has interviewed four physicians over the past few months, he said, and none of them have taken the job, presumably for better-paying offers.
"This job is a tough job," he said. "We're taking care of the needs of folks who have tremendous need." Ideal candidates need language skills and empathy, said Aguilar, on top of the medical know-how.
And it's only going to get worse before it gets better, he said. But Aguilar believes it's worth it.
"We have to face it and grow up," he said. "We have to be an adult country about health care."
Part of facing it, says McCarthy, is giving those providers in clinic leadership positions more support. It also means that clinics need to make themselves "a provider of choice."
"it's a very specific kind of individuals that becomes a primary cary doctor," she said. "And it's a very specific individual that does that in a clinic setting."
And even with the quasi-exodus, South Los Angeles is still full of them.