Doctors Wanted: Health clinic has searched for two years

Brownsville Community Health Center is hiring doctors, but no one is applying for the jobs.

For two years, the federally funded clinic has searched for primary care doctors to fill two vacancies, to no avail. Officials also have been looking for a dentist for nearly eight months with no luck, executive director Paula Gomez said.

"It's difficult because of what we pay. We're competing with a whole community, because everyone's looking for doctors and dentists," Gomez said. "Primary care doctors are hard to come by."

The Brownsville clinic primarily serves low-income, uninsured residents, and with a limited budget can't offer sign-on bonuses and other incentives that the private sector might provide to attract doctors, Gomez said.

Some clinic directors hope legislation currently under consideration in the Texas Legislature will help ease their struggles to recruit doctors and dentists.

House Bill 1876, filed by Rep. Richard Raymond, D-Laredo, and Rep. Warren Chisum, R-Pampa, would establish the Texas Health Care Access Fund to help repay the debts of doctors and other health professionals if they commit to serving in high-need areas.

The state already has a debt-repayment program for doctors and some health professionals, but the program doesn't provide enough incentive for debt-burdened doctors and dentists to take lower-paying jobs, said Jose Camacho, executive director of the Texas Association of Community Health Centers.

"Right now, (these programs) only pay a fraction of what it would take to pay off someone's loan debt," Camacho said.

Texas is facing a shortage of primary care physicians in general, according to state figures. The state has 68 primary care doctors per 100,000 people, compared to the national average of 81 per 100,000. Increasingly, U.S. medical students are choosing other specialties besides primary care because they can make more money in them.

The average medical student carries a debt of nearly $140,000 upon graduation, according to the American Medical Association. Currently, the state's debt repayment program offers doctors who work in high-need areas $13,000 for the first year, going up to $20,000 for the fifth. To qualify, doctors must agree to work in federally designated health professional shortage areas, at a community health center or for certain state agencies.

The proposed legislation would increase that amount to $25,000 for the first year and to $55,000 for the fourth year. Dentists, physician assistants, advanced practice nurses, dental hygienists and mental health providers could also qualify for debt repayment.

Funding for the program would come from increasing taxes on smokeless tobacco products and closing a loophole on cheaper smokeless tobacco products, officials said.

But not everyone thinks the proposed program is the best approach to addressing the primary care physician shortage.

The Texas Medical Association supports increasing funding to the state's current loan-repayment program for physicians, rather than establishing a new program that would also include other health professionals, said Dr. Albert Gros, chairman of Texas Medical Association's Council on Legislation. Physicians and other health professionals shouldn't compete for repayments through one program, but participate in separate programs instead, he said.

The doctors group also disagrees with using a tobacco tax to fund the program because it's not a reliable revenue source, and the ethics of such an arrangement are a concern, Gros said.

"We'd be benefiting from tobacco usage," he said. "Ethically, we'd prefer not to go there."

The doctors group has thrown its support behind Senate Bill 2243, authored by Sen. Judith Zaffirini, D-Laredo, which would provide repayment assistance to doctors of up to $140,000 over a four-year period. The legislation also would offer similar assistance to dentists.

Local clinic directors, however, think the Texas Health Care Access Fund is a good idea.

"I envision us being able to have more applicants with the loan-repayment program," said Lucy Ramirez, executive director of Nuestra Clinica del Valle.

Nuestra Clinica, which has nine sites in the western portion of the Valley, currently has three doctor vacancies and two dentist vacancies, Ramirez said. The vacancies limit the number of patients for which the clinics can care, she said.
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Melissa McEver covers health and environment issues for Valley Freedom Newspapers. She is based in Harlingen and you can reach her at (956) 430-6252.