Grant will help New Jersey medical student work in pediatrics among needy

Aspiring pediatrician Claudia Clarke will be loaded down with $210,000 in loans when she graduates in June from the University of Medicine and Dentistry of New Jersey with plans to practice medicine in depressed areas where doctors are scarce.

"I don't think that where you live should determine what kind of medical care you get," she said.

Clarke's idealism is getting some financial affirmation from the federal government. She is one of 77 medical students nationwide - and the only one in New Jersey - chosen in this year's round of grants from the National Health Service Corps, which provides incentives to increase the number of primary-care doctors serving communities in need.

The young physician has witnessed firsthand the effect of disparities in access to health care.

"I have seen a lot of disease in my own family that would have been prevented if they had good care, so it really rings home to me," Clarke said. "I have cousins with cancer that went undiagnosed, and strokes that people didn't understand how to recognize, so they went untreated."

Clarke will receive $30,000 a year during her residency in pediatrics and internal medicine, for a total of $120,000 to be used to help repay her student loans. As a condition of the grant, she must work for two years after her residency in a medically underserved area.

Clarke said she would like to do a rotation in a Native American community "because I've heard a lot about how health care is pretty limited. It's very difficult to recruit physicians, and they need a lot of help."

For years, New Jersey had a loan-repayment grant program nearly identical to the National Health Service Corps. The state's loan-redemption program provided up to $120,000 to doctors, dentists, and nurses going into primary care, in exchange for two years of service in a medically underserved community.

The program had been funded at $2 million annually but was not funded this year, said Deborah Briggs, senior vice president of health policy at the New Jersey Council of Teaching Hospitals. It is not known whether the money will be restored in the budget Gov. Christie will announce Tuesday.

The state Department of Health and Senior Services did not respond to questions about the future of the funding. But Briggs said the state's loan-redemption program is "absolutely critical for us to be competitive with other states." Restoring the program and raising its funding level "would be a step in addressing our physician-retention problem."

Studies by the council have shown the state will need an estimated 1,500 additional primary-care doctors in 2014, when the Affordable Care Act significantly reduces the numbers of uninsured and spurs demand for medical care. But exit surveys have revealed that just more than a third of doctors who complete their residencies at New Jersey hospitals decide to stay in the state.

At the UMDNJ medical school in Stratford, Dean Thomas A. Cavalieri said more than 60 percent of the school's graduates go into primary care, compared with an average of 30 percent for medical schools overall. By providing students such as Clarke with substantial assistance to repay their student loans, the federal grant removes one of the main motivations for a medical student to decide against the lower-paid primary-care route in favor of a more lucrative medical specialty.

"Historically, our payment system in terms of reimbursing doctors has emphasized reimbursement for procedures and not for cognitive skills," Cavalieri said. "When you come to see a pediatrician - to really do a good job - it takes time to do a thorough history and a thorough physical exam and careful thought in terms of what needs to be done to prevent illness and keep people healthy. Historically our reimbursement from insurance companies and Medicare has not appropriately rewarded the cognitive skills of physicians. It rather has rewarded procedural skills. So if you have surgery the reimbursement is higher, but if you go to a geriatrician or family doctor the reimbursement has been low."

This "very flawed reimbursement system" is up for major overhaul, Cavalieri said. The changes are driven in part by the Affordable Care Act, which funded the grant Clarke is receiving. But they also are driven by the need for employers, individuals, and the nation as a whole to rein in the U.S. health-care bill, which is headed to consuming more than 20 percent of gross domestic product.

A family physician might earn $130,000 to $160,000 a year. A cardiologist might make $400,000. And the pediatrician earns the least, at about $120,000. "Yet it's well-recognized that the key to an effective health-care system that is truly aimed at keeping people healthy is quality primary care," Cavalieri said.

Because pediatricians are among the lowest-paid doctors, "it is difficult in general pediatrics to make a living, especially when you have to pay back loans," Cavalieri said. Medical students who graduate with debt ranging from $175,000 to $200,000 "may not have a choice in terms of wanting to go into primary care. Fortunately, Claudia does and that is where her heart is, and so that is why we are very, very happy."

Clarke hopes to earn between $150,000 and $200,000 in pediatrics and internal medicine, "but that is being optimistic," she said. "I am interested in taking care of special-needs patients, so I'll probably earn closer to $130,000."

A number of National Health Service Corps grants have been awarded to New Jerseyans in past years, and 41 NHSC graduates now are working in areas of New Jersey where health care is hard to find.

Clarke is hopeful that if she dedicates herself to delivering primary care to those who need it, there will be other resources available to help her repay her student debt.

"I know I'm not going to be earning a lot in comparison to specialists, but making a lot of money is not why I chose this profession in the first place," she said. "So that's really something that is not going to discourage me from something I want to do."

Read more articles by health-care writer Beth Fitzgerald at www.njspotlight.com.