Syed Alishan Nasir, a fourth-year medical student, recently completed a clinical rotation at Norwalk Community Health Center, which, like other community health centers, treats many low-income and underserved residents.
The experience further cemented Nasir’s idea to one day become a primary care physician and work in a similar setting, but said he and others face significant barriers to going into primary care, which typically doesn’t pay as much as other specialties.
“The financial aspect of primary care is definitely one of the biggest deterrents that we, amongst ourselves, discuss about when we talk about, when we think about what career we want to go into,” he said at a recent legislative caucus meeting in Hartford.
Providers at community health centers said a combination of lower wages, difficult work, and a lack of financial incentives for clinicians in the state is preventing centers from attracting the doctors they need.
As experts in the field predict a national physician shortage in the next decade, Connecticut health providers like Dr. Cynthia Feher, associate program director at Norwalk Hospital, said issues with recruiting and retaining primary care physicians will affect communities and their patients.
“I love it [primary care], but I can’t make it fun enough,” she said. “So, how do I increase the workforce, how do I hire more people, convince more people to stay with me?”
A U.S. Department of Health and Human Services report projects that by 2025, Connecticut will be short about 4.7% of primary care physicians needed to meet demand. Meanwhile, the report estimates that other New England states such as Maine, Massachusetts, New Hampshire and Vermont will sufficiently meet demand.
Nasir said finances, especially loan debt, remain a significant concern among medical students as they consider where to do their residency training and continue their careers. For example, Nasir said he will graduate with more than $300,000 in debt -- he also supports a family.
Given the average lower salaries paid to primary care doctors, Nasir said choosing to practice primary care in a state like Connecticut, which paused its loan repayment program for clinicians about eight years ago, becomes a tough choice.
“When I’m deciding to work, and what place I’m choosing to go to work, what do you think would be more appealing to me?” he asked. “A place that offers assistance for loan repayments versus a place that doesn’t? So, I think the answer becomes pretty obvious.”
The now frozen Connecticut Student Loan Repayment Program was designed to address health professional shortages and disparities in health care access. It repaid a portion of a physician’s loan debt in exchange for that doctor’s work in medically underserved areas.
But for now, the state Department of Public Health website advises physicians to seek out federal assistance programs instead.
Sen. Saud Anwar, who is a doctor, said at the recent caucus meeting that the primary care field is being harmed.
“Not only the next generation is feeling it more difficult to be a part of it,” he said, “and then the ones who are actually in primary care, they feel that they’ve become more data entry personnel, rather than actually taking care of the people and humans that they were trained to take care of.”
Anwar said he and other legislators are looking at ways to revisit the status of the former loan assistance program in 2022.
But for now, Dr. Suzanne Lagarde, CEO of Fair Haven Community Health Care, said there’s a deeper, ongoing issue -- a general lack of resources and money going into supporting the primary care field.
“If you can infuse those dollars into primary care, and there are a number of ways to do it,” she said, “but by whatever vehicle, if you infuse more, you will get more, you will save more, you will have better clinical outcomes. It will allow us to pay people like this young doctor here a fair salary. So, we have some real problems.”