How the School of Medicine built a primary care pipeline to address physician shortages

(SACRAMENTO)

America needs more primary care doctors. And UC Davis has built a model to help address the shortage.

The successful effort was on full display last month at Match Day: Half of the School of Medicine's graduating class of 2026 will train in primary care residencies.

Few other medical schools prepare a larger share of students for careers in primary care fields, which include family medicine, pediatrics and internal medicine.

In fact, of the roughly 200 medical schools in the country, the UC Davis School of Medicine is grouped with 15 other institutions in the top tier ranking for primary care the past three years, based on U.S. News & World report data published last week. When U.S. News last reported individual school rankings in 2023, UC Davis was at the No. 6 spot for primary care.

Students are often drawn to UC Davis because of its strong emphasis on primary care. One of those is Abigail Vidrio, a first-year medical student from Orange Cove, a majority Hispanic town of fewer than 10,000 residents southeast of Fresno.

Abigail Vidrio, center, surrounded by parents Maria and Miguel Vidrio, at her medical school induction ceremony. Vidrio aspires to become a family medicine physician in her native Fresno County.

She remembers a childhood with long drives to see a doctor and encountering crowded clinics and cultural barriers to care. In her teenage years, she would wake up at 4 a.m. to prepare her grandfather for his dialysis regimen.

"After each appointment, it became more apparent that accessible, quality care was a luxury rather than a right in communities like mine," Vidrio recalled.

"My goal is to return to Fresno County and work in rural communities and make health care a little bit more accessible to people in the community," she added.

The primary care commitment goes back to the school's founding in the 1960s: The California Legislature created the medical school to help alleviate physician shortages in Northern California, especially outside major cities. Over the years, the school strengthened that purpose through mission-focused admissions policies. More recently, it developed unique programs and academic tracks centered on primary care that have gained national attention.

"Our founding mandate or mission is to train the physicians California needs; that's our goal," said Mark Servis, the vice dean for medical education. "And if primary care is the greatest need, then we want to excel at it."

A mission rooted in community need

The rise of UC Davis as a primary care powerhouse is closely tied to the needs of the communities it serves. Located in Sacramento, the school serves vast rural regions and pockets with limited access to health care in the northern and central valley areas.

Six decades ago, state officials recognized the location as key to serving patients in a 33-county area that other public medical schools couldn't reach. That commitment solidified even more in the late 1960s and early 1970s when the Sacramento County Hospital was part of UC Davis Health.

"Access to physicians was a big issue back then, and the shortages were the most acute in primary care medicine," Servis said.

"The feeling was that UCSF, UCLA, UC San Diego and UC Irvine were all doing a pretty good job of training specialists," he noted. "The hope was that UC Davis would get more primary care physicians into the interior of California."

From its inception, the UC Davis School of Medicine endeavored to deliver medical education with that focus. The school selects many applicants committed to primary care, exposes them to primary care mentors and emphasizes primary care experience in third-year clinical rotations, commonly known as clerkships.

The significance of primary care medicine

Primary care physicians are the linchpin of the health care delivery system.

These doctors often serve as the first point of contact for patients. They build trusted, long-term relationships and coordinate care with specialty providers to ensure continuity. They also improve access for underserved populations. In addition, primary care physicians play a vital role in communicating medical information in a clear and supportive way, which helps patients stay on medications and follow prevention tips.

Medical school graduates who go on to become primary care physicians are required to spend three years in a residency training program.

Those who choose internal medicine, for example, will work in outpatient clinics, while others will become hospitalists rounding on patients in medical centers. Many others enter internal medicine residency as a springboard to subspecialty training, fulfilling requirements needed to then move into fields such as oncology, cardiology, and nephrology.

Those who enter family medicine, however, are more likely to spend their careers practicing the full scope of primary care, including caring for children and adults and delivering babies.

Their breadth and depth of practice is especially valuable in medically underserved communities that lack pediatricians and obstetrician-gynecologists.

Family medicine: Caring for patients "from cradle to grave"

"We hold patients' medical histories from cradle to grave and partner with them over their lifetimes to ensure good health," said Micaela Godzich, a clinical professor in the UC Davis Department of Family and Community Medicine. She adds: "We're often the first person to identify life-threatening conditions, we counsel them on preventive care, and we celebrate when they manage their chronic diseases effectively."

Primary care doctors have proven to reduce health care costs by keeping patients healthy and minimizing the need for emergency and surgical care.

Nearly all adults with regular primary care access receive cost-effective preventive services versus about 68% of those without regular access, according to a recent report. The work was co-funded by The Physicians Foundation and the Milbank Memorial Fund.

The report, developed by researchers at the American Academy of Family Physicians' Robert Graham Center, also found primary care access was linked to 11% fewer emergency department visits and 20% lower odds of hospitalization.

Unlike most medical schools, UC Davis requires students to complete a five-week clerkship in family medicine, in keeping with the school's mission, said Kris Srinivasan, clinical professor in the Department of Family and Community Medicine and director of its medical student education program.

"UC Davis is unique in that family medicine is generally held in pretty high regard here," Srinivasan said, "which I don't think is necessarily true at a lot of other academic institutions."

Family medicine students can select from many clerkship experiences. Some will focus on reproductive health, others will be assigned mentors at the Sacramento County Health Center, which serves a large Medi-Cal population. Some students will learn about gender-affirming care in Sacramento while others will spend several weeks in far Northern California to treat patients in rural communities.

UC Davis is home to ACE-PC, the only medical school program on the West Coast that allows students to graduate in three years to help fill the urgent need for primary care physicians in California.

Medical education tailored to community needs

UC Davis also stands out from most medical schools in how it offers academic options for students to practice where the need is greatest: among underserved communities which lack access to primary care.

Nearly a third of students choose to join a pathway that trains them in how to care for specific populations. The learning starts in the classroom and extends into rural and urban underserved areas.

"We are innovative, and the pathway programs we've created are the most expansive in the country," said Vice Dean Servis. "It's because of this programming that we're ranked so highly."

Most of the pathways were launched with seed money from the state and earmarked for a University of California initiative called Programs in Medical Education (PRIME). The pathways are meant to address specific needs among underserved communities determined by each campus. UC Davis has continued to add pathways and now offers seven.

The school's PRIME pathways focus medical education by region or population groups, including:

• The Central Valley
• Urban underserved patients
• Rural communities
• American Indian and Alaska Native populations
• The Central Coast

In addition, UC Davis hosts the only program on the West Coast that allows medical students to complete their education in three years instead of four, so they can more urgently fill the need for primary care physicians.

ACE-PC, short for Accelerated Competency-based Education in Primary Care, was established in partnership with Kaiser Permanente in 2014.

Its success led to the launch of a new pathway this year, Rural ACE-PC, which relies on community partnerships to host UC Davis students at clinical training sites in Shasta, Nevada and Humboldt counties. The end goal of the new track is to boost the local primary care and psychiatry workforce in places such as Redding, Grass Valley, Nevada City and Eureka.

"It is deeply fulfilling to work at a school that places primary care at the heart of its mission and as a core expression of its values and responsibility to our communities," said Alicia Gonzalez-Flores, the ACE-PC leader and an internal medicine physician.

A common thread links pathway students

Many students who study primary care at UC Davis can relate to health inequities because they grew up in households with government insurance, or no insurance at all. Some were expected to serve as interpreters for their parents at medical appointments.

Having experienced barriers to care is a motivating factor for wanting to provide care for underserved and vulnerable populations.

"If you grew up on Medi-Cal, you understand how such patients struggle to access care because many primary care practices don't accept patients with Medi-Cal," said Mark Henderson, the UC Davis dean of medical school admissions who also teaches hands-on doctoring skills to students and residents.

Abigail Vidrio, in her first year at the UC Davis School of Medicine, is part of REACH, the pathway to boost the number of physicians in the Central Valley.

She is eager to be the kind of barrier-breaking doctor she rarely saw while growing up.

The aspiring family medicine physician wants to provide preventive care, health education and help patients manage their medical needs.

"This is very important to me" she said. "Every time I go back home and see the community I'm going to help, it just reignites my passion and reminds me why I'm doing this."