Ethan Epstein is associate editor of The Weekly Standard.

PALM SPRINGS, Calif. — This desert resort town some 100 miles east of Los Angeles, in the sprawling Coachella Valley, is known for many things: Its spectacular setting, nestled next to towering Mount San Jacinto; its vibrant gay and lesbian community (fully 100 percent of the City Council identifies as LGBT); and its midcentury modern architecture. It’s also known, perhaps above all, as a haven for old people: The median age here is about 54, compared with 36 for the rest of California.

The age skew certainly has positive effects—crime, for example, is very low—but also presents its own challenges. For example, geriatric populations have their own unique medical needs, and require a robust physician population to support them. But for myriad reasons, the area has long suffered from a dearth of physicians: “Some pockets of Coachella Valley have one physician for every 9,000 patients, whereas the normal ratio [throughout the country] is one physician for every 2,000,” says Dr. Gemma Kim, a physician here. The result? Either endure long waits to see physicians, or travel far to an area with more of them—not necessarily an easy task for older people. The other option, of course, is to forgo necessary medical care.

This shortage is not unique to Palm Springs. The entire surrounding county of Riverside—with 2. 4 million people it is the 11th largest in the nation—is suffering from a doctor shortage and it is affecting every segment of the county’s demographically varied and rapidly growing population. The county, which boasts a bumper crop of distribution centers for companies such as Target and Amazon, piled on 644,000 new residents in the 2000s. But the county is little more than a vast bedroom community, with scant economic development of its own. Residents endure long commutes into Los Angeles or Orange County simply because housing is so much more affordable out here. As one local resident put it to me, “Often, when I ask people why they moved here, it’s the same story. They drove east from Los Angeles and stopped as soon as they could buy a home.”

But what they gain in housing affordability, residents lose in access to medical care. Riverside County has fewer than 35 primary care physicians for every 100,000 residents. Los Angeles County, by contrast, has 48 primary care docs per 100,000, which is still considered too low. The San Francisco Bay area is home to a more robust 64 primary care doctors per 100,000 residents. Drill down into specific fields of medicine, things look even worse: There’s one pediatrician for every 2,800 youngsters under the age of 5, for instance. That’s six times lower than the rate for the state of California as a whole. The effect of this shortage on the health of the population has been disastrous. Riverside’s death rates from cancer, liver disease, and heart disease are well above the state average, for example. In 2016, the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation ranked each California county by overall health outcomes, and pegged Riverside at 40th out of 57. (Fellow Inland Empire counties San Bernardino and Imperial counties fared even worse.)

The University of California-Riverside and its associated residences are poised to tackle the city's dramatic doctor shortage: just 35 doctors for every 100,000 residents. | Mark Peterson/Redux Pictures for Politico Magazine

But soon, local residents may be able to see more doctors locally, thanks to the new medical school at the University of California, at Riverside (UCR) and its associated residencies. (The city of Riverside is about 50 miles west of Palm Springs.) UCR’s medical school, the brainchild of the region’s top education and public health officials is predicated on one big idea: growing new doctors in Riverside County and making sure they stay here. A strategic set of incentives—chiefly, free medical education for those who agree to practice in the region, and local residencies embedded in the community—will appeal to not only debt-stressed millennials but also be a boon to the region’s health.

In June, UCR graduated the first class of doctors from what Dr. Michael Nduati, the school’s senior associate dean for Clinical Affairs, calls its “community-based medical school.” To that end, UCR has focused laser-like on its commitment to increasing the physician population in the area. Unusually, moreover, UCR’s medical school has no teaching hospital, so its residents are instead based at local community institutions. “Everything is in partnership with community health providers,” Nduati says, noting that its residents are embedded at “all local hospitals ... all over Riverside County.”

Michael Nduati, the UCR medical school’s Senior Associate Dean for Clinical Affairs. | Mark Peterson/Redux Pictures for Politico Magazine

That would include here in Palm Springs, which since 2015 has hosted a family medicine residency program attached to the Desert Regional Center Hospital. The program is headed by Dr. Kim, the residency’s founding director.

Kim says that historically, it’s been very difficult to lure physicians for the long haul precisely because of the region’s demographics. The doctors who did move here tended to be “towards the tail end of their careers when they would come out here,” she says. But now that’s beginning to shift, she says. Evidence of that abounds in this very residency: Some young residents have bought homes, a clear sign of their commitment to the area. Teresa Koo, who will graduate later this year as part of the Family Medicine Residency’s first class, tells me that she too plans to stay in the area.

If UCR’s programs induce physicians to stay in Riverside County, it could have a serious positive effect here—as well as demonstrate a way for other doctor-deprived parts of the country to attract and keep the medical personnel they need. The program could serve as a model for other parts of the country with grievous physician shortages: the Mountain West, in states like Idaho and Montana, as well as large swaths of Appalachia like southern West Virginia.

To that end, Mark Huelsman, a senior policy analyst at the think tank Demos, who focuses on student debt, says “we’ll see more and more” programs like Mission Scholarships. “There’s everything right with an institution looking at a labor market shortage” and trying to ameliorate it. “Free education is an obvious carrot.”



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Of course, it can be hard to disentangle the various factors—economic, social, environmental—that lead to deleterious health outcomes, but everybody I spoke with agrees that the doctor shortage has been a serious contributing factor.

And a big reason for that shortage, the local medical community long ago determined, was that Riverside did not have a medical school of its own.

Riverside is known for its mid-century architecture, beautiful setting, vibrant gay and lesbian community and unusually high median age. | Mark Peterson/Redux Pictures for Politico Magazine

In fact, what it did have was a program that may have even encouraged local doctors to leave the area. Starting in 1974, UCR operated a joint program with UCLA in biomedical sciences, serving about 25 students a year. The way it worked was, students did their first two years of medical school in Riverside; they then went on to UCLA, from which they graduated. The upshot? Graduates of this program, seduced by the siren song (not to mention, higher salaries) of coastal California, invariably did their residencies in Los Angeles and its environs, and then would settle there as well. Rarely did they return to Riverside.

UCR’s associate dean, Michael Nduati, a graduate of the UCR-UCLA program himself, was one who did return. Cognizant of the way that program was draining Riverside of medical talent, “the region wanted [its own] medical school,” he recalls.

In 2008, after years of preparing and lobbying, the region got its wish: The University of California approved the new medical school, which would be the system’s sixth, and the first one to open since the 1960s. Unfortunately, that approval came right around the onset of the Great Recession, an economic calamity that had a particularly blunt impact on California, home to a major housing bubble (centered largely on the Island Empire). The UC system’s budget was slashed (about $900 million in state funding was cut from 2008 to 2012), and the medical school’s opening was put on hold.

The new medical school welcomed its first class, of 50 students, in 2013. | Mark Peterson/Redux Pictures for Politico Magazine

But, in a testament to the deep well of support for the school, then-Dean G. Richard Olds was able to put together $100 million in support over 10 years, from local donors, the county and foundations. Nonfinancial donations were also secured: For instance, UCR’s medical school owns several incredibly sophisticated dummies, which students practice medical procedures on. (Yes, if you prick them, they bleed.) These were given to the school by the likes of the Kaiser Foundation.

The new medical school welcomed its inaugural class of 50 students in 2013. This year’s entering class had 70 students; the plan is to eventually go up to 125 students per class.

Recognizing the profound medical needs of the area, the medical school will focus on basic fields: family medicine, obstetrics and gynecology, psychiatry, pediatrics, general surgery, and internal medicine. As of now, it does not teach pricey specialties like oncology or anesthesiology. And in a bid to reduce the hypercompetiveness that plagues other medical schools, UCR decided that the first two years of its program would be pass-fail rather than graded. Clinical rotations—where students embed with local doctors—also begin in the first year. At most med schools, they commence in year three.

Opening a new medical school is a major undertaking, but two factors made the process a little easier than it might have been elsewhere. For one, because of the prior UCR-UCLA joint program, there already were a significant number of medical school faculty in place at Riverside; moreover, UCR had already operated a curriculum covering the first two years of medical school. The program, in other words, didn’t need to be fashioned out of whole cloth.

Second, and unique among the UC system’s six medical schools, UCR would not have a medical center, meaning no teaching hospital. The benefit of this was twofold: For one, it would result in major cost savings—running a hospital is nothing if not expensive. And UCR would also use the lack of a medical center as an opportunity to further its community focused mission: All of its residents would be embedded in local health institutions, including many that serve indigent populations.

Because of its particular ethos, UCR’s medical school and its residencies have tended to attract a specific kind of medical student. “All of the students and residents are here to serve the underserved,” says Dr. Gerald A. Maguire, associate dean of graduate medical education at UCR. Meetings with students seem to bear this out.

“All of the students and residents are here to serve the underserved,” says Dr. Gerald A. Maguire, the associate dean of graduate medical education at UCR. | Mark Peterson/Redux Pictures for Politico Magazine

Take Antonio Garcia, one of 12 children, who is midway through his second year at UCR’s medical school. Garcia, who grew up in Anaheim in Orange County, had actually thought he would be a professional boxer, just like several of his siblings. But a program for gifted students at his high school set him on the path to college at the University of California at Irvine. There, a chance encounter with a group called Chicanos and Latinos for Community Medicine pointed him toward a doctor’s degree.

At UC Irvine, “medical students and physicians would come and talk to [Chicanos and Latinos for Community Medicine] about health care disparities,” he recalls. There, he learned that “5 percent of the physician workforce is Latino even though Latinos make up [a plurality] of California residents ... that got me thinking about going into medicine.”

Image Antonio Garcia at play sparring in the gym, top, and at work with a simulation medical dummy, lower right. | Mark Peterson/Redux Pictures for POLITICO Magazine

Garcia was attracted to UC Riverside because, unusually, it offers a joint MD/Master’s degree in Public Policy. (It’s one of only three med schools across the country to do that.) This would provide a way for Garcia to serve his community beyond simply practicing as a physician: “As physicians, we can’t really control much of the environment [around patients,]” he says, even though environmental factors are a huge determinant in health. By combining an MPP with his MD, he hopes to shape the broader factors—air and water quality; access to health insurance—that affect the health of his neighbors.

Kleshie Baisie from Upland, about 30 minutes from Riverside, is another second-year student at UCR’s medical school. Baisie, the daughter of immigrants from Ghana, was an academic high performer who had originally thought she would go into research. Baisie says she has a “strong interest in social justice,” which motivated her to get a master’s in public health from the University of Southern California after finishing her undergrad degree at UC Irvine. She says after that, she wanted to be in a position in which she could “affect people on an individual level,” and that motivated her to go to medical school.

She says she chose UCR because she’s always community-minded, and the medical school aligned with that. “I’ve always been really passionate about the community around me,” she says. “I really like UCR because they are making an effort to take care of people here in the Inland Empire.” As a local, Baisie has suffered from the doctor shortage firsthand. “Just to get my own health care, a lot of times, I’d have to go to Los Angeles County to see certain specialists,” she says. That “UCR is focusing on people here [is great],” she declares.

The ethos of public spirit applies to UCR’s faculty and administrators as well. Take Dr. Deborah Deas, who became dean of the medical school in 2016. (The founding dean, G. Richard Olds, departed shortly after the med school got off the ground.) Deas, a black woman who grew up on a farm in rural South Carolina, went on to become a leading researcher in child psychiatry, and then a celebrated med school administrator. Deas said she was moved to take on her role at UCR precisely because of its mission.

“When I read the school’s mission,” she says, “to train a diverse physician workforce; to develop clinical as well as research programs; to serve the people of Inland Southern California, which are predominately underserved populations, I just couldn’t believe it, because this has been a lifetime of what I’ve believed in, what I’ve worked toward, and what I’ve been an advocate for.”

She took to the area as well. “I was invited here to Riverside [in 2016]” Deas recalls. “This was my first time in Riverside, I took some time to just walk around the area. It just really felt right. The people I met; the student groups I met.” Her arrival at UCR really felt like “divine intervention,” she said.



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UCR’s grand plan to keep doctors in the area has two major prongs. The first are Dean’s Mission Awards, which waive all university tuition and fees for graduates who agree to practice medicine in the area. (They do not have to do their residency here, they simply have to return.) These awards are funded by foundations and individual donors. Crucially, should the grads renege on their promise to stay at least five years, the grants automatically convert into loans.

Kleshie Baisie is one of those Mission Scholars. She describes how the program works: “[After graduation] I’m allowed to do my residency anywhere I want, but when I began practicing, for the first five years, I have to do it in the Inland Empire.”

“It’s nice that I don’t have to deal with certain financial worries,” she says with a hint of understatement (these days, the average medical student graduates with $166,000 in student debt). There are 38 UCR med students currently on these fellowships.

Class in session on the UCR campus, top. Below, Paul Lyons, the head of UCR’s department of family medicine. | Mark Peterson/Redux Pictures for POLITICO Magazine

But it’s not just by offering carrots like free education that UCR has strategized to get doctors to stay local. It has also focused on building a student pool that is likely to remain. Part of this is self-selecting, of course: As discussed above, the school tends to attract students with a strong sense of social mission. But UCR has also designed an admissions program with an eye toward people who already feel tied to the area. For one, 100 percent of its students come from California. And most (though not all) have ties to Riverside County or at least the broader Inland Empire.

UCR has also worked to diversify its medical school, a mission it laid out in its charter. The first graduating class comprised roughly 20 percent underrepresented groups in medicine (Latino, black, and Native American) and nearly half were disadvantaged in some form (English as a second language; grew up in a poor area; went to underperforming high schools etc.).

After graduation, a quarter of the newly minted physicians elected to do their residencies in the Inland Empire; the long-term goal is to get that number up to 50 percent. Of course, that UCR’s first graduating class achieved 100 percent residency-match is in itself a feat: The process of matching graduates with residencies is a complicated one, and in many cases across the country, graduates fail to find a slot. Dean Deas takes particular pride in the fact that nobody from UCR’s first graduating class was left in out in the cold.

The second long-term strategy to build a more robust doctor population in the area is the residencies themselves: That’s because medical residents often end up putting down roots. The theory, then, is that the residencies will be part of what Gemma Kim of Palm Springs calls a “pipeline,” which will end up supplying doctors for the area for years to come.

Since its inception four years ago, UCR has built a robust residency program of some 110 slots across a number of hospitals and clinics throughout Riverside County. Of course, without its own teaching hospital, that puts the school at somewhat of a disadvantage.

“We are the Blanche Dubois of medical residencies,” allows Dr. Paul Lyons, chairman of the department of family medicine at UCR, “we are entirely dependent on the kindness of strangers.”

Theresa Khoo, a resident at UC Riverside Health Family Medicine in Palm Springs, seeing patients, top left. A patient receives assistance with a sling at UCR's Citrus Tower, top right. Below, UCR residents visit with a patient at Riverside Community Hospital. | Mark Peterson/Redux Pictures for POLITICO Magazine

It hasn’t always been easy embedding new residencies programs in extant medical facilities, which have long established procedures and staff. “It’s a 24/7 job to match what we are doing with the community’s perception of what their needs are,” Lyons continues.” Some days it goes well, some days it doesn’t go well ... We have had lots and lots of blowups over the seven years. We are in a rapidly cycling marriage-divorce relationship with all of our partners.”

One marriage that does seem to be going well—perhaps because it’s still in the honeymoon phase—is a new OBGYN residency at Riverside Community Hospital, just south of the city’s quaint Mission-style downtown. That residency, which holds four slots, just launched last fall.

Dr. Mikio Nihira, who founded and now directs the program, says that “he has not met any resistance to bringing his residents into the hospital,” which he admits was a “concern.” The residency was like “any other start up, [requiring] a lot of just building relationships and building trust, and honoring that trust ... It requires a whole lot of maintenance and direct communication.” He notes that the residency has actually allowed the hospital to increase the services it offers, simply because now there is always a supervising physician on hand.

Dr. Nihira wants to make sure that the program doesn’t suffer from the problems that plague many other residencies: Punishing schedules; low morale; even suicides. (In our interview, Nihira noted that some 100 medical residents kill themselves each year across the country.) He’s put a focus on what he calls “resident wellness.”

Dr. Trina Mansour, the daughter of immigrants from Afghanistan, is a graduate of UCR’s first medical class. She’s also now enrolled in Dr. Nihira’s OBGYN residency. Her brother is also a physician, and he warned her that residency would be stressful and miserable. Not so, says Mansour. The schedules are reasonable, she says, and we “communicate very openly.” The hospital holds wellness events for the residents to “decompress, to talk.” The upshot? “I don’t feel overwhelmed at all,” she says.

If the goal is to increase the number of obstetricians in Riverside, it appears to be working as well: “I definitely see myself working here in the future,” Mansour concludes.

She’s not the only one. Dr. Ceyda Zarifi, a UCR resident in internal medicine at Riverside University Health System (a safety net hospital in suburban Moreno Valley that largely serves Medicaid patients), grew up in Germany. But having now been exposed to the Inland Empire through her residency, she plans to be here for the long haul. (She went to medical school in Southern California at the Western University of Health Sciences in Pomona.) The same goes for Dr. Doug Grover, a UCR resident in psychiatry at the same hospital. Grover, who grew up in Riverside, and who graduated from UCR’s medical school as part of its first graduating class, plans to stay local as well.

UCR’s residents also make significant effort to not stay cloistered in their medical facilities—they work in the community at large. Dr. Edward Lin, the son of Taiwanese immigrants, is also a resident in family medicine at Riverside University Health System. “We have a lot of different programs that reach out to local high school students,” he says. “We speak on panels for even as young as elementary and middle school kids, to start [generating] that interest in science and in health ... there’s a ton of outreach that we’re doing.”

The Palm Springs residency is similarly outward looking. It has a program, for instance, called Street Medicine: “Every third Friday, we go out to a local church that’s doing a food event,” Teresa Khoo explains, “and basically we provide basic health care and answer questions.” The clinic is also in the process of buying a van, which will allow it to increase the care it provides (it will be able to perform minor medical procedures in the van). The residents are also involved in teaching sex education in the local public school system. That the typically territorial public schools are allowing residents to teach sex ed speaks to the community really embracing the program, Dr. Gemma Kim says. No signs of an imminent divorce there.

Antonio Garcia and siblings Mary and Gerardo (left to right) with their two dogs, overlooking their Inland Empire home. | Mark Peterson/Redux Pictures for POLITICO Magazine

Some areas have tried similar programs, though they tend to be less well designed. New York State’s Excelsior Scholarships, which provide free college, for example, are simply too blunt. They apply to any college student in any field, and they lock people into the state of New York. That’s a bad idea, given that New York is part of a tri-state economic area encompassing Connecticut and New Jersey, and that it ties people’s hands. (E.g., What if they get a good job offer in California?) It is the precision of UCR’s program—only for doctors, and only to meet a specific need in a specific area—that could prove so effective.

In a broader sense, the replication of programs like UCR’s could also help jump start the economy, given that so many young people are hobbled by student debt. Medical graduates’ “ability so save money and spend money are constrained,” policy analyst Huelsman says. Should recent graduates be able to get out from under their massive debt load, they’ll sooner be able to start families, and buy homes and cars. Of course, the ability to replicate it is in doubt at a time of reduced funding for public education. There’s a reason, after all, that the Mission Scholars are funded privately, and not by the UC system.

Ultimately, of course, the doctor population of any given area will be tied at some level to the general desirability of it as a place for middle-class professionals to live. Credit UCR for working creatively to overcome that challenge. The Inland Empire may never have the glamour of Los Angeles or the tech riches of San Francisco. But if all goes to plan, at least it’ll have its health.