South of downtown San Diego’s towering skyscrapers, where hundreds of homeless people have taken refuge in large tent shelters or are languishing on the streets, Dr. Harris Niazi serves on the front lines of caring for some of the region’s poorest residents.
“We had a patient last week who just wanted to put his feet in warm water and he had soap with him,” said Niazi, M.D., assistant medical director of urgent care at Family Health Centers of San Diego. “We didn’t have to charge for that visit. We just gave him a bucket. ‘Here, sure, wash your feet. We’ll take care of you.’”
The modern, three-story clinic in the Logan Heights neighborhood provides numerous health and support services with a commitment to serving uninsured and low-income residents. It established its own residency program to help recruit and retain medical professionals like Niazi and address gaps in care.
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Most patients are among the millions of Californians who joined Medi-Cal under Obamacare, including Lorenzo Sarabia. The 74-year-old suffered a heart attack three years ago after losing his job and becoming homeless. He said the clinic is his lifeline.
“For me it’s very important because if we didn’t have that I’d probably die on the streets,” said Seravia, who spends nights on downtown sidewalks and relies on free handouts for food.
Others who seek help at the clinic have no insurance at all, Niazi said.
“We serve a large amount of homeless people," he said. “These are the people in our community and we take care of them the best we can.”
Layered beneath acute issues that draw people to the clinic, such as the flu, colds and infections, are often a multitude of complex problems.
“Psychiatric problems," Niazi said. “And on top of that the social, financial and the drug issue — that’s tremendous.”
Niazi said his job requires a special set of skills.
“It’s very easy to throw a pill at somebody and very easy to diagnose,” he said. “You read the book and it tells you, 'This is the problem, this is the management, this is the treatment.' But for patients that are non-compliant, they’re poor or they don’t speak the same language as you, you have to know how to talk to these people.”
He said that includes how to talk to people without being judgmental and learning how to listen, but most importantly, to understand where they’re coming from.
“To be able to treat them, you have to know what it feels like to be in their shoes,” Niazi said.
The assistant medical director knows exactly what it feels like.
“I was a war refugee from Afghanistan,” he said. “I came here when I was about 1 years old, and we came to project housing in the Bronx, New York.”
He grew up in poverty and watched his parents struggle with health care — in and out of emergency rooms, mismanaged chronic illnesses and language barriers. It’s why everyone at his clinic is treated as someone, he said.
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“At the end of the day I don’t think it matters to me if you’re black, white, if you’re gay, Muslim, if you’re Latino, if you’re undocumented, if you’re documented,” Niazi said. “If you’re a patient in front of me and you’re ill, I'm going to treat you the same no matter what.”
Finding dedicated doctors like Niazi to work at Family Health Centers' 23 primary care clinics in San Diego County that serve nearly 3,000 people each day is a challenge amid a growing physician shortage, said Anthony White, director of the center’s community and government relations.
“Being a nonprofit organization that provides care for free sometimes, it’s hard for us to pay competitive rates,” White explained. “There’s a shortage to start with and there’s all kinds of competition."
That’s why the center started its own doctor residency program that trains and works to retain physicians to help fill the gap. The three-year program gives medical graduates real world experience with an emphasis on improving health disparities. Residents rotate through three clinics providing primary care medicine, including at a location in San Diego's City Heights community that serves a large number of refugees.
Training also includes inpatient medicine, surgical and elective experiences at Scripps Mercy Hospital, Rady Children’s Hospital and University of California San Diego Medical Center.
“Research shows graduates are more likely to stay and practice where they trained,” White said. “We have between 800 and 1,000 people apply for six slots we have available every year.”
The rigorous interview process is not just about who has the best grades, White said.
“A lot of it, especially with our clinic, is their dedication to serving the community, and do they have that in their background, and what’s their vision for their medical career."
That’s why Sarah Matthews applied. The third year chief resident knows a medical specialty would boost her salary, but it’s not about the money, she said. It’s about helping those in need.
“I also really love refugee and immigrant health so I was really excited to come here where we have 41 languages spoken in our clinic,” Matthews said. “I was also very interested in LGBTQ health care, and we have this amazing nighttime clinic that does transgender medicine and HIV care.”
Financial tuition incentives are also available for medical students who commit to working in underserved communities. Gov. Gavin Newsom plans to expand the Obama-era funding using part of the $1 billion in Proposition 56 tobacco tax money that he’s pumping into health care.
“There has been earmarked $40 million of the Prop 56 money that is going toward enhancing and increasing the number of residency slots here in California,” said David Bazzo, M.D., president of the San Diego County Medical Society. “But one of the more important things, $190 million is going to go toward loan repayment for those physicians that go into a traditionally underserved area to practice.”
Bazzo said the timing couldn’t be better as 25 percent of California doctors are nearing retirement. Meanwhile, the number of people 65 and older in San Diego County is expected to double over the next decade, adding more strain on the health care system.
Bazzo said a physician shortage would hit underserved areas hardest.
“Typically, when you are working in an underserved area as part of a community clinic, many times the remuneration is lower for those particular practices,” Bazzo said, “because there are budget constraints that go along with that as opposed to, perhaps, some of the other systems that are in town and available.”
Niazi is a recent graduate of Family Health Centers’ residency program. It’s a place he plans to stay, he said, because it’s where he’s needed most.
“I couldn’t see myself doing anything else,” Niazi said. “I feel I’m making a difference.”
