Further fee cuts force a Medi-Cal exodus

Aside from treating patients others won't see, Strohm's clinic plays another vital role for the community: It trains family physicians who then serve in low-income areas. The state is facing a shortage of such physicians as new doctors, confronting medical school debt and other costs, opt for more lucrative practices. Strohm's clinic alone provides enough graduates each year to care for more than 10,000 patients.

Doctors at clinics with the resources to remain open say they have either stopped accepting new patients or expect to soon do so, as they have as many as they can handle. "There comes a point where you just have to say we can't be responsible for any more people," said Eric Ramos, medical director at Del Puerto Health Center near Modesto, a clinic that stopped taking new patients a few months ago. "There are a number of areas around here where nobody is accepting new patients."

Patterson resident Nona Hughes, 42, a furniture maker and mother of two who has back problems, said she called every doctor in the Modesto region listed in the Medi-Cal enrollment book. None has room for her.

"They all say they are full," she said. "Where am I supposed to go?"

Joseph Leonard, a primary care physician in private practice in San Diego, said he stopped taking new Medi-Cal patients years ago. Treating the few holdovers in his practice, he says, has become an administrative nightmare. His referrals are routinely refused by specialists because they are unwilling to work for the rates the state pays.

"I don't know of a single neurologist in the area who will see a Medi-Cal patient," Leonard said.

Jason Brown, 36, a patient of Leonard's who has debilitating seizures, has been turned away by a dozen of them, according to Brown's sister-in-law, Karie Brown, who is helping to care for him.

"I've spent countless hours calling facilities and doctors," she said. "I cannot find anyone who will see him."

Jeffrey Luther, a primary care physicianwho treats Medi-Cal patients at a clinic at Long Beach Memorial Medical Center, said he knows of only one cardiologist in the area to whom he can send Medi-Cal patients. In the town of Winters, outside Sacramento, family doctor Carla Kakutani can't find a urologist to treat an 8-year-old boy in need of circumcision after some infections.

Family doctors who treat Medi-Cal patients are spending much of their time on the phone with specialists, "begging and pleading" for appointments, said Paul Sucgang, a primary care physician at Dreamweaver Medical Group in San Gabriel.