Local doctor cuts his retirement short to help address ongoing primary care shortage in Santa Cruz County

Last summer, Dr. Frank Ravago made the tough decision to close his family medical clinic in Watsonville and retire after working as a primary care physician for nearly 33 years. 

Ravago had built a community in his South County clinic, caring for every patient like a member of his own family. He, along with five other family doctors, treated nearly 1,700 patients. But maintaining an independent practice was becoming too financially difficult, Ravago said. 

When Ravago retired, many of his patients faced challenges finding a new doctor, as other clinics either weren’t accepting new patients or didn’t accept their insurance. 

Ravago’s retirement didn’t last too long. 

Nearly three weeks after hanging up his white coat, Ravago said he was approached by members of Watsonville Community Hospital’s leadership team to talk about how to expand access to primary care for local residents. 

The Pajaro Valley Health Care District, which owns the hospital, was getting ready to launch a new primary care clinic in Watsonville in early 2025. For Ravago, coming out of retirement to help launch the new clinic was a no-brainer.  

The community needs access to health care, he said. Primary care is not just treating patients for high blood pressure, diabetes or a common cold, it’s about educating community members about the services that are available to them, Ravago said.

Santa Cruz County, much like the rest of the country, is facing an ongoing shortage of primary care physicians, driven by a variety of factors. 

Locally, the high cost of living in Santa Cruz County has created a challenge for Watsonville Community Hospital and other local health care providers to recruit and hire doctors, said Watsonville hospital CEO Stephen Gray. 

For the third consecutive year, Santa Cruz County was named the country’s least affordable rental market. That’s a major problem, said Ravago. It’s not that there aren’t new family doctors fresh out of residency or medical school looking for jobs, he said; rather, it’s a matter of whether they can survive living in this county. 

The state’s primary care workforce is also aging. Nearly 20% of California’s physician workforce is 65 or older, and at least 22% of the workforce is between the ages of 55 and 64, according to an annual report from the Healthforce Center at UC San Francisco. 

Yet as primary care physicians reach retirement age, they are no longer being easily replaced by younger doctors fresh out of residency, said Nancy Gere, spokesperson for Watsonville Community Hospital. 

Medical students rack up an average of nearly $300,000 in student loan debt, and many are forgoing family medicine and instead choosing to train in speciality fields, such as cardiology or surgery, that offer more lucrative salaries and insurance reimbursements, said Ravago. 

“A lot of them think that specialty medicine is the way to go because it pays more,” he said. Ravago often tells young doctors that if they plan to go into primary care or family medicine that they need to be passionate about the profession, or they’ll be disappointed. 

Primary care providers are reimbursed by Medicare and private insurance companies at lower rates than specialists, said Ravago. In the 33 years that he’s been practicing medicine, Ravago said reimbursement rates for family doctors have continued to decrease by almost 3% every year. And whatever Medicare does, private insurance companies follow, he said.

The fee-for-service reimbursement model — in which health care providers are paid separately for each service, test or procedure they perform — often pays more for single procedures compared to the ongoing comprehensive care provided by primary care physicians, according to a report from the Robert Graham Center for Policy Studies in Primary Care. 

“What we tend to find is that when we do find a physician who is a good fit, they often have ties here,” said Gray. “Whether it be family or a spouse who grew up here, and they want to come back to take care of their community.” 

That was the case for Shannon Nicol Clasen, a nurse practitioner with more than 13 years of experience. Clasen, a Santa Cruz native, joined Ravago as the second primary care provider at the clinic in June after spending more than a decade treating patients in New Orleans.  

Clasen told Lookout that she always knew she wanted to return to Santa Cruz to be closer to family and serve the community where she grew up. “There’s definitely, even in Santa Cruz County, a shortage of primary care services,” she said. 

One of Clasen’s goals is to ensure that community members don’t end up in local emergency rooms or urgent care centers to receive treatment for issues like sore throats or rashes, she said. Emergency rooms should be the last resort when pain or illness gets too unbearable. At a clinic, primary care providers like Clasen and Ravago are there to prevent patients from getting sicker, she said. 

Ravago understands that finding a solution to the primary care shortage, at least locally, is a long-term effort. “It’s always going to be difficult from the very beginning, but if you know how to approach a problem, you’ll be able to solve that,” he said. 

While managing his private practice, Ravago told Lookout that he was able to recruit primary care doctors and specialists who have chosen to stay in the community and build their own practices. It’s a skill he’s excited to bring to the Coastal Healthcare clinic, in order to bring more primary care physicians to the area.  

A short-term goal Ravago has for the clinic is to recruit at least five doctors. He’s giving himself, at most, a decade to attain that goal, he said — meaning Ravago’s official retirement won’t happen anytime soon. “I always say that that question [of retirement] is always going to be answered by him,” Ravago said while pointing a finger up toward the sky.  

Ravago told Lookout that it takes years for a doctor to get acquainted with the community and to build a self-sustaining practice — especially fresh out of residency. Ideally, once a doctor has built up his or her patient list, it’s time to bring in another doctor or nurse practitioner, he said. 

At the rate he and Clasen are going, Ravago said it’s possible for the clinic to start recruiting more doctors to work there. The two have been able to create a welcoming environment with their patients, and are ready to accept more. 

Another possible way to bring more physicians to Santa Cruz County is to train them in clinics and hospitals and hope that they stay, Ravago said. 

Before working at Coastal Healthcare, Ravago would always welcome medical students and residents to do a rotation at his private practice to show them what working in primary care looks like. “I open my practice to students,” he said. 

Ravago added that over the summer, he had a student from UC Los Angeles do a rotation at the Coastal Healthcare clinic. Allowing the students to witness first hand the demand for primary care is the best approach, he said. In the past, medical students who have expressed interest in pursuing a speciality have decided to enter primary care instead after spending two months at Ravago’s clinic. 

Gray told Lookout that Watsonville Community Hospital is currently in its second year partnering with Dominican Hospital’s family medicine residency program. The three-year program aims to increase the number of local and diverse practicing physicians and improve access to health care. He added that as the program — which started last year — continues to welcome more residents, Gray hopes that the hospital and other health care organizations in the county will be able to keep those physicians practicing locally. 

“I think we’re using all the same kind of tools that everybody else is using trying to find those primary care physicians to come in and fill gaps,” Gray said. 

UC Santa Cruz is also in the early stages of exploring the establishment of a medical school on the campus to increase career pathways for its students while addressing the shortage of primary care doctors in the county and aiming to help the school solve its longstanding budget challenges. While those plans are a bit more long-term, the university has partnered with UC Davis to launch a new medical program, set to begin in 2027, focused on bringing students to the Central Coast. 

“We’ve been in those conversations from the beginning,” said Gray. “We hope and plan that we can work with UCSC to make sure that Watsonville Hospital and the Pajaro Valley Health Care District are a part of that plan with the idea that you will be able to train some of those new doctors here, and keep them here in the community.” 

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