Quick Take
Santa Cruz County already faces a growing physician shortage and a lack of diverse providers, writes Dr. Salla Hennessy, who supervises the primary care training of both resident physicians and medical students at Santa Cruz Community Health. Now, federal policy changes threaten the sort of medical training pathways she oversees. She argues that culturally competent care depends on these local physician training programs, and cuts to funding and student loans risk shrinking the pipeline even more. She calls on local leaders to push for investment in medical education pathways before all of our access to care worsens.
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“Tú eres un ángel de Dios.” (You are an angel of God.)
These are the Spanish words an 87-year-old abuelita recently used to warmly thank a Latino resident physician for his care at a primary care community clinic. As I witnessed this moment of gratitude, I was struck, as I so often am, by how much shared language and culture can do to improve the care we provide as physicians.
That’s why, as a medical educator who works at this clinic, I want people to understand the importance of supporting physician workforce pathway programs.
Physician workforce pathway programs support those who could not otherwise become doctors due to financial hardship, bias, lack of role models and many other systemic barriers. In Santa Cruz County, we are fortunate to have two programs so far –vwith a third set to launch in 2027. UC Santa Cruz has a premed baccalaureate program that helps those who have already completed a four-year college get accepted into medical school. Dominican Hospital has a residency program that trains those who have graduated from medical school to become family medicine doctors. UC Davis is starting a Central Coast PRIME program that will train medical students in our local hospitals and clinics.
Unfortunately, the imposition of federal bill H.R. 1 targets the viability of these physician workforce pathways.
Santa Cruz County is already in the midst of a considerable physician shortage.
Santa Cruz County is a federally designated health professional shortage area, and half a million people living on the Central Coast lack access to primary care.
We need 1,100 more primary care physicians in our county to fill this deficit.
California already ranks 29th among the 50 states for medical residents per capita; this means we are training fewer new doctors overall, already falling behind. Cutting off physician workforce pathways will only result in fewer primary care physicians and lower-quality care.
H.R. 1 has already slashed Medicaid funding, escalated administrative burden and increased our uninsured population. Effective July 1, H.R. 1 student loan restrictions will go into effect, making it much more difficult for applicants from our community to afford medical training, further contributing to the strain on community health centers that provide medical education.
Community health centers in our county, such as Salud Para La Gente, Santa Cruz Community Health and Santa Cruz County Health Services, provide primary care to tens of thousands of patients per year – providing more than 200,000 primary care patient visits in 2025, numbers that are only increasing.
These sites help train medical students and residents, such as through the Dominican Hospital Family Medicine Residency program. However, given the impact of H.R. 1, these community health centers will need additional financial support from the state to continue supporting physician workforce pathway programs.
In Santa Cruz County, we do not have a medical school and we have only one residency training program – a 24-total-resident training program that graduates eight family medicine residents yearly. The community health centers that serve as training sites for these residents in Santa Cruz and Watsonville attract these future primary care physicians to stay here.
When training sites lose funding and local students cannot obtain loans, fewer students from our own community can start medical training and fewer physicians will end up in our community.
In my current role, I supervise the primary care training of both resident physicians and medical students.
Evidence shows that providing cultural and language concordant care results in better health outcomes, yet while 40% of our Central Coast population is Latine, only 6% of Central Coast physicians are Latine. The family medicine residency program in Santa Cruz has successfully recruited resident trainees who match our population, and as our pathway programs expand to include medical students and premedical students, our physicians will begin to better represent our whole community, improving care for our whole community.
Physician workforce pathway programs also directly address our physician shortage in Santa Cruz County. The existing physician shortage on the Central Coast is palpable and is expected to increase exponentially with our rapidly aging population.
Older patients carry a larger burden of chronic conditions, requiring more primary care. Additionally, our primary care workforce itself is aging, with 25% of our primary care physicians older than 65. Burnout is causing younger physicians to leave primary care as they are forced to shoulder unsustainable workloads brought on by chronic physician shortages.
We also know from decades of experience that physicians who train in their community are more likely to stay in that community, which benefits us all by increasing the number of primary care physicians on the Central Coast. Providing financial support for community health centers to participate in pathway programs directly targets this physician shortage by training students from our communities who are likely to stay in our communities.
Finally, H.R. 1 makes it more difficult for students from low-income families to get medical school loans. An upcoming provision of H.R. 1 eliminates the Grad PLUS loan program and caps the overall yearly medical student loan maximum at $50,000, which is below typical medical school tuition in the United States. This severely limits the pool of potential future physicians.
The state of California must address this gap by creating medical education loan programs for those who don’t have financial resources.
Some might argue that as safety net clinics, community health centers lack sufficient financial, staffing and educational resources to train physicians, and therefore medical education belongs in traditionally resource-rich academic settings. However, isolating primary care medical education from the communities it is meant to serve fundamentally fails to teach our learners both the full scope and nuance of the care we provide in community-based settings.
Academic settings provide an excellent training ground for specialists, but primary care training belongs in our community.
I call on our state leaders, including Assemblymember Dawn Addis and state Sen. John Laird, to support increased California funding for community-based medical education programs that train the physicians our county desperately needs.
We must prioritize training our future primary care physicians and expanding our undergraduate and graduate medical education training programs in primary care.
Otherwise, who will take care of us, our families, our children and our communities?
If we do not proactively address the impacts of H.R. 1, the heartwarming, culturally aligned care I watched offered to an abuelita will become more infrequent. We have the potential to provide exceptional primary care in our diverse county.
We must fight to realize it.
Dr. Salla Hennessy is a family medicine physician and residency faculty member who educates medical students and resident physicians in Santa Cruz. She is the founding academic medical director at Santa Cruz Community Health. She has been living and working as a primary care physician at a community health center in Santa Cruz since 2019.