I wonder: What is the future of primary care in California? One year from now, I will graduate from medical school along with 170 or so of my classmates and we will receive the title "doctor." We will go our different ways, to different hospitals and specialties. But many of us will continue to share one particular medical school bond--considerable debt from educational loans of $250,000 and up. While that amount is common among my peers, it surprises many people. Private medical school tuition now costs more than $40,000 per year. Combine that with board exams and the cost of living in Los Angeles, and the yearly loan quickly rises to $67,000 to $74,000.

For some of my colleagues this loan amount has influenced their career decisions. The very thought of having to pay back about $250,000 is terrifying; they have chosen specialties that will allow them to pay back their loans as quickly as possible. Granted, some of my classmates made their career decisions in childhood, and the majority of us have chosen our specialties based on experiences in the core clerkships, but it is hard for all of us to ignore this financial reality. It's an even harsher reality for those of us who wish to stay in California. Not only is this an expensive state to live in, but it also has lower physician reimbursements than most other states. For students graduating from private schools, this combination can make going into primary care cost prohibitive.

I am going to be a pediatrician. It was a decision that came slowly, but now I am certain that it is right. I enjoyed all of my rotations but truly loved pediatrics--I loved the children and I loved the doctors. I saw in many of the pediatricians the qualities of the kind of doctor that I hope to be--a doctor who genuinely cares about their patients, advocates and educates, emphasizes prevention, considers the necessary, multi-pronged approach to health, and who is very knowledgeable in their field. Pediatricians that I have met have responded with excitement and offered me encouragement and advice.

I have been surprised, however, by the reaction that I have gotten from other doctors when I tell them of my plan to become a pediatrician. It's common that they take a deep breath, pause, and then ask, "Are you sure? Why don't you consider being a ...[specialist]?" When I say that I am certain I want to be a pediatrician and explain why, they jokingly reply that I can always marry rich. This reflects the common advice given to students, whether intentional or not: Avoid primary care and become a surgeon or a subspecialist to receive higher financial reimbursement.

For future primary care doctors like myself, who plan on practicing in California, there is a solution on the table. The Steven M. Thompson Physician Corps Loan Repayment Program currently offers loan repayment to those of us who wish to practice in California in underserved areas. Yet, this program has never been fully funded and many more doctors wish to participate than there are funds available. Senate Bill 1379 would require that the state Department of Managed Health Care use the fines and administrative penalty payments gained from health plans to fund the loan repayment program.

Under this program, I would agree to work in an underserved area in California for three years and receive $105,000 in loan repayments. In April, I joined medical students and doctors in Sacramento for the California Medical Association's Legislative Leadership Day. I found that legislators were under the mistaken impression that everyone in medicine is essentially a millionaire. Few had considered the burden of medical student debt and the implications on the future distribution of doctors. In my opinion, this bill makes sense not only for aspiring doctors' financial security, but also for the integrity of healthcare in our state.

I am hopeful that SB 1379 will pass and that I will be a participant in the program. Regardless of the outcome of the bill, however, I am committed to caring for the underserved children of California and I am excited about my future as a pediatrician.