A LOOMING DOCTOR SHORTAGE IN SAN DIEGO COUNTY IS EXPECTED TO HIT LOW-INCOME COMMUNITIES THE HARDEST.
KPBS HEALTH REPORTER SUSAN MURPHY MET A DOCTOR WORKING TO MAKE SURE THAT DOESN'T HAPPEN.

{South of downtown San Diego's towering skyscrapers -- where hundreds of homeless people sleep in large tent shelters or on the streets -- And get their meals from soup kitchens or trash cans (Niazi: deep breath in) -- Dr. Harris Niazi cares for some of the region's poorest residents.

HARRIS NIAZI, M.D.
FAMILY HEALTH CENTERS OF SAN DIEGO
5:55:25 We had a patient last week who just wanted to put his feet in warm water and, you know, he had soap with him. 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, you know, we do the best we can.

Some who seek help at the modern clinic in Logan Heights are among the millions of Californians who joined the Medi-Cal rolls under Obamacare, like 74 year old Lorenzo Sarabia.

8:51:33 SERABIA: I had a heart attack three years ago and was in the hospital for four days.

Now he's homeless and sleeps on city sidewalks. He relies on the clinic for ongoing care.

8:36:39 SERABIA: For me it's very important. Because if we didn't have that we'd probably die on the streets.

Dr. Niazi says others who come to the clinic have no insurance at all.

5:53:56 NIAZI: We serve a large amount of homeless people.

Patients come in with typical issues: flu, rash, infections… but many have a multitude of complex problems.

5:55:06 NIAZI: Medical problems, psychiatric problems and on top of that the social, financial, and the drug issue -that's tremendous. (5:53:21)

Dr. Niazi, a 30 year old assistant medical director for Family Health Centers of San Diego, says his job requires a special set of skills.

5:50:30 NIAZI: It's very easy to throw a pill at somebody, very easy to diagnose and you know, 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.

…How to talk to people without being judgmental, he says. And how to listen. And most important: to understand where they're coming from.

5:50:56 NIAZI: To be able to treat them, you have to know what it feels like to be in their shoes.

Dr. Niazi knows exactly what it feels like.

5:44:16 NIAZI: I was a war refugee from Afghanistan. I came here when I was about one years old and we came to the Bronx New York,

He grew up in poverty and watched his parents struggle with health care.... It's why everyone at his clinic is treated as someone.

5:2:18 NIAZI: 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. 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 Dr. Niazi to work at Family Health Centers' 23 primary care clinics(in San Diego serving 3,000 people each day… is a challenge amid a growing physician shortage. Anthony White is director of the Center's community and government relations.

6:27:57 WHITE: Being a nonprofit organization that provides care for free sometimes, it's hard for us to pay competitive rates.

That's why the center started a doctor residency program that trains and works to retain primary care physicians to help fill the gap. (00:15:48 Have you had any shortness of breath that…..? No") The three year program gives medical graduates real world experience with an emphasis on empathy and improving health disparities.

6:31:50 WHITE: They're rotating throughout our clinics of Family Health Centers of San Diego but also they have to learn about hospital intake care. So they're working with Scripps Mercy Hospital ….

White says research shows graduates are more likely to stay and practice where they trained. He says last year nearly 1,000 medical students applied for six open residency slots.

6:24:47 WHITE: It's not always necessarily who has the best grades or who is the most stellar person. A lot of it - especially with our clinic is their dedication to serving the community and do they have that in their background.

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 says. It's about helping those in need.

00:08:42 MATTHEWS: 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.

There are also financial tuition incentives for working in underserved communities that began under Obamacare. -- It's a program Governor Gavin Newsom plans to expand using proposition 56 tobacco tax money he's pumping into health care. Dr. David Bazzo is president of the SD County Medical Society.

17:37:48 BAZZO: 190 million dollars is going to go towards loan repayment for those physicians that go into a traditionally underserved area to practice.

Bazzo says the timing couldn't be better. 25 percent of California doctors are nearing retirement. He says the physician shortage will hit underserved areas hardest.

Dr. Niazi is a recent graduate of Family Health Centers' residency program.

5:56:05 NIAZI: I couldn't see myself doing anything else.

It's a place he plans to stay. Because it's where he's needed most.