Part 4 of VOA's 5-part series on Health Care

U.S. health experts say a shortage of primary care physicians will worsen in coming years, with American medical school graduates continuing to shun family medicine in favor of more-lucrative specialized practices like cardiology and oncology.  But increasing the availability of general practitioners who treat everything from strep throat to diabetes is seen as a key to improving America's health-care system, preventing disease, and reducing cost. 

Trend toward specialized medicine

David Ellington is an increasingly rare type of American physician.  In a nation where many of the world's most-renowned doctors practice highly-specialized medicine, Ellington has spent much of the past two decades tending to the varied health care needs of everyday people in Lexington, Virginia.  He would not have it any other way.

"I love people," he said.  "I love old people.  I love young people.  And you get to know an awful lot about the people for whom you care, about how they live their lives day-to-day - their joys, their disappointments."

A bespectacled man with a jovial manner, Ellington spends time getting to know his patients, who seem to appreciate the personalized attention.  Jane Patten came to the doctor complaining of numbness in her fingers.

"What makes him special is that he sits down and talks to you," said Patten.

Less students opting for family medicine

But studies show a declining number of American medical graduates opting for family medicine, and project a shortage of 40,000 primary care doctors in the United States by 2020.

Dr. Ellington says this is no surprise.

"I am paid about a third as much as an oncologist [cancer specialist], dermatologist, and some types of surgeons," he said.

And that pay differential matters as young doctors struggle to pay off student loans.  The cost of a U.S. medical education can approach a quarter-million dollars.

Important role

Ellington began practicing medicine in the U.S. armed forces, in California and Germany.  His sense of public duty continues in civilian life.  In addition to his practice, he helped set up a free clinic outside Lexington that treats thousands of the area's poorer residents.

Director Suzanne Sheridan says Dr. Ellington's contribution to the community is incalculable.

"He just does not talk about it [addressing needs]," said Sheridan. "He really gets out there and does it.  We collect numbers of hours that are volunteered.  There are hundreds of hours that he spends here a year."

Ellington says he hopes for U.S. health care reform that reduces paperwork and provides coverage for all Americans, especially in primary care.

"There have been a number of studies that have shown that if you increase primary care in a certain area by 'X' amount, that you will see a decrease in the death rate, a decrease in utilization of resources, a decrease in hospitalizations, a decrease in surgeries, and an increase in the health of the community," he said.

Fear-driven debate

But he fears that America's health care debate is being driven by fear and misinformation, rather than a rational discussion of needs and solutions.

"People are afraid that they are going to lose what they have. They are afraid of it," said Ellington.

While debate rages in Washington and across the nation, Dr. Ellington continues his work, which he describes more as a calling than a job.

"If you go into medicine to make money, it is not a calling," he said. "You miss a lot of meals with your family.  But you do it for a reason."

Honoring Ellington's life's work is the local chamber of commerce, which placed his name on a ballot for "health care provider of the year" for 2009.