SALINAS, Calif. — Dr. Sumana Reddy has spent nearly three decades serving patients at Acacia Family Medical Group, the independent primary care practice she founded in this agricultural city often referred to as “the salad bowl of the world.” But after 27 years, Reddy is grappling with mounting financial pressures that threaten the survival of her clinic—and the future of primary care in California’s underserved communities.
Unlike large health systems that can offer lucrative salaries and broad support networks, Reddy’s small practice operates on thin margins. Recruiting and retaining physicians is a constant uphill battle, made even more difficult by a nationwide shortage of primary care doctors.
That shortage, experts say, is rooted in deep systemic issues: lower pay, heavier workloads, and less prestige than medical specialties, making primary care an increasingly unpopular career choice for new medical graduates. “It certainly is challenging to expose medical students early in their careers to the joys of this kind of integrated health care,” Reddy said. “The relationships we build and the care we provide truly allow people to live longer with a better quality of life.”
To boost revenue and remain competitive, Reddy has enrolled Acacia in value-based payment programs through various health plans. These arrangements reward clinics for meeting specific preventive care benchmarks—such as childhood vaccinations, cancer screenings, and mental health evaluations. The goal is twofold: improve patient outcomes and help independent practices like Acacia stay afloat.
These pay-for-performance models are part of a broader push by California policymakers and healthcare organizations to revitalize primary care. Six years after the influential California Future Health Workforce Commission predicted a shortfall of more than 4,000 primary care providers by 2030, the state has rolled out a flurry of initiatives in response.
Those include expanding medical residency slots, forgiving student debt, waiving tuition for aspiring primary care doctors, and increasing the role of nurse practitioners. The state has also set a formal target to raise overall spending on primary care, with hundreds of millions of taxpayer dollars allocated to support these programs.
Yet despite the activity, critics say the efforts lack coordination and urgency. “The pieces are there,” said Dr. Monica Soni, chief medical officer of Covered California, the state’s Affordable Care Act insurance exchange. “I am worried we started a little too late, and I think it’s a little too siloed.”
For patients, the stakes are high. Regular access to primary care has been shown to reduce emergency room visits, improve chronic disease management, and break down language and cultural barriers—especially in diverse communities like Salinas, where many residents are Latino farmworkers.
But unless systemic issues are addressed—starting with how primary care is valued and compensated—the model may continue to erode. For Reddy, the mission is clear, even if the road ahead is uncertain.
“We’re not just treating illness,” she said. “We’re helping people live fuller, healthier lives. That should matter enough to protect what we do.”
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