With every application essay—for college and for medical school—Dr. Edgar Chavez ’98 returned to the same theme.
“In all my essays I wrote, ‘Give me a chance and I’m going to go back and work in my community,’” says Chavez, who was still a boy when his family landed in a struggling South Los Angeles neighborhood after fleeing war-torn El Salvador. “That’s what got me into Pomona. That's what got me into Stanford. Everybody saw this sort of drive in me to accomplish my goals because I wanted to go back to the community that I grew up in because I wanted to help.”
But by the time he completed his residency, “I had a mountain of loans,” he says. He was married, with a 2-year-old daughter. “I needed to get a job.”
Kaiser Permanente offered the young doctor with a Stanford medical degree the sort of position many physicians now covet—one with an excellent salary and benefits, freedom from the challenges of running a practice, and maybe most of all, work-life balance.
Hesitantly and then determinedly, Chavez turned away and followed a dogged and entrepreneurial path that led to the creation of the Universal Community Health Center, now a three-clinic nonprofit he founded in 2009. The first clinic is practically in the shadow of the 10 Freeway near downtown L.A.—only blocks from where he grew up in an immigrant family at the corner of Washington and Broadway. Another is on South L.A.’s Central Avenue and a third on San Pedro Street.
Chavez saw the need, even as a boy. But he could never have imagined the depths of the need he and Universal have worked to fill as the COVID-19 pandemic has laid bare economic, racial and healthcare disparities. At one point, the Los Angeles Times reported, public health data showed that one in six people in South L.A. had tested positive for the virus, yet only one in 24 in a population that is majority Latino and Black had received the vaccination. Meanwhile, in some wealthy coastal neighborhoods, more than one in four had received vaccinations in areas where fewer than one in 30 had tested positive.
Chavez has seen up close what the numbers mean.
“In the past year, I've probably lost upwards of 15 to 20 patients to COVID, my own patients that I've seen over the past 10 years that I've been at the clinic,” he says. “A lot of our population historically has gotten poor healthcare, so they have lots of diabetes, hypertension, heart disease. When they get COVID, it's not a flu, it's not a cold. It's actually something that drives them to the hospital. We're seeing a lot of deaths.
“The reason that's happening is because a lot of our community lives in multi-generational households, and so you'll have the young that have to go out to work. They're the people that work in restaurants and shops, where they're the first line to deal with the public. And they're repeatedly being exposed to COVID. The young may not have issues. They will get over COVID. But the problem is that they're taking this COVID back home, and they have grandpas and parents who have these high-risk conditions that end up getting COVID, and then they end up dying. A lot of our patients are undocumented, too. They don't have the luxury of saying, ‘I am going to rely on the subsidies that the government gives for me to stay home, from unemployment.’ They don't have access to that money. It's a hard situation to see with our patients.”
Frustrated early in the pandemic with waiting up to 10 days for results from COVID tests sent out to labs—rendering them clinically useless, he says—Chavez made a decision to go big on testing that provides quick results.
“You can tell people to stay home, but if they don't have a positive result, people are like, ‘maybe I'm negative,’” he says. “They don't really listen to you.”
With the help of $650,000 from the federal CARES Act, Chavez purchased a mobile van for testing, hired additional staff and ordered 200,000 of Abbott’s ID Now tests that provide a result in less than 15 minutes. The Universal clinics now provide three types of COVID tests—antibody, antigen and the rapid PCR test. In a typical month before the pandemic, the clinics might have 2,000 patient visits. Now, he says, it’s 4,500 a month, in part because of access to testing.
Along with testing, Chavez transitioned many clinic visits to telephone or virtual with a simplified system called Doxy.me that allows people to simply click on a text for a video call rather than going through a portal or requiring a computer and wi-fi. That allowed both patients and his healthcare providers to limit contact.
With the arrival of the vaccine, Chavez pivoted again, quickly ordering vaccines and spending close to $10,000 on a used ultra-low temperature freezer to store them.
Chavez’s journey has been unexpectedly entrepreneurial. After turning down the Kaiser offer, he accepted a job in a small practice in his old neighborhood under what is known as an income guarantee program. A hospital—in this case what is now Adventist Health White Memorial on L.A.’s Cesar E. Chavez Avenue—helps support a doctor’s salary to attract physicians to underserved communities.
A month or so into Chavez’s income guarantee, however, the doctor who owned the practice decided to sell. Chavez and another young doctor approached the hospital for a $350,000 loan to buy the practice. Then his partner decided to leave. Before long, Chavez was underwater on the loan, owing more than the practice was worth.
“They train you to be a doctor, go out there and treat patients. They don't train you to be a businessperson because that's not part of medicine,” he says.
Chavez turned to his longtime advisors at One Voice, an L.A.-based organization that helps families and students struggling against poverty and had helped him pursue his education. With their leadership, $100,000 in private funding kept his practice afloat and started the process of becoming a nonprofit and a Federally Qualified Health Center. Kathleen Momii, the chief financial officer for One Voice, now serves as board president for Universal Health Care Center, a nonprofit with a $5 million annual budget.
In addition, federal programs for healthcare providers serving communities with limited access to care repaid most of Chavez’s mountain of medical school loans.
Though he still treats patients a couple of days a week, much of Chavez’s time is devoted to administration and expanding services related to such issues as addiction and behavioral health in addition to primary care, perinatal care and nutrition services. In addition to physicians, he has hired physician assistants, nurse practitioners, licensed clinical social workers and a nutritionist.
Yet even as COVID cases rapidly decline, Chavez knows there is an invisible epidemic still to come. The need for behavioral healthcare has increased by more than 25%—though in one positive development clients seem more comfortable seeking care by telephone and video call, Chavez says.
Untreated depression was already widespread in the community, he says, contributing to high levels of hypertension and diabetes. The need for treatment will not disappear with the virus.
“There are a lot of people who are depressed and we're going to have a lot of survivor grief, a lot of anxiety, just so much pain,” he says.