Objective: To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas. Design: Retrospective data on primary care were collected over a 4.5 year period from both computerised and manually filed records. Standardised data on socioeconomic status were obtained by postal questionnaire. Setting: Inner city group practice with a socioeconomically diverse population. Subjects: 382 male and female subjects of all ages, with a total of 1296 person years of observation. Main outcome measures: Primary care costs resulting from consultations with a general practitioner or a practice nurse and both new and repeat prescriptions. Results: Morbidity, workload, and costs of drug treatment increased with decreasing socioeconomic status. The difference in cost for patients in social classes IV and V combined compared with those in I and II combined was about £150 per person year at risk (£47 for workload and £103 for drugs). Deprivation payments met only half the extra workload cost for patients from qualifying wards. Conclusions: The greater workload caused by social disadvantage has been previously underestimated by simple consultation rates. The absolute difference in costs for socially disadvantaged patients increases as more detailed measures of workload and drug treatment are included. Current deprivation payments only partially offset the increased expenditure on workload. This shortfall will have to be addressed to attract general practitioners to, or retain them in, deprived areas.

The Program in Medical Education for the Latino Community (PRIME-LC) at the University of California-Irvine (UCI) School of Medicine was designed to improve health care delivery, research, and policy in underserved Latino communities. Specialized training develops strongly committed physicians with linguistic skills and cultural understanding, enabling them to serve Latino patients. Presently, the health care system's shortage of providers with this expertise renders it unable to address the Latino community's needs adequately. The UCI School of Medicine realized they were proposing a radically different type of program at the onset of this project -- one designed to address the health care needs of a specific ethnic group. Developed with dual goals, PRIME-LC aspires to provide the Latino community with culturally sensitive, Spanish-speaking physicians who are well aware of medical and social conditions prevalent among Latinos, in addition to physicians with a broad understanding of community medicine who are well versed in advocacy and able to become leaders within and outside the Latino community. PRIME-LC must be placed within the context of predicted physician shortages in the United States attributable to the projected population increase in general and, more specifically, within the context of a growing Latino population nationwide. As medical schools prepare to increase their output, programs like PRIME-LC that address society's special needs deserve serious consideration.

Reactivating the FPP may increase the raw number of physicians in California, but two decades of this program did not recruit physicians to practice in California's Latino community at a rate much above that for traditional medical school graduates, especially for communities having the highest Latino population densities.