California Medical Provider Shortfall Is A Looming Crisis. This Commission Has a Plan
by Sammy Caiola
California’s population is aging, patients from more diverse backgrounds are seeking care and Gov. Gavin Newsom is pushing to get thousands more patients insured. Meanwhile, many physicians are nearing retirement, and experts say a health care worker crisis is looming.
A commission studying the medical workforce is out with a new report offering solutions for how to prevent it.
UC President Janet Napolitano, who co-chairs the California Future Health Workforce Commission, says it is ready to make sure “the health system will have enough qualified professionals” as the state expands access to care.
Roughly 7 million Californians live in counties lacking primary, dental or mental health care providers, according to the report. The shortfall is already tangible for people who live in rural areas, which often have slim provider networks, and for minority patients who struggle to find multilingual doctors.
Without action, the commission predicts the state could be short more than 4,000 primary care physicians and 600,000 home care workers in the next decade, and will have only two-thirds of the psychiatrists it needs. Their report lays out 10 priorities, which could cost $3 billion to implement over the next 10 years..
California spent $292 billion on health care in 2014, according to the most recent federal data.
“California does not have enough of the right kind of health professionals with the right skills in the right places to meet the needs of our state’s growing and increasingly diverse population,” said Lloyd Dean, president of Dignity Health and commission co-chairperson.
Its recommendations include subsidizing medical education for minority students and students who pursue health professions in minority communities. That would include expanding the Programs in Medical Education initiative across UC campuses, which trains students to meet the medical needs of underserved communities.
Experts say the pipeline to becoming a doctor hits a bottleneck because there are not enough residency positions in the state. The report recommends adding more residency slots to yield 1,872 primary care physicians and 2,202 psychiatrists by 2030.
The report points out the success of building workforce capacity among nurses, which now make up the single largest group of health care workers in the state. A program that launched in 2005 resulted in a 78 percent increase in nursing school enrollment over a five-year period, significantly reducing the shortage or registered nurses.
One piece of the plan includes giving nurse practitioners more authority, and recruiting more psychiatric nurse practitioners.
Karen Bradley, president of the California Association for Nurse Practitioners, applauded the commission and said nurse practitioners are “ready to step up and provide quality care in communities across California.”
At the University of San Francisco, health policy analyst Janet Coffman has been studying the provider shortage for several years. She said the commission’s priorities mostly line up with recommendations by experts in the field.
“They’re all promising,” she said. “The investment in residency has a fairly quick return on investment. As much as I think medical school investment is important, residency yields a shorter return.”
She said it’s not clear how much the governor and Legislature are ready to embrace the workforce issue, and how much health plans and health systems are willing to invest.
The report also suggests a training program to address the shortage of home health workers in California. Newsom increased spending for in-home support services in his budget proposal.
The commission hopes the report will guide lawmakers on future decisions about the capacity of the health care workforce.
Capital Public Radio
Feb 7, 2019