Leading the Charge: California’s Primary Care Workforce Shortage

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I spent two days last week at the California Primary Care Association (CPCA) office in Sacramento attending our Workforce Convening: A Pathway to Building a Long-Term Primary Care Strategy aimed at developing strategies to address California’s primary care workforce shortage. I am proud to have sat across the table with leaders and stakeholders from all sectors – academia, nonprofit, government, and business – to develop public policy and programmatic priorities and identify advocacy strategies.

We can no longer afford to wring our hands about this problem.  The time for action is now.  For many years, community health centers have become increasingly vocal about the primary care workforce shortage in their communities. Each year, despite incremental efforts to address their concerns, the crisis has only worsened. The tremendous success of health care reform, resulting in the expansion of health insurance to five million Californians, only exacerbated this brewing crisis.  Two years ago, CPCA decided it was necessary to tackle the issue head-on. We had to make it THE issue for CPCA and our newly formed advocacy affiliate, CaliforniaHealth+ Advocates.

To help quantify the challenge, CPCA commissioned a report last year that found California would need 8,243 additional primary care physicians, or 32 percent of our current workforce, by 2030. The report, titled “Horizon 2030: Meeting California’s Primary Care Workforce Needs,” provided a sobering analysis of the situation and underscored the challenges health centers face in the recruitment of primary care clinicians.

Responding to CPCA’s report, CaliforniaHealth+ Advocates developed a multi-pronged advocacy strategy to bring about much needed solutions. The centerpiece of this strategy was a successful joint advocacy campaign with the California Medical Association and the California Academy of Family Physicians, among others, to secure an investment of $100 million for primary care workforce programs in California. This monumental appropriation was designed to support and expand primary care residency programs, teaching health centers, and help recruit providers to practice in medically underserved areas.   We were particularly pleased with the investment in Teaching Health Centers, which will result in utilizing community health centers as residency training programs for physicians – greatly increasing the likelihood that they will practice in primary care in an underserved community.

Coming into 2017, California’s health centers were excited and energized, ready to build on our funding victory to begin addressing the myriad of issues that plague our ability to educate, train, recruit and retain the professionals that keep our state healthy. But, our excitement and energy was dealt a devastating blow when, in his 2017-18 budget proposal, Governor Brown eliminated the $100 million workforce investment – all of it.

Backtracking on this investment hinders existing primary care residency programs and eliminates the potential for expansion or the development of desperately needed new residency programs in underserved communities.  It was a shortsighted move motivated by placing immediate fiscal considerations over a recognition that California’s primary care work force, and thereby health care access for all Californians, is in jeopardy.

CPCA recently partnered with the Healthforce Center at the University of California, San Francisco to publish a report titled “California’s Primary Care Workforce: Current Supply, Characteristics, and Pipeline of Trainees.”  This report finds that previously identified deficits in California’s primary care workforce persist and will be exacerbated in the coming decade as the supply of primary care physicians in California retire. Our pipeline is insufficient to meet the population’s needs. The report also found that there are large disparities between the diversity of the California population and the diversity of all medical clinicians.

While we have an overall shortage of physicians, our need is, and will continue to be, particularly great for physicians of color. By 2050, racial and ethnic minorities are projected to account for half of the U.S. population. Currently, Latinos represent 40 percent of California’s population, but only represent five percent of physicians. Less than 20 percent of physicians speak Spanish, and physicians who speak Middle Eastern or Asian languages are even less prevalent.

Among advance practice graduates, the statistics are starker. Latinos only represent seven percent of allopathic medical school graduates, three percent of osteopathic medical school graduates, nine percent of nurse practitioner graduates, and 14 percent of physician assistant graduates.

College degrees in science, technology, engineering and mathematics (STEM), which feed advanced healthcare practice degrees, may contribute to these insufficient results. According to a recent Addeco report, approximately 271,000 graduates a year earn a degree within a STEM, but in 2013, Latinos represented only nine percent of total STEM degree and certificate recipients.

This diversity shortage is particularly acute for community health centers.  Of the 6.2 million patients we serve, 54% are Latino and 36% percent speak a language other than English.  The current situation is simply unacceptable and is only projected to worsen.  As organizations which have committed themselves to addressing this crisis, CPCA and CaliforniaHealth+ Advocates are already working to find solutions.

In the coming weeks and months, here are a few of the projects we will be advancing:

  • Stop the Budget Cut: Governor Brown’s 2017-18 budget proposal eliminates the $100 million primary care workforce investment that the legislature and Governor committed to just last year, it must be stopped. This money was intended to support and expand physician training programs in California. If the funding is not reinstated, there isn’t room for expansion and existing programs may falter. We are advocating for funding restoration in the state’s 2017-18 budget and beyond. Thankfully the Assembly Budget Subcommittee, led by Assemblymember and Emergency Room physician Joaquin Arambula, took the first step towards defeating the proposal when they voted unanimously to reject the Governor’s proposal on Feb. 28.
  • Save the Teaching Health Center program: Teaching Health Centers focus on training primary care physicians in community health centers. They are in jeopardy if Congress fails to enact legislation that extends funding for the Teaching Health Center Graduate Medical Education (THCGME) program past September 30, 2017.  The two-year partial-funding extension Congress approved on a bipartisan basis early in 2015 will sunset unless Senators and Representatives agree on similar legislation in the next few months. We are advocating for a long-term extension of funding at pre-2015 funding levels.
  • Advance policy solutions: The public policy priorities and advocacy strategies developed in the recent two-day Workforce Convening will form the basis of a multi-year public policy agenda. It was my honor and privilege to bring such a distinguished group together to find real solutions.  Now we must put energy and effort into getting these solutions adopted and implemented.

As community leaders who are committed to the health of California, we need to lead the charge on addressing the workforce crisis. We need to protect funding for training and education. We need to protect our programs and create new ones.  We need to find long-term solutions that will withstand the test of time.  CPCA is committed to leading the charge to address the diversity of the primary care workforce of the future.  The health of everyone in our state depends on it.