California’s Primary Care Workforce Shortage
California has made great strides in the implementation of the Affordable Care Act. Community health centers have been at the forefront of that implementation and have had a tremendous contribution toward its success. Community health centers played a central role in getting uninsured Californians into coverage options and serve as a major access point for health care in our most vulnerable communities. According to a recent study by the California HealthCare Foundation (CHCF), safety-net clinics are providing care to 54 percent, or 1.3 million, of new Medi-Cal patients who are enrolled in managed care plans.
While this is great news, it also highlights the fact that our health centers are experiencing a severe provider shortage. It is an issue that has been building for years and has now become a crisis. It has hit California’s community health centers particularly hard. California’s ratio of primary care physicians participating in Medi-Cal is approximately half of the federal recommendation. Even more daunting, six out of nine regions in California have a primary care provider shortage. We’re losing doctors at an alarming rate with recent reports showing 30 percent of our state’s doctors are over 60 years-old and are nearing retirement.
A recent report commissioned by the California Primary Care Association (CPCA) indicates that California will 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, provides a sobering analysis of our current situation and underscores the challenges health centers face in physician recruitment.
On top of that, our lack of physician diversity and cultural understanding cripples us further. 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 5 percent of physicians. Less than 20 percent of physicians speak Spanish, and physicians who speak Middle Eastern or Asian languages are even less prevalent. These statistics will only continue to worsen if we don’t do something about it.
We need to recognize that our communities are full of bright, caring, and diverse individuals who, if provided the opportunity, are eager to serve their communities and would play a critical role in health care. In fact, research indicates that physicians with racial and ethnically diverse backgrounds are more likely to treat racial and ethnically diverse patients, and more likely to set up practice in typically underserved communities. Sixty percent of physicians from the National Health Service Corps remained in underserved communities ten years after their service obligation was completed. Let’s build those connections with a health care workforce pipeline in every school district in California where we support programs that engage students and get them thinking about health care careers where they can give back.
We must ensure that there are pipelines for students of all backgrounds. California must develop robust healthcare professional training and education programs. To expand opportunity to more students, California has to chart a new course and make more meaningful investments in graduate medical education programs. We have to address the crushing weight of student loans as well. California must offer affordable options and service-based loan forgiveness programs. As a state, we are past due in addressing these issues adequately, but reasonable solutions can be adopted if we work together.
I, along with CPCA, have made these issues a priority. We cannot do this alone, but by working together, building partnerships and being bold in our endeavors, we can make great strides. We are poised to lead this work and truly influence our future – and that work starts today!