How California is addressing the primary care shortage

California, along with the rest of the nation, is facing a serious primary care physician shortage that grows worse every year. As health care reform takes full effect and millions more Americans gain coverage and therefore can afford to seek the care they need, many will have trouble finding a family physician or other primary care doctor to care for them, as many patients already do. We must make certain that patients aren’t just given insurance cards and monthly premiums. Working in each state and together at the federal level, we must make it a priority to increase our primary care physician workforce so patients can see a physician when and where they need one.

In his excellent series, Stephen C. Schimpff, MD has outlined many of the factors causing the shortage and has suggested a range of possible remedies. California family physicians, policymakers, medical school faculty and family medicine educators are working together on many of these. In addition, three bills pending in our state Legislature are policy approaches that physician groups and legislators in other states may wish to pursue.

The California Academy of Family Physicians (CAFP) is cosponsoring the bills with the California Medical Association.

Assembly Bill (AB) 2458 would create a graduate medical education fund to support additional residency training slots in programs that graduate primary care physicians and serve the underserved. By creating additional slots at residency programs focusing on these needs, California can gain an immediate return on investment. Residents provide an average of 600 patient visits per year during training alone, often to underserved populations.

This would also significantly grow our long-term workforce, as the majority of physicians who train in a region stay there to practice. In our state, nearly 70 percent of medical residents remain here to practice after graduation. The Association of American Medical Colleges 2011 State Physician Workforce Data Book provides analyses like this and can be useful in other states’ advocacy efforts.

CAFP also is co-sponsoring two bills to improve Medicaid (Medi-Cal in our state) beneficiaries’ access to physicians.  California is among the states that have expanded eligibility in their Medicaid program, but expanded coverage will not mean much without access. AB 1759 would extend the Affordable Care Act provision that increases primary care physician Medicaid payment to Medicare levels and is set to expire at the end of 2014. This bill also would create an annual independent assessment of Medicaid provider payment rates and their impact on access and quality of care for patients in the Medicaid program.

AB 1805 would reverse a 10 percent Medicaid provider payment cut that California legislators adopted in June 2011 and implemented late last year. Our state repeatedly ranks among the very lowest paying Medicaid programs in the nation, a factor that seriously compromises physicians’ ability to see patients whose care is covered by this program.

Interested physician advocates can review the language used in these bills and their path through the California Legislature.

Working together in our respective states and at the national level, physicians interested in improving patient access to primary care, which ultimately means improving patient health, can partner with knowledgeable, committed legislators and others to make immediate improvements. We in California look forward to hearing more about our colleagues’ approaches in other states, to learn from you as well.

Mark Dressner is president, California Academy of Family Physicians.

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  • Robert177

    Sadly, no matter what they do, the state of CA is a lost cause.

  • Dave Mittman, PA, DFAAPA

    I would ask why you have no use of PAs in your plans? PAs have been partners with the CMA for many years and are excellent providers of primary care.
    I am sad to see no mention at all.
    Dave

  • Jennifer Jonsson

    My suggestion would require politicians to get together with medical schools and loan companies, but my thought is offer to forgive some amount of student loan debt (maybe a percentage?) if the graduate agrees to practice primary care in the state for 5 years. It would only work with in-state students, but damn, I’d do it in a heartbeat.

  • EmilyAnon

    California now grants law licenses to people here illegally. The State Assembly will soon pass a bill that all professions requiring licensing will be available to them, including healthcare. Curently the undocumented are eligible for university funding through the Dream Act, the only requirement to access this public financial aid is that they have no documentation and have been in the state for at least 3 years.

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