Note to readers: Each week through November 2019, a selection of our 101 California Influencers answers a question that is critical to California’s future. Topics include education, healthcare, environment, housing and economic growth.
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Most of the political debate over health care reform focuses on expanding coverage for the uninsured and making care affordable for working Californians and their families. But an even more fundamental question for many communities across the state is simply ensuring that there are enough doctors and other medical professionals to serve their health needs.
“Under the Affordable Care Act, California has expanded access to care more than any other state,” said California Medical Association CEO Dustin Corcoran. “But that expansion has further strained a system that is being hit hard by increased demand from an aging patient population and physician retirements as Baby Boomers age out of the workforce and physician burnout increases.”
Anthony Wright, executive director for Health Access California, emphasized the disparity of medical care available to different communities, pointing to the greatest needs for rural, minority and low-income patients.
“There’s no dearth of doctors in Beverly Hills, but there is in fast growing regions like the Central Valley and Inland Empire. And while 40 (percent) of Californians are Latino, just 7 (percent) of California physicians are,” Wright said. “We need to train and recruit more medical professionals… and those who have the language and cultural competency to address the needs of all Californians.”
California Health and Human Services Secretary Mark Ghaly called for targeted recruitment efforts toward bringing practitioners to at-risk communities.
“We know that health professionals often work where they train. Given this, we should build training programs… in regions where we want trainees to work (and live) and in specialties where we project shortages: behavioral health, primary care, geriatrics,” Ghaly said. “If we want a workforce that looks like California, we must… create pathways for the full diversity of Californians to find appeal in health careers.
Other Influencers stressed the importance of creating incentives for health care professionals to return to the communities where they were raised.
“We must ensure that trained and skilled health workers are available in both urban hubs and small towns,” said Lloyd H. Dean, CEO of CommonSpirit Health and co-chair of the California Future Health Workforce Commission. “We need to build our local workforce from within, supporting students from underserved areas – at all levels of their academic careers – with mentorship and scholarship opportunities.”
Sacramento public affairs specialist Robin Swanson suggested other potential sources from which to address the state’s shortage.
“We simply don’t have enough medical school students to keep pace with the growing demand of elderly and sick people here,” Swanson said. “California communities should also look at recruitment from creative sources, like doctors who have served in our military... Providing these experienced service men and women incentives to come live and work in California should be a high priority in the quest to find qualified doctors and medical practitioners.”
Skyrocketing student loan debt was another frequently cited obstacle to attracting doctors.
“Today’s medical professionals graduate with educational debt that’s generally the size of a modest home mortgage and that often means idealism and service are pitted against monthly bills,” said Bruce Chernof, president of The SCAN Foundation. “California should create a much more robust debt forgiveness and loan repayment program for doctors and other care professionals willing to provide care in underserved communities.”
Santa Cruz County Supervisor Zach Friend also proposed loan repayment and forgiveness programs as a strategy for attracting medical professionals to rural areas.
“In our county, we’ve experienced difficulties recruiting and retaining family physicians, mental health professionals and other specialists,” Friend said, who also suggested housing support and flexible coverage schedules as potential lures. “The cost of such program(s) is less than the cost of negative health outcomes associated with longer wait times to see specialists… or other forgone preventive opportunities.”
State Assemblywoman Marie Waldron (R-Escondido) focused on another daunting obstacle to attracting doctors to rural California.
“Doctors are struggling to keep their practices open because reimbursement rates for Medi-Cal patients are too low, especially in rural areas,” said Waldron. “California… needs to increase Medi-Cal reimbursement rates so doctors are incentivized to work in rural and underserved areas.”
Sierra Health Foundation President Chet Hewitt underscored the importance of increasing early educational outreach to young people in underserved communities.
“We need to focus on the need for educational equity for students – particularly those from low-income neighborhoods… who are interested in pursuing health careers and who would benefit from educational and mentorship support,” Hewitt said. “Effective solutions will require a deep and honest look at who we are, and who has been included and supported in our society.”