January 12, 2017
Area(s) of Interest: Access to Care Advocacy
In his 2017-18 budget proposal, Governor Jerry Brown eliminates $33.4 million in health care workforce funding that would begin addressing the primary care workforce crisis that is gripping California’s underserved communities. This is the first year of a three-year $100 million investment. The budget investment came at the urging of a broad coalition of statewide healthcare organizations including the California Academy of Family Physicians (CAFP), CaliforniaHealth+ Advocates, and the California Medical Association (CMA), who recognized that access to care challenges must be systemically and comprehensively addressed.
“While our organizations recognize the health care challenges that may confront America and California this year, we are alarmed to see the Governor’s proposed elimination of health care workforce funding that has already been allocated to help address the dire access-to-care issues facing numerous regions in California,” said Carmela Castellano-Garcia, CaliforniaHealth+ Advocates President and CEO. “We are committed to working with the Legislature and the Governor to forge solutions that protect our state’s most vulnerable communities, but must not turn our back on those we have already committed to helping.”
The $100 million appropriation in the 2016-17 State Budget currently is set to support and expand primary care residency training and programs in medically underserved areas through the Song-Brown Workforce Training Program and targeted investment in Teaching Health Centers. The goal is to create a reliable and continuous funding stream that primary care residency programs in California so desperately need.
“The Governor’s proposed elimination of funding is of serious concern in California as our primary care residency programs have recently lost more than $60 million,” said CAFP President-elect Michelle Quiogue, M.D,. “Last year’s appropriation was intended to save these programs, but this proposed cut would be devastating, causing programs to close and exacerbating serious access problems for some of the state’s most vulnerable patients.”
Without this appropriation, California primary care training programs cannot replace significant federal and private foundation grants that recently expired, including $18 million in federal Health Resources and Services Administration funding for the Primary Care Residency Expansion program; a $21 million California Endowment grant to the Song-Brown Program; $15 million allotted through the federal Teaching Health Center program; and a one-time $4 million California Health Data and Planning Fund appropriation to Song-Brown.
Even if these cuts were replaced dollar for dollar, California would struggle to provide sufficient access to primary care. Only 36 percent of California’s active patient care physicians practice primary care and, according to the Council on Graduate Medical Education (COGME), 23 of California’s 58 counties fall below the minimum required primary care physician-to-population ratio. That’s why this new appropriation is so critical.
“A robust, well-trained primary care workforce is essential to meeting the health care demands of all Californians,” said CMA President Ruth Haskins, M.D. “The Legislature’s move to restore and stabilize funding for these programs is an important first step toward reversing our shortage of primary care physicians, particularly in the underserved communities that need it the most.”
California faces a drastic shortage of primary care physicians. The federally recommended number of primary care physicians per 100,000 people is 70. According to the California Health Care Foundation, the number of primary care physicians participating in Medi-Cal per 100,000 enrollees is 42. With an increase of more than four million individuals in the Medi-Cal program, it has never been more important to fully support the training programs that bring primary care physicians to underserved areas.