April 16, 2013
Gathered on the steps of the California Capitol, a coalition of physicians, legislators, medical students and residents came together today to support several key pieces of legislation that will address the state’s mounting issues regarding its physician workforce.
Already strained by the state’s massive population, California’s health care industry is expected to see an enormous surge in demand beginning in 2014, when the implementation of the Patient Protection and Affordable Care Act (ACA) begins the process of extending coverage to what many analysts are projecting could be more than 5 million currently uninsured residents. To compound this problem, a large number of these currently uninsured residents live in areas of the state already grappling with long-standing physician shortages.
“The problem with workforce is a complicated one,” Paul Phinney, M.D., president of the California Medical Association, told the assembled crowd. “Not only do you need enough doctors, you need them in the right place.”
In order to address this complex question, several members of the state Legislature have introduced bills dealing to the various stages of physician training and development in California.
The first step, lawmakers agreed, was to ensure that California was taking the necessary measures to educate its future physicians, a goal which Senator Richard Roth (D – Riverside) and Assembly member Jose Medina (D – Riverside) believe would be furthered by funding the University of California, Riverside School of Medicine.
The pair, which has each authored a bill to allocate $15 million annually in state funds to the operation and expansion of the UC Riverside School of Medicine, agreed that the expansion of coverage called for under the ACA was a tremendous first step toward health care reform in California, but that more needed to be done, especially in regions struggling with existing physician shortages.
“In my area, we have one of the lowest physician-to-people ratios in the country,” said Assembly member Medina, author of AB 27.
Senator Roth, author of SB 21, echoed such statements regarding California’s Inland Empire, adding that coverage alone would not solve the region’s health care woes. “If the people of inland southern California cannot find a doctor, what good is that coverage?” he asked.
Other members of the Legislature have directed their attention toward California’s lack of residency slots, a problem which they claims sends California-educated physicians off to neighboring states, while the problem of access to care at home grows worse.
To remedy this issue, Assembly members Raul Bocanegra (D – Pacoima) and Rob Bonta (D – Alameda) have authored AB 1176, which would help fund and expand residency programs in California by placing a small fee on the state’s health plans.
Both Bocanegra and Bonta noted that an overwhelming majority of residents ultimately lay down roots in the state where they complete their residency training, and that California is doing itself a disservice by forcing California-educated physicians to seek programs in other states.
“The odds are stacked against us,” said Adam Dougherty, a third-year medical student at the UC Davis School of Medicine, who noted that each year it is more likely that students will have to venture outside of California to find residency slots.
The financial burdens of a medical education also pose an enormous challenge to California’s students, speakers said, adding that the average medical student in California graduates with roughly $150,000-$160,000 in debt.
To relieve some of this burden, Assembly member Rudy Salas (D-Bakersfield) has authored AB 565, which would expand and strengthen the Steve Thompson Loan Repayment, which offers repayment assistance to physicians practicing in medically underserved areas of the state.
Such legislation would be of great value to many California communities, including Salas’ own Kern County, where he said patients outnumber physicians by a margin or roughly 12,000 to one.
Also seeking to direct physicians toward these medically underserved areas, Assembly member V. Manuel Perez (D-Coachella) has authored AB 1288, which would prioritize licenses for physicians going on to practice in underserved areas of the state.
Perez noted that the state’s licensing process is already laden with obstacles, and that those physicians who can demonstrate an intent to practice in rural and underserved areas should have their licensing applications be given priority review status by the state medical board.
Together these bills will ensure that California’s physicians can continue to lead a health care model that will fully and adequately serve the state’s population.
"Every Californian deserves access to quality health care, which means having physicians available in our communities," said Richard Pan, M.D., a health care work force expert and Chair of the Assembly Health Committee. "California Physicians have to complete four years of medical school after college, three to over seven years of residency training caring for patients under supervision, and passing rigorous exams in their specialty after training and every decade afterwards. In the process, many students and residents accumulate over $100,000 of debt. This package of bills will lower barriers for those physicians who wish to practice in underserved communities."
AB 1176 passed out of the committee on with a 10-5 vote and AB 565 passed out of committee with unanimous support.