Universal health care gets all the attention, but here’s an increasingly urgent challenge for California’s leaders to address: the state’s looming doctor drought.
California faces a shortage of 4,100 primary care doctors in the next decade, according to a study by the California Future Health Workforce Commission. Left unchecked, this shortage of doctors could mean long waits and less care as Boomers enter their golden years.
Even if California’s leaders enact universal care, will the state have enough health professionals to satisfy demand?
The coming shortage stems from a simple fact of life: California’s population is aging, and doctors age just like the rest of us. As Boomers reach retirement age, many doctors are hanging up their stethoscopes for good. More than one-third of the state’s health care professionals are over 55.
So, as California’s population ages and its health care demands increase, we may have fewer doctors available.
“By 2030, the population over 65 in California will double to 9 million, and the fastest-growing group in that population will be people over 75 years of age,” Heather Young, dean emerita at the Betty Irene Moore School of Nursing at UC Davis, told The Sacramento Bee’s Cathie Anderson. “This population is becoming increasingly diverse, and many of these people live in rural communities and face economic hardship.”
As usual, communities in poorer areas like the Central Valley – where health care resources are already strained – will be hardest hit. Today, for example, the San Joaquin Valley has 39 primary care providers per every 100,000 residents, and Sacramento has 54. The Bay Area, on the other hand, has 64 primary care doctors per every 100,000 residents.
And it’s not just primary care doctors we have to worry about. Specialists, nurses, home care workers and psychiatrists may also be in shorter supply.
“There’s always more demand than we’re able to fill,” said Dr. Ellen Piernot of the Golden Valley Health Centers, which operates 36 health centers in the Central Valley. “We have severe shortages.”
In addition, Piernot said, it’s difficult to find medical practitioners who match the diversity of Valley communities with big Latino, Sikh, Hmong and Afghan populations.
Latinos make up nearly 40 percent of the state population, yet only 7 percent of doctors are Latino. Fewer than 20 percent of medical professionals speak Spanish, according to the report.
“Very rarely are we able to find someone who is of the culture or speaks the language of our population,” Piernot said. “So we rely heavily on our office staff, which generally tends to be from the community, to provide us with more of that cultural relevance.”
To avert future shortages, the California Future Health Workforce Commission has proposed an ambitious plan to increase the number of health workers by over 47,000.
The commission, co-chaired by University of California President Janet Napolitano and Dignity Health President and CEO Lloyd Dean, has issued 27 recommendations to encourage over 60,000 students to pursue health careers. The top 10 recommendations include:
▪ Expanding the educational pipeline to recruit more students into health careers. The commission proposes “mentorship, academic, career and psychosocial support” so that “5,700 low-income and underrepresented minority professionals will be able to join the California health care workforce” during the next 10 years.
▪ Funding scholarships for qualified students who pursue health care careers and commit to serving in underserved and rural communities. A proposed “Emerging California Health Leaders Scholarship Program” would help fund the creation of approximately “1,707 physicians, 696 nurse practitioners, 152 physician assistants, 325 public health professionals and 930 social workers” over the next 10 years.
▪ Expanding the home care worker “family of jobs” to provide more career paths and training. California will need an estimated 600,000 home care workers by 2030. Investing in their training and “career ladders” could save billions by “reducing spending on unnecessary emergency department visits and hospitalizations by more than $2.7 billion over 10 years.”
Implementation of the top 10 recommendations would cost $3 billion. That’s less than 1 percent of what Californians are projected to spend on health care in 2019.
Top recommendations also include maximizing the role of nurse practitioners, recruiting students from rural areas who want to work in their home communities and expanding the number of residency positions for new doctors and psychiatrists.
The need for mental health professionals is especially pronounced in the Valley, according to a survey conducted by the California Health Care Foundation and the Kaiser Family Foundation.
Some 54% of residents in the Sacramento/North Valley region and 56% of residents in the San Joaquin Valley said their communities don’t have enough mental health providers to meet local needs. The poll also found that ensuring access to treatment for people with mental health problems was the number one health care priority for Californians.
The need for mental health treatment has grown in recent years, said Piernot.
“Especially as a lot more of the substance abuse treatment is coming to light and people are really starting to think of it as a chronic disease instead of as an addiction in a separate category, I think that needs have really grown there,” she said.
Currently, she said, the shortage of mental health professionals in the Valley means doctors must sometimes consult with patients through video conferences.
“It’s better than nothing to patients getting care, but it’s sure not the same as face to face,” she said.
Some current efforts provide hope for the future. California Northstate University plans to open a 250-bed teaching hospital in Elk Grove to help train new doctors. This year, CNU will graduate its first class of 60 new physicians. In addition, Proposition 56, the tobacco tax increase passed in 2016, has provided tens of millions of dollars to fund doctor residencies and training.
Yet the question remains: Can California move a new generation into health care careers before the situation becomes an emergency? The commission’s report provides a critical plan for progress.