With rising costs and millions of Californians struggling to access the care they need, California’s health system is facing a crisis.
When California doesn’t have enough of the right types of health workers in the right places to meet the needs of its growing, aging, and increasingly diverse population, is a challenge that would require bold action from not only the new governor and legislators but a broad spectrum of stakeholders in the public and private sectors, according the California Future Health Workforce Commission.
The commission – made up of 24 state leaders in the health, policy, workforce development and education field – spent almost two years focusing on responding to the challenge of workforce shortage and provider mismatches.
The commission recently released a report with recommendations that includes a comprehensive plan to build the workforce that California needs by 2030.
“It’s going to take time and commitment,” said Rishi Manchanda, president and CEO of HealthBegins and a commission member, during an April 23 policy briefing on how California can close its looming health workforce gaps with a look at primary care shortage in the Central Valley.
“It can be done, and it must be done,” Manchanda said of the commission vision, values and strategies for the state to have a health workforce that reflect the diversity of the state and have the capacity and competencies to improve health, equity, and well-being in all communities; provide accessible, affordable, high-quality services at the right time, at the right level and in the right places; and transform health care delivery to address social needs and improve health outcome across the life course.
“It’s about saving and improving lives,” said Janet Coffman, professor at Healthforce Center at UC San Francisco, adding that it will improve the lives of low-income people in rural areas.
According to a 2018 assessment by UC San Francisco, the San Joaquin Valley region has the lowest ratios of licensed physicians, doctors of osteopathic medicine, nurse practitioners, registered nurses, marriage and family therapists, licensed counselors, and licensed social workers per 100,000 population in California and the second lowest ratios of physician assistants, clinic nurses, and psychologists per capita.
The San Joaquin Valley is also challenged by being one of the least healthy regions of California. Among California’s 58 counties, Fresno, Kern, Madera, and Tulare counties rank 52nd, 53rd, 49th, and 50th respectively for health outcome, according to UCSF’s assessment.
The cost estimated for the top 10 recommendations is about $3 billion investment over a 10-year period, however better access to care leads to cost savings of $2 billion.
The Commission’s 10-point plan is projected to eliminate the state’s primary care shortage and nearly eliminate shortfalls in other fields, including behavioral health.
Some of the recommendations will increase the number of health workers by more than 47,000, while other will improve diversity in the health professions, producing approximately 30,000 workers from underrepresented communities and another will train over 14,500 providers – physicians, nurse practitioners and physician assistants, including more than 3,000 underrepresented minority providers.
Health workforce needs are critical for San Joaquin Valley residents.
Fresno State President Joseph I. Castro, one of 24 commissioners, said when 40 percent of the state population is Latino, but only 7 percent of the doctors are Latino the need to act is high.
Castro said 7 million patients in the state have limited English proficiency and the state has 20 percent as many Spanish-speaking doctors as needed across the state.
“That is a significant gap,” Castro said, adding that the Valley has several talented students that want to stay in the Valley.
“This is an area that is underproducing bachelor’s degrees,” Castro said.
Dr. Katherine Flores, director, UCSF Fresno Latino Center for Medical Education and Research, and Associate Clinical Professor, UCSF said it is important to help undergraduate students from disadvantage backgrounds prepare for careers in medicine, adding that programs such as Health Careers Opportunity Program or HCOP does that in the Fresno area with a 60 to 70 percent success rate of students entering a health field, most at a master or doctoral level.
Flores said it is getting more and more difficult for people in the Valley to find primary health care providers as many of her colleagues in the area are reaching retirement age.
That includes people with private insurance and people in Medi-Cal being affected by doctor’s shortage, Flores said.
“The need is huge,” Flores said, adding that “who is going to take our place.”
Tony Iton, senior vice president for Healthy Communities, The California Endowment, said to implement the commission’s recommendation it’s going to take advocacy and policy change. “This is the status quote,” said Iton of the shortage of health workforce. “We will not get Iton said the state won’t get any different results unless action is taken.
“Help lighten the fight to change the status quote. Don’t stop,” Iton said.
The commission’s top 10 priorities for action are:
- 1. Expand & scale pipeline programs to recruit & prepare students from underrepresented & low-income backgrounds for health careers;
- 2. Recruit & support college students, including community college students, from underrepresented regions & backgrounds to pursue health careers;
- 3. Support scholarships for qualified students who pursue priority health professions & serve in underserved communities;
- 4. Sustain & expand the PRIME program across UC campuses;
- 5. Expand number of primary care physician & psychiatry residency positions;
- 6. Recruit & train students from rural areas & other under-resourced communities to practice in community health centers in their home regions;
- 7. Maximize role of nurse practitioners as part of care team to help fill gaps in primary care;
- 8. Establish & scale a universal home care worker family of jobs with career ladders & associated training;
- 9. Develop a psychiatric nurse practitioner program that recruits from & trains providers to serve in underserved rural and urban communities; and
- 10. Scale the engagement of community health workers, promotores & peer providers through certification, training & reimbursement.