A looming shortage of doctors?

Now that election year hoopla has abated in California, at least for the moment, it’s time to discuss an issue of real world importance — whether the state faces a serious shortage of registered nurses.

A polite debate has been underway in health planning circles over that question because while supply is relatively easy to quantify — we have about 350,000 RNs now and are graduating about 11,000 more each year — there’s no agreement on how to measure demand. At one extreme, a 2017 article in the American Journal of Medical Quality, written by a team of academic researchers, declared that California will have a shortage of 141,348 registered nurses by 2030, the third-worst shortage, in relative terms, of any state.

However, that dire forecast was based on an assumption that California’s population would grow by more than 6 million by 2030, at least twice as much as current growth rates indicate. In its 2017 report on the nursing workforce, the National Center for Health Workforce Analysis, a federal agency, said California’s shortage would be 44,500 by 2030. That’s still serious, but less than a third of what the other report stated.

Studies within California are less alarming. A 2017 survey of nurse employers by the University of California, San Francisco, medical school found “the vast majority of hospitals reporting that there was greater demand for RNs than supply...primarily for nurses with clinical experience.”

But a 2017 study for the state Board of Registered Nursing found that “supply of and demand for RNs are fairly well-balanced over the next 10 years if current enrollment and state-tostate migration patterns are stable.”

So does California face a looming shortage of nurses or doesn’t it? Obviously there’s no consensus, which makes the politics of nursing more difficult. The issue popped up in the Legislature last year in Assembly Bill 1364, aimed at cracking the informal quota on nursing school students imposed by the state Board of Registered Nursing. Assemblywoman Blanca Rubio, a Democrat from West Covina, introduced the bill at the behest of accredited private nursing schools that wanted to expand their enrollments. They had been stymied by board’s refusal to approve their expansions on its rationale that educational slots must be matched with onthe-job clinical positions.

Rubio and her sponsors hailed the American Journal of Medical Quality’s 141,348-nurse shortage. She described it as an “onrushing emergency” and in a Sacramento Bee article argued, “We don’t cap the number of students attending law school or medical school. Yet a board of non-elected officials is limiting the number of students who can pursue a nursing degree.”

Rubio implied that the nurse-dominated board is restricting supply to improve the nurses’ position in contract negotiations with hospitals and other employers. Stoutly opposed by the nursing board, the powerful California Nurses Association and community colleges which offer nursing courses, the bill died.

Another political conflict has been whether the community colleges with nurse training programs should be authorized to award the four-year degrees that employers prefer. When community colleges, as a pilot program, were allowed by the Legislature to offer a limited number of baccalaureate degrees in a few fields, nursing degrees were specifically excluded due to pressure from the state university system. Community colleges argued, in vain, that they are already providing baccalaureate-level training but their graduates must transfer to four-year schools to obtain the degrees employers want.

The confusion over nursing supply and demand and the infighting over nurse training cry out for some independent fact-finding and policymaking.