Top health problem: doctor shortage
California is taking on the state’s doctor shortage by budgeting $33 million to fund medical residencies in the Golden State’s neediest areas. That funding is sorely needed as the state’s doctor shortage is acute in many parts of the state and growing worse.
Though government funding is vital, we clearly can’t rely on it for an adequate, or even consistent, supply of resources. There are simply too many other priorities competing for tax dollars.
Earlier this year, the UCSF’s Healthforce Center reported that the state’s rural areas were experiencing chronic doctor shortages, even though the number of primary care doctors statewide had increased over the past 12 years.
Only two regions — the Greater Bay Area and Sacramento — had a sufficient number of primary care doctors. The Council on Graduate Medical Education recommends between 60 and 80 doctors for every 100,000 people.
Three regions — all rural — had 50 or fewer doctors per 100,000 people. In the vast Inland Empire, there are only 39 per 100,000.
The California Primary Care Association calculates that the state will need 8,243 additional primary care physicians by 2030. That would require increasing the size of the primary care workforce by nearly one-third. Doing so could be difficult.
That’s in part because most of the state’s medical residencies are in areas that already have a healthy ratio of doctors to patients. And research shows that most doctors end up staying where they did their residencies. A study published in Family Medicine, a medical journal, found that 55 percent of family physicians practice within 100 miles of their residency programs.
California appears to recognize this reality. But the state budget approved represents a turnabout for the Brown administration, which initially called for cutting the $33 million in spending for residencies in underserved areas. Back in May, the state’s Department of Finance called the proposed cut “a question of affordability.” Never mind that it represented less than .01 percent of the state’s $183 billion budget.
Nationally, support for medical residencies is severely lacking. In 2010, Congress allocated $46 million a year for five years to support 750 primary care residents in underserved areas in 27 states. Lawmakers extended the program for two years in 2015 — but allocated only $43 million a year. That reduction has caused some teaching health centers to train fewer residents and others to close.
What’s needed is an approach that enlists medical schools, private foundations, and individual donors to help fill the gap. Fortunately, there’s been some progress in this area.
Given that doctors tend to stay where they’re trained, public officials and educational leaders should consider bringing medical education to the places where physicians are in demand. UC Riverside, for instance, recently built a new public medical school in the Inland Empire, site of the state’s worst primary care shortage.
The University of Kansas Medical School has a “Scholars in Rural Health” program that recruits undergraduates willing to complete an M.D. and practice in rural Kansas. Successful candidates are guaranteed admission to the medical school and can receive a full scholarship.
The CityDoctors program at St. George’s University, the school I lead, offers scholarships that can cover the cost of medical school for those who commit to practicing at public hospitals in New York City. More than three-quarters of our grads pursue careers in primary care.
The Walmart Foundation last year awarded a $750,000 grant for a Northwest Arkansas Community Internal Medicine Residency Program that will cover its first two years of operating costs. Northwest Arkansas was short about 148 medical residents.
Californians eager to do their part can contact lawmakers and encourage them to fund more residencies and establish new graduate medical education centers in underserved areas, such as the Central Valley and inland Southern California. Individuals can also make a difference by donating to hospitals like the Desert Regional Medical Center or San Joaquin General Hospital, both of which host residents in underserved communities.
The United States has historically proved capable of galvanizing public and private resources to make great strides in public health. The successful decades-long campaign against smoking is a prime example.
We need the same level of urgency when it comes to the most basic health care need of all — access to a primary care physician.