California’s cuts to medical education will harm patients
On March 17 — Match Day — medical students like me across California will open envelopes to be “matched” with a residency-training program. As matched residents, we will spend three or more years in intensive training in our specialties to deliver the best possible care to our patients.
But on Match Day, many medical students in California will find that they’re unable to stay. Future doctors born and educated right here in California may end up matching in far-away cities, away from the communities we’ve grown up around and trained to care for. Some may not end up matching at all.
A major reason for this is a shortage of primary care residency training positions in California.
The Affordable Care Act (ACA) and a renewed focus on social justice in medical training have increased the number of students interested in practicing primary care, especially in underserved areas. While California ranks #1 for residency program graduates staying in-state to practice in their communities (70 percent!), we rank #32 for the number of residency spots per capita.
There’s a shortage of primary care doctors in California, especially in rural and low-income neighborhoods. It’s currently impacting the ability of a MediCal patient to get actual medical care and will only get worse over time.
According to the California Primary Care Association, Medi-Cal has a physician-to-enrollee ratio which is about half of the federal standard, and they estimate California will need over 8,000 new primary care physicians by 2030.
Creating more residency program slots would increase the number of primary care physicians who will train (and are likely to stay) in California. If we do not create more residency program slots, we will be exporting medical students after heavily investing in their education at some of the best medical schools in the country.
A sustained and predictable source of funding for Graduate Medical Education (GME) is critical to addressing this problem, as residency programs are multiyear and depend on substantial educational efficiency gains when older residents can train new ones.
California is one of only seven states not obtaining matching Medicaid dollars for residency funding, which has led to patchwork crisis funding for the past several years.
Gov. Jerry Brown’s proposed 2017-2018 budget was expected to significantly improve funding for residency programs and signal that the state would begin to fund them in a reliable manner.
The recently passed tobacco tax, Proposition 56, included a provision to allocate $40 million dollars annually to GME in primary care. The 2016 budget had included a three-year commitment to provide $100 million in the state budget for residency training.
None of this happened, and Brown’s budget proposal, unfortunately, has taken us a step backward.
The proposed budget eliminates the previously-approved $100 million in ongoing residency program funding and, through a budget trick, places the $40 million in Prop. 56 GME funding into the UC budget while cutting $40 million from UC elsewhere.
Gov. Andrew Cuomo of New York does it right. He supports GME annually to the tune of $1.8 billion. Brown’s budget proposes 3 percent of that for a state twice as populous.
There’s a clear way out of this, Gov. Brown: respect the will of the voters with the dedicated Proposition 56 funds, restore last year’s $100 million commitment to primary care training, and seek federal funding for residency programs through Medicaid.
This solution will mean a substantial and sustained source of funding for primary care workforce training in California, will end the export of medical students, and will ensure that Californians on Medi-Cal (like yours truly) can get high-quality medical care. Nuriel Moghavem is a student at Stanford School of Medicine concentrating in Health Services and Policy Research. He is a trustee of the California Medical Association and a former legislative assistant in the California State Assembly. He wrote this for The Mercury News.