How can all Cal­i­for­nia com­mu­ni­ties at­tract med­i­cal prac­ti­tion­ers?

The Fresno Bee (Sunday) - - Insight - BY DAN SCHNUR Spe­cial to The Sacra­mento Bee

Note to read­ers: Each week through Novem­ber 2019, a se­lec­tion of our 101 Cal­i­for­nia In­flu­encers an­swers a ques­tion that is crit­i­cal to Cal­i­for­nia’s fu­ture. Top­ics in­clude ed­u­ca­tion, health­care, en­vi­ron­ment, hous­ing and eco­nomic growth.

Stay in the know: Go to www.fres­ in­flu­encers to sign up for the Cal­i­for­nia In­flu­encers news­let­ter – and tell us what you think.

Most of the political de­bate over health care re­form fo­cuses on ex­pand­ing cover­age for the unin­sured and mak­ing care af­ford­able for work­ing Cal­i­for­ni­ans and their fam­i­lies. But an even more fun­da­men­tal ques­tion for many com­mu­ni­ties across the state is sim­ply en­sur­ing that there are enough doc­tors and other med­i­cal pro­fes­sion­als to serve their health needs.

“Un­der the Af­ford­able Care Act, Cal­i­for­nia has ex­panded ac­cess to care more than any other state,” said Cal­i­for­nia Med­i­cal As­so­ci­a­tion CEO Dustin Cor­co­ran. “But that ex­pan­sion has fur­ther strained a sys­tem that is be­ing hit hard by in­creased de­mand from an ag­ing pa­tient pop­u­la­tion and physi­cian re­tire­ments as Baby Boomers age out of the work­force and physi­cian burnout in­creases.”

An­thony Wright, ex­ec­u­tive di­rec­tor for Health Ac­cess Cal­i­for­nia, em­pha­sized the dis­par­ity of med­i­cal care avail­able to dif­fer­ent com­mu­ni­ties, point­ing to the great­est

needs for ru­ral, mi­nor­ity and low-in­come pa­tients.

“There’s no dearth of doc­tors in Bev­erly Hills, but there is in fast grow­ing re­gions like the Central Val­ley and In­land Em­pire. And while 40 (per­cent) of Cal­i­for­ni­ans are Latino, just 7 (per­cent) of Cal­i­for­nia physi­cians are,” Wright said. “We need to train and re­cruit more med­i­cal pro­fes­sion­als… and those who have the lan­guage and cul­tural com­pe­tency to ad­dress the needs of all Cal­i­for­ni­ans.”

Cal­i­for­nia Health and Hu­man Ser­vices Sec­re­tary Mark Ghaly called for tar­geted re­cruit­ment ef­forts to­ward bring­ing prac­ti­tion­ers to at-risk com­mu­ni­ties.

“We know that health pro­fes­sion­als of­ten work where they train. Given this, we should build train­ing pro­grams… in re­gions where we want trainees to work (and live) and in spe­cial­ties where we pro­ject short­ages: be­hav­ioral health, pri­mary care, ge­ri­atrics,” Ghaly said. “If we

want a work­force that looks like Cal­i­for­nia, we must… cre­ate path­ways for the full di­ver­sity of Cal­i­for­ni­ans to find ap­peal in health ca­reers.

Other In­flu­encers stressed the im­por­tance of cre­at­ing in­cen­tives for health care pro­fes­sion­als to re­turn to the com­mu­ni­ties where they were raised.

“We must en­sure that trained and skilled health work­ers are avail­able in both ur­ban hubs and small towns,” said Lloyd H. Dean, CEO of Com­monSpirit Health and co-chair of the Cal­i­for­nia Fu­ture Health Work­force Com­mis­sion. “We need to build our lo­cal work­force from within, sup­port­ing stu­dents from underserve­d ar­eas – at all lev­els of their aca­demic ca­reers – with men­tor­ship and schol­ar­ship op­por­tu­ni­ties.”

Sacra­mento pub­lic affairs spe­cial­ist Robin Swan­son sug­gested other po­ten­tial sources from which to ad­dress the state’s short­age.

“We sim­ply don’t have enough med­i­cal school stu­dents to keep pace with the grow­ing de­mand of el­derly and sick peo­ple here,” Swan­son said. “Cal­i­for­nia com­mu­ni­ties should also look at re­cruit­ment from cre­ative sources, like doc­tors who have served in our mil­i­tary... Pro­vid­ing th­ese ex­pe­ri­enced ser­vice men and women in­cen­tives to come live and work in Cal­i­for­nia should be a high pri­or­ity in the quest to find qual­i­fied doc­tors and med­i­cal prac­ti­tion­ers.”

Sky­rock­et­ing stu­dent loan debt was an­other fre­quently cited ob­sta­cle to at­tract­ing doc­tors.

“To­day’s med­i­cal pro­fes­sion­als grad­u­ate with ed­u­ca­tional debt that’s gen­er­ally the size of a mod­est home mort­gage and that of­ten means ide­al­ism and ser­vice are pit­ted against monthly bills,” said Bruce Ch­er­nof, pres­i­dent of The SCAN Foun­da­tion. “Cal­i­for­nia should cre­ate a much more ro­bust debt for­give­ness and loan re­pay­ment pro­gram for doc­tors and other care pro­fes­sion­als will­ing to pro­vide care in underserve­d com­mu­ni­ties.”

Santa Cruz County Su­per­vi­sor Zach Friend also pro­posed loan re­pay­ment and for­give­ness pro­grams to at­tract med­i­cal pro­fes­sion­als to ru­ral ar­eas. “In our county, we’ve ex­pe­ri­enced dif­fi­cul­ties re­cruit­ing and re­tain­ing fam­ily physi­cians, men­tal health pro­fes­sion­als and other spe­cial­ists,” Friend said, also sug­gest­ing hous­ing sup­port and flex­i­ble cover­age sched­ules. “The cost of such pro­gram(s) is less than the cost of neg­a­tive health out­comes as­so­ci­ated with longer wait times to see spe­cial­ists… or other for­gone pre­ven­tive op­por­tu­ni­ties.”

Assem­bly­woman Marie Wal­dron, R-Es­con­dido, fo­cused on an­other daunt­ing ob­sta­cle to at­tract­ing doc­tors to ru­ral Cal­i­for­nia.

“Doc­tors are strug­gling to keep their prac­tices open be­cause re­im­burse­ment rates for Medi-Cal pa­tients are too low, es­pe­cially in ru­ral ar­eas,” said Wal­dron. “Cal­i­for­nia… needs to in­crease Med­i­Cal re­im­burse­ment rates so doc­tors are in­cen­tivized to work in ru­ral and underserve­d ar­eas.”

Sierra Health Foun­da­tion Pres­i­dent Chet He­witt un­der­scored the im­por­tance of in­creas­ing early ed­u­ca­tional out­reach to young peo­ple in underserve­d com­mu­ni­ties.

“We need to fo­cus on the need for ed­u­ca­tional eq­uity for stu­dents – par­tic­u­larly those from low­in­come neigh­bor­hoods… who are in­ter­ested in pur­su­ing health ca­reers and who would ben­e­fit from ed­u­ca­tional and men­tor­ship sup­port,” He­witt said.

JOHN WESTBERG jwest­[email protected]­

Crit­i­cal care tech­ni­cian Ken­neth Perkins, left, works with Dr. Ni­cole McLawrence, who was in her sec­ond year of res­i­dency in fam­ily medicine, at Doc­tors Med­i­cal Cen­ter in Modesto in 2015.

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