Six out of nine regions in California have a shortage of primary care physicians, and the problem may be worsening: With nearly 30 percent of our physicians more than 60 years old, more doctors are nearing retirement here than in any other state.
The findings are part of a report on the state's physician supply, published last week by the California HealthCare Foundation. The report highlights geographic, ethnic and linguistic disparities among California's residents and physicians, as well as how the state compares to the rest of the nation.
California's ratio of physicians to population increased 7 percent from 1998 to 2008, but demand is expected to rise as well, with a growing senior population and more people obtaining health insurance as a result of health care reform. And many of our doctors are nearing retirement.
Twenty-nine percent of active physicians in the state are older than 60, compared to an average of 25 percent in the U.S. Dwindling supply and other barriers could harm access to care, as well as quality, for some Californians.
For example, Latinos represent 37 percent of the state's population, but 5 percent of its doctors. The disparity is even greater in the Central Coast, Inland Empire and San Joaquin Valley regions, and most severe in Los Angeles County, where 47 percent of the population and only 5 percent of doctors are Latino. Statewide, 18 percent of doctors speak Spanish.
Cultural and linguistic aspects of care can make a big difference, said Craig Paxton, author of the report and a principal at the consulting firm Cattaneo & Stroud in Burlingame, Calif. Patients often feel more comfortable describing symptoms, and providers can better assess what kind of care is most appropriate, when "somebody is seen as being within the same community," he said.
The report also found an uneven distribution of physicians, with two-thirds of the state falling short of national supply standards.
Only the Greater Bay Area, the Sacramento Area and Orange County meet the recommended primary care doctor supply set by the U.S. Department of Health and Human Services' Council on Graduate Medical Education. The council recommends 60 to 80 primary care physicians and 85 to 100 specialists per 100,000 people.
California HealthCare Foundation
A substantial portion of California's doctors, especially those in primary care, come from out-of-state or foreign medical schools, Paxton said. One way to increase California's physician-to-patient ratio could be to bolster enrollment in University of California medical schools, he said.
California led the country in medical student retention in 2008, with 62 percent of its graduates practicing in the state, compared to a nationwide average of 39 percent of doctors practicing where they were educated. We keep 69 percent of those whose residencies were in the state.
If more Californians enroll at the five UC medical schools – and therefore pay less tuition than they would out of state – they are more likely to practice here, Paxton said.
But increasing medical school and residency head count alone is not enough, said Joanne Spetz, a community health systems professor at UC San Francisco who studies the health care work force.
"You need to be careful what fields in medicine you're opening up … (and) where those programs are," Spetz said. A primary reason why UC Riverside, in the Inland Empire, and UC Merced, in the San Joaquin Valley, are starting medical schools is to address these disparities, she said.
Riverside plans to enroll its first class of medical students in fall 2012. Merced hopes to establish its school by 2015. Building costs for Riverside are projected at $550 million; for Merced, as high as $75 million.
But the campuses could be derailed by California's budget crisis. Riverside has financial support from local leaders, private foundations and the federal government.
But without $40 million from the state during the next four years, the campus won't get up and running, said G. Richard Olds, the school's founding dean. Merced, though it recently secured $5 million from the state, is still searching for funds.