Gov. Gavin Newsom has proposed bold steps to ensure more Californians have health coverage, but a new report underscores that his success may depend in part on large-scale investments to expand the state’s health care workforce.
A coalition of health, labor and education leaders, in a report released Monday, cited a dearth of health care workers in many regions of the state and recommended spending up to $3 billion over 10 years to address the shortfall. It’s not clear where that money would come from, though the report cited several possible sources.
The proposals of the group, the California Future Health Workforce Commission, include: creating more primary care and psychiatric residency slots; increasing the use of nurse practitioners; boosting scholarships for low-income students who agree to work in underserved areas; and expanding the supply — and training — of home care workers.
The commission also recommended building a more culturally and linguistically diverse pool of health care professionals to better match California’s demographics.
To meet the needs of an aging population, the commission recommended training home care workers and putting them on a more defined career path. In addition, the report focuses on shortages in mental health care, with proposals to create a new training program for psychiatric nurse practitioners and expand the use of mental health peer counselors.
“As we strive to get everyone covered … we need to have the providers there to actually provide the care,” said California Assemblyman Jim Wood, a commission member and chairman of the state Assembly Health Committee. “We need to realize that this is a growing state and our workforce is not growing proportionally.”
Health care providers simply aren’t working in the areas of greatest need, resulting in a two-tier system for the haves and have-nots, he said.
An estimated 7 million Californians live in shortage areas, and the problem is expected to worsen as older physicians retire, baby boomers age and more people live with chronic diseases. About 45 percent of psychiatrists and 37 percent of psychologists in the state are over 60 years old, according to research from the University of California-San Francisco.
Among the areas experiencing shortages are the San Joaquin Valley and the Inland Empire, as well as the state’s rural northern and Sierra regions, according to the commission.
The report comes less than a month after Newsom unveiled his ambitious health care agenda.
On his first day in office, the Democratic governor proposed extending Medicaid coverage to undocumented young adult immigrants, requiring all Californians to have health insurance, and supplementing federal health insurance subsidies with state money to help them pay for it. He also asked President Donald Trump and congressional leaders to amend federal law to allow California to move toward a single-payer health care system.
Wood said such policies would not be effective without enough providers in the places where they are needed. “Coverage isn’t care, and we can’t just say ‘Everybody’s got coverage’ and walk away,” he said. “If you don’t have access to physicians or dentists or mental health providers in your area, that is an empty promise.”
The commission was established in August 2017 by several health philanthropies hoping to forge a strategy to build the workforce needed by 2030. It consisted of two dozen representatives from hospitals, schools, businesses and labor, and was chaired by University of California President Janet Napolitano and Dignity Health president and CEO Lloyd Dean.
Some of the commission’s proposals would face challenges — especially financial ones. Creating more residencies for primary care physicians and psychiatrists, for example, would cost an estimated $1.56 billion over a decade. And the state’s physicians are likely to oppose giving nurse practitioners more authority.
C. Dean Germano, CEO of Shasta Community Health Center in Redding, Calif., said his community has significant mental health needs and that health centers are often the first place many people go for treatment of depression or anxiety.
“We are sort of handicapped by not having the workforce on the primary care side or on the mental health side,” he said, adding that training students to work in underserved communities is the “golden ticket.”
In Los Angeles County, L.A. Care Health Plan is already working to expand the primary care workforce by offering full scholarships to certain medical school students and loan repayment for physicians recruited to practice in underserved areas.
Investing in more health care professionals — especially primary care providers — can help reduce the overall cost of health care, said Dr. David Carlisle, president and CEO of Charles R. Drew University of Medicine and Science in Los Angeles who served on the commission. The state is expected to need an estimated 4,100 more primary care clinicians in 2030.
“We shouldn’t be intimidated by the $3 billion price tag because, in many ways, we are paying for this already,” Carlisle said. “This is part of the reason why our health care system is so expensive — because patients have to delay care until they are really sick.”
Wood said the estimated cost of the commission’s proposals is a small fraction of the state’s $201 billion annual budget. The report cited other possible funding sources, including philanthropic grants, education dollars, health plan contributions and federal dollars.
Gov. Newsom has “established a vision for how to pursue a pro-health agenda” in California, Carlisle said. “This report provides him with a road map.”
(Five organizations funded the project of the California Future Health Workforce Commission: the California Endowment, California Health Care Foundation, the California Wellness Foundation, Blue Shield of California Foundation and the Gordon and Betty Moore Foundation. Kaiser Health News, which produces California Healthline, has received support from each of these organizations.)