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Leading California CEOs, educators, nurses and physicians announced Monday an ambitious set of 10 recommendations that they say will eliminate the shortage of primary care physicians and nearly eliminate shortages in psychiatry by 2030.
The plan, if implemented, would come at a pricetag of $3 billion, they said.
These recommendations would increase the number of health care workers by over 47,000 people and improve diversity by producing approximately 30,000 workers from rural and under-served communities, said Janet Napolitano, president of the University of California and co-chair of the California Future Health Workforce Commission.
“The commission recognizes that bolstering California’s health care workforce is a significant undertaking,” Napolitano said. “Health care represents almost 12.6 percent of the state’s economy, employing 1.4 million skilled workers across dozens of different highly technical and closely regulated fields.”
While the price tag might sound like a lot, Napolitano said, it’s less than 1 percent of what Californians are projected to spend on health care in 2019 alone. She and her fellow co-chair, CommonSpirit Health CEO LLoyd Dean, emphasized that the commission had spent more than a year researching, listening to and working with top medical industry experts and stakeholders as they developed the recommendations. They said their work is not over. Rather, they will now begin implementation by working with political leaders and regional educators, nonprofits and medical professionals.
The commission’s recommendations are:
▪ Expand and improve the transitional programs, also known as pipeline programs, that help students get from high school to a baccalaureate degree and then into medical school.
▪ Find college students from rural and other under-served communities who have the acumen to become physicians. These students will need mentoring as they overcome obstacles such as poverty, cultural barriers and a lack of role models who have achieved a graduate degree.
▪ Ensure sufficient funding or scholarship programs to help qualified students pursuing priority health professions.
▪ Sustain and expand a UC program that seeks out socially conscious graduates who want to practice medicine in underserved communities.
▪ Make it a goal to increase by 2030 the number of primary care physicians by 1,872 individuals and psychiatrists by 2,202. This would mean maximizing the role of nurse practitioners and psychiatric nurse practitioners.
▪ Provide scholarships to students willing to practice at community health centers in rural areas and other under-resourced communities. The commission predicted that, when this partnership with 10 California medical schools and community health centers is fully implemented in 2026, California would see an increase of 200 to 480 medical students annually.
▪ Increase the number of nurse practitioners in care teams to help fill gaps in primary care.
▪ Grow the number of home universal home care workers who can help with preventive care needed by the state’s aging population, thereby reducing unnecessary emergency room visits and hospitalizations by more than $2.7 billion over 10 years due to enhanced training and care.
▪ Develop a psychiatric nurse practitioner program that recruits from and trains providers to serve in underserved rural and urban communities, expanding treatment to hundreds of thousands of individuals who need it.
▪ Train and certify a new legion of community health workers and providers who can help with the social support of the elderly and largely home-bound population of the state. These individuals can also help with self-sufficiency for people with mental illness and substance-use disorders.
Dr. Rishi Manchanda, president of Health Begins, has worked as a primary-care physician in underserved communities such as South Los Angeles and in the San Joaquin Valley. He co-chaired the Future Health Workforce Commission’s committee on primary care and prevention.
He said he was particularly excited about the idea of expanding scholarships to students in exchange for a commitment to work in geographic regions of need. Manchanda signed up with the National Health Service Corps in exchange for financial assistance with his education, committing himself to work in rural or disadvantaged communities where the shortage of primary care workers is evident.
“In South L.A. and the San Joaquin Valley,” he said, “I have seen a constant mismatch in the demands of the patients and the needs of the patients who require good primary care, primary care that’s right-sized to their lives, primary care that’s provided in a way that’s accessible and affordable and appropriate. It’s been clear to me time and again in my career to date that these gaps have been unmet.”
Manchanda said he gained a great degree of respect for community health workers and lay persons who provide a health-care lifeline for the elderly and shut-in in the poorest communities all around the state.
They have built trust in the communities they serve, Manchanda said, and it is that ensures acceptance for primary care clinicians and that will allow health care to move from just a sick-care model to a model that prevents the conditions that cause disease in the first place.
Heather Young, a Future Health Workforce commissioner and the dean emerita at the Betty Irene Moore School of Nursing at the University of California, Davis, said that the coming demographic shift should make these recommendations a priority to all Californians.
“By 2030, the population over 65 in California will double to 9 million, and the fastest-growing group in that population will be people over 75 years of age,” she said. “This population is becoming increasingly diverse, and many of these people live in rural communities and face economic hardship.”
Half of all older adults do not have life partners, Young said, but they wish to age in place. What has allowed the Greatest Generation to age in place is that they were often married, research has shown, and one spouse often maintained life skills that the other spouse lost. As single people age, Young noted, they will need home health care workers to help them perform daily functions they can no longer handle.
“We also expect a 33 percent increase in the prevalence of Alzheimer’s disease by 2025,” Young said. “That means we’ll have 845,000 people in our state living with Alzheimer’s disease and other cognitive impairments.”
She added: “These demographic changes translate into the need for at least 200,000 additional home-care workers by 2024 and importantly better coordination of care among community agencies, primary care and health systems. It’s in our interest to bolster the home-care workforce because this is in line with preferences of older adults and is a more cost-effective solution in most instances.”