Primary Care Physician Supply Not Keeping Up With Medi-Cal Demand

The supply of primary care physicians in California has not kept pace with increasing enrollment in Medi-Cal, the state's Medicaid program, the San Jose Mercury News reports.

Background

According to the Mercury News, about 2.7 million additional state residents have enrolled in Medi-Cal since the program was expanded under the Affordable Care Act in January 2014. Further, state health officials project that a total of more than 12.2 million residents will be on the program's rolls by the middle of next year.

Meanwhile, there are 84,628 fee-for-service doctors participating in Medi-Cal -- more than half of whom are specialists, according to the California Department of Health Care Services, which oversees the Medi-Cal program.

Delays in Care

A recent report by the California HealthCare Foundation found that while access to specialists meets federal guidelines, the ratio of PCPs to Medi-Cal beneficiaries was about 35 to 49 physicians per 100,000 beneficiaries -- far below federal guideline of 60 to 80 PCPs per 100,000 beneficiaries. CHCF publishes California Healthline.

The shortage of PCPs participating in Medi-Cal has caused delays in care, and experts expect the situation to worsen, in part because of the program's low reimbursement rates.

The PCP shortage also is causing a surge in the number of Medi-Cal beneficiaries that seek treatment at emergency departments, the Mercury News reports. According to data from the Office of Statewide Health Planning and Development, "treat and release" ED visits by Medi-Cal patients increased by 30% between the first three quarters of 2013 and the same period in 2014.

Reaction

Steven Harrison, a PCP and director of a residency program at the Natividad Medical Center in Salinas, said, "We had a shortage of [PCPs] before this flood [of Medi-Cal beneficiaries] came about. Now we have a dire shortage."

Del Morris, president of the California Academy of Family Physicians, said, "California did a good job of getting people signed up, but they basically stuck their heads in the sand and assumed that California physicians would just jump right on board and want to take more Medi-Cal patients." He added, "It's unacceptable to say, 'We are not ready for you yet, you'll just have to suffer with your disease.'"

Meanwhile, some health officials say that delays in care and increased ED patient volume are expected parts of expanding Medi-Cal.

Bill Barcellona, vice president of the California Association of Physician Groups, said, "There's a lot of talk about physician shortages in California, and I don't buy it," adding, "We have plenty of doctors -- in fact, we have an oversupply of specialists in many areas, like the coastal areas" (Seipel, San Jose Mercury News, 2/7).