While legislators in Washington, D.C.,Â haggle over the health care impacts of reducing the national debt and California health care providers absorb a 10% cut in Medi-Cal payments, physicians continue to be scarce — and so do ideas for solving the physician shortage. Medi-Cal is California’s Medicaid program.
Convincing arguments can be made that efforts to reduce the national debt — no matter what the congressional “super committee” comes up with — coupled with recently approved Medi-Cal cutbacks might exacerbate what is already a worrisome shortage of physicians in California. The problem, expected to become more severe over the next couple of years, could undermine the state’s ability to handle millions of newly covered residents when major parts of national health care reform come into play in 2014.
“It’s the big irony that nobody’s really talking about,” said William Guertin, who represents theÂ California Medical Association on the national Physicians Foundation board of directors. “Neither the feds nor the state want to deal with what is in effect the gutting of a big part of the country’s — and California’s — health care system right before these major changes come into play.”
The shortage of physicians is a symptom of larger problems associated with funding contractions in the largest and most influential health care plans in the country — Medicare and Medicaid.
More cutbacks in Medicare are likely as part of the national debt reduction effort underway in Congress. California, already near the bottom of all states in terms of Medicaid provider reimbursement rates, received federal approval last week to reduce Medi-Cal payments by 10%.
“California is a big state with a lot of rural areas and a big physician distribution problem,” said Dustin Corcoran, CEO of the California Medical Association. “We already have a difficult time making sure portions of our state are covered with adequate physician services and the problems tend to be worst in the rural areas where we have a large population of Medi-Cal patients. It’s already hard to keep enough doctors in those areas,” Corcoran said.
“The state is being very shortsighted with these cutbacks. These people are not going to go away, and they’re going to have a harder time finding physicians,” Corcoran said.
One in four California counties currently has the recommended ratio of 60 to 80 primary care physicians for each 100,000 residents, according to the California Medical Association. When more than six million newly insured Californians arrive in the system in 2014, that ratio could drop significantly.
Because Medi-Cal reimbursements are low and getting lower, fewer primary care physicians are expected to accept new Medi-Cal patients in California. According to a recent survey by Fairbank, Maslin, Maullin, Metz & Associates, Medi-Cal beneficiaries are far more likely than other Californians to be turned down by a physician and are more than four times more likely to get care in a hospital emergency department because they could not get an appointment with a doctor or clinic.
Ruth Haskins, a physician in Folsom, says the scarcity of physicians is a daily reality for patients and health care providers throughout the state.
“Finding a pediatrician for Medi-Cal patients is darn near impossible now,” Haskins said. “Without some changes, it’s only going to get worse.”
Next Generation of Physicians
With budget cuts and general austerity as a backdrop, California is having a hard time wooing and training new physicians.
Jessica Cook, a Sacramento area student applying to medical schools, said help with financing a medical education would make her decision easier.
“I’d like to stay in California, but it’s a pretty daunting prospect to be going into so much debt. I recently looked into loan repayment programs here, and they didn’t look as good as other states,” Cook said.
She said Oregon’s financial aid packages looked more appealing.
A couple of bills in the California Legislature — AB 589 by Assembly member Henry Perea (D-Fresno) and SB 635 by Sen. Ed Hernandez (D-Los Angeles) — aim to help students afford medical school and allied medical training in California with scholarships and loan forgiveness.
Statewide budget cuts have made financial aid more difficult at the state’s nine medical schools and have put two new medical schools on hold. A proposed medical school at UC-Riverside –Â in the heart of the Inland Empire, where primary care physicians are particularly scarce –Â is in limbo. The school is unable to get national accreditation partly because the state has not guaranteed funding for it.
New Ways To Train Primary CareÂ Providers
The California Academy of Family Physicians and its parent organization, the American Academy of Family Physicians, are hoping to sponsor a bill in Congress that would create pilot projects to study the effects of changing the way physician training programs are funded, sending payment directly to community-based primary care training programs.
U.S. Rep. Mike Thompson (D-Calif.), a member of the House Ways and Means Committee’s Subcommittee on Health, recently visited the Santa Rosa Family Medicine Residency program to drum up interest in the idea. So far, the proposed bill has no sponsor, but proponents are hopeful.
“By better supporting community-based primary care residency programs, the bill would help communities recruit, train and retain much-needed primary care physicians,” according to Jeff Haney, director of the Santa Rosa residency program.
Support from Medicare, which funds the majority of physician training in the U.S., flows directly to hospitals, where decisions are made about which medical specialties to support. CAFP officials and Haney believe spreading the money to community-based programs would bolster primary care education.
“The outdated model makes it more difficult for primary care residency programs to secure the funding we need,” Haney said in a prepared release. “The contemporary model is to focus strongly on preventive care to keep people as healthy as possible, and on expert management of chronic illnesses, such as diabetes and heart disease. This kind of care takes place in the community, and our program is a national model for training physicians on how to provide that care.”