Transcript Slide 1

California Medical Association
Physicians dedicated to the health of Californians
Darin Latimore, M.D.
Assistant Dean, Office of Student and Resident Diversity
UC Davis School of Medicine
Physician Workforce 101
California Physician Supply Estimates
• There are about 119,000 physicians with an active
California license
• However, MBC reports only 66,500 are active patient
care physicians working more than 20 hours a week
• Of those not found to be active patient care physicians,
6,000 are still in training, 20,000 are practicing outside
of California, and 19,000 are practicing fewer than 20
hours per week
California Physician Demographics
Physician Age
• Nearly 30% of active CA physicians are over 60 years old, the largest
percentage of any state
• In the last 20 years, the number of physicians over 65 has tripled
while the number of physicians 55-64 has doubled
• More physicians are retiring each year in CA than are entering the
workforce. This trend is expected to continue until 2020
California Physician Demographics
Physician Ethnic and Racial Diversity
California Physician Demographics
Physician Education
• 74% of California’s active patient care physicians come from out-ofstate or foreign medical schools
• International medical graduates represent 26% of all active patient
care physicians and 31% of all primary care physicians in the state
• Approximately 2/3 of California’s “home-grown” physicians
graduated from UC medical schools
California Physician Demographics
Primary Care and Specialty Distribution
• 34% of active CA patient care physicians are PCPs and 66% are
specialists
• California has an uneven distribution of physicians across counties
▫ 74% of CA’s 58 counties have an undersupply of PCPs
▫ 45% of counties have an oversupply of specialists
▫ 43% of counties have an undersupply of specialists
• Primary care residencies continue to draw lower levels of interest
California Physician Supply and Demand:
Demographic Factors
Educational Opportunity
• There are 17.2 medical students per 100,000 population in
California (US average: 30.1)
• There are 25.1 medical residents per 100,000 population in
California (US average: 35.7)
• California medical schools have room for 41.1% of medical students
born in the state (US average: 61.9%)
California Physician Supply and Demand:
Financial Factors
Medical Student Debt
• The average medical student graduating in 2009 carried over
$156,400 in debt
• 86% of medical students carry an outstanding loan when they
graduate
• Public medical school tuition increased 11.1% annually from 2001 to
2006 and continues to grow
• If current trends continue, the average medical school debt will be
$750,000 by 2033
California Physician Supply and Demand:
Financial Factors
Medical Student Debt (cont.)
• The cost of medical school is the #1 deterrent for Black, Hispanic
and Native American students
• Since 2000, medical students are increasingly coming from higherincome families
• Students with high debt are less likely to pursue family practice and
primary care
Figure 5: Medical School Debt, Medical School Tuition, and Physician
Income Before Taxes, 2006-2050
$3,000,000
$2,500,000
Dollars
$2,000,000
$1,500,000
Income
$1,000,000
Debt
Tuition
$500,000
$0
2006 2011 2016 2021 2026 2031 2036 2041 2046 2051
Year
California Physician Supply and Demand:
Political Factors
Medi-Cal Rates
• CA has the 4th lowest Medicaid (Medi-Cal) rates in the US, paying
on average 56% of the Medicare fee schedule
• Only 57% of physicians were able to accept new Medi-Cal patients in
2008
• There is considerable overlap between medically underserved
regions and areas with a high proportion of Medi-Cal patients
California Physician Supply and Demand:
Political Factors
Federal Healthcare Reform
• Expands Medicaid to nearly all citizens with income at or below
133% of the Federal Poverty Level (FPL). This should make 1.7
million uninsured Californians newly eligible for Medi-Cal
• Establishes a state-run Health Insurance Exchange, and offers
premium credits and federal subsidies for individuals with incomes
between 133% and 400% of the FPL. 1.4 million currently uninsured
Californians should be eligible for some level of assistance
• This represents a nearly 10% increase in California’s insured patient
population
California Physician Supply and Demand:
Political Factors
Federal Healthcare Reform (cont.)
• Primary care and rural workforce reforms
• Diversity enhancement and cultural competency training
• Workforce analysis and development commissions
California Physician Pipeline:
Medical School
Population Growth
• In the last 15 years California’s population has grown by 20%, while
the number of medical school graduates has remained stagnant at
approximately 1,000
• In 2009, there were over 45,500 applications submitted to
California medical schools for 1,084 positions
California Physician Pipeline:
Medical School
In-State Matriculation
• Only 41% of medical students from California are able to attend an
in-state medical school
• California is ranked 37th in the nation in this category
• 90% of public medical school matriculants and 53% of private
medical school matriculants are state residents
California Physician Pipeline:
Medical School
Retention
• California has the #1 retention rate for medical school graduates in
the nation (62%)
• California has the #2 retention rate for residents/fellows in the
nation (69%)
• However, only 26% of active patient care physicians in the state
went to medical school in California
California Physician Pipeline:
Graduate Medical Education
Residency Positions
• In 2010, over 37,500 medical students applied for only 25,520
residency positions in the United States
• There is a particular shortage of residency slots in California, which
hosts 12% of the nation’s population but only 8.3% of its residency
positions
• California ranks 32nd among states in its resident-to-population
ratio, with 25.1 residents per 100,000 people (the national average
is 35.7 residents per 100,000 people)
California Physician Pipeline:
Graduate Medical Education
Funding
• Medicare funds nearly 70% of GME ($8.4 billion in 2008) but has
been frozen since 1997
• Medicaid funds almost 30% of GME ($3.78 billion in 2008, $187.3
million in CA) but is skewed away from CA by the FMAP formula
• Unlike most states with Medicaid managed care, California does not
fund GME through its capitation rates, but through fee-for-service
programs only
California Physician Pipeline:
Graduate Medical Education
Process Concerns
“The approval process…is time consuming at best and at
worst frequently a major barrier that must be negotiated
in order to expand the number of trainees in any
accredited program.”
-Council on Graduate Medical Education, 19th report
Recommendations
1. Train more physicians in California
• Increase medical school enrollment and the number of medical
schools in California. Direct logistic and financial support for two
new medical schools currently being developed at UC Merced and
UC Riverside.
• Expand the number of residency slots in California by aggressively
pursuing private funding in the short term, while advocating for
long term federal reforms in the areas of the Medicare funding
freeze and the Medicaid FMAP formula. California should also
encourage innovation in residency training to better reflect the
ambulatory care models of the future.
Recommendations
2. Increase incentives for pursuing primary care
• Increase scholarships/grants for medical students to reduce medical
education debt.
• Provide higher compensation for primary care services.
• Explore the possibility of a shortened primary care education track
that does not compromise the quality of physician training or the
breadth of clinical exposure
Recommendations
3. Increase incentives for working in underserved
areas
• Expand existing state loan repayment programs for PCPs and
specialists working in underserved areas
• Increase Medi-Cal reimbursements
Recommendations
4. Increase diversity of the physician workforce
• Support and expand post baccalaureate premedical programs that
help to increase ethnic and socioeconomic diversity of medical
students. Research indicates that graduating from these programs
increases the likelihood going to medical school by over three-fold.
• Encourage and recruit more students from underserved
communities, who will likely return to serve those areas after
completing training, to go into medicine. This includes the support
of premedical advising services and mentorship opportunities in a
clinical setting for youths considering medical careers.
Recommendations
4. Increase diversity of the physician workforce
(cont.)
• Reduce financial barriers to pursuing medicine by offering more
scholarships and grants to students with ethnically and
economically diverse backgrounds.
• Develop and support medical education programs and continuing
medical education courses with specialized curricula that teach
physicians the art of providing culturally competent care.
Questions?