BILL ANALYSIS �
AJR 13
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ASSEMBLY THIRD READING
AJR 13 (Lara)
As Introduced June 2, 2011
Majority vote
HEALTH 19-0
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|Ayes:|Monning, Logue, Ammiano, |
| |Atkins, Bonilla, Eng, Garrick, |
| |Gordon, Hayashi, |
| |Roger Hern�ndez, Bonnie |
| |Lowenthal, Mansoor, Mitchell, |
| |Nestande, Pan, |
| |V. Manuel P�rez, Silva, Smyth, |
| |Williams |
| | |
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SUMMARY : Urges the President and the Congress of the United
States to continue to provide resources to increase the supply
of physicians in California, in order to improve access to care,
particularly for Californians in rural areas and members of
underrepresented ethnic groups, and to consider solutions that
would increase the number of graduate medical education
residency positions to keep pace with the growing numbers of
medical school graduates, and the growing need for physicians in
California.
FISCAL EFFECT : None
COMMENTS : According to the author, in 2010, President Obama
signed into law the Patient Protection and Affordable Care Act
(PPACA) in order to expand health insurance coverage, reduce
health care costs, and address the growing shortage of
physicians. PPACA aims to specifically address shortages in
primary care through adjustments to the Medicare and Medicaid
fee schedules, re-allotment of unused Graduate Medical Education
(GME) slots, and a suite of grants, scholarships, loans and loan
forgiveness programs. The author cites findings from multiple
studies that suggest the supply of physicians in California -
especially in underserved areas serving ethnic populations - is
inadequate. The author has introduced this resolution to urge
the President and Congress to increase the supply of physicians
and the number of GME residency positions in California.
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Key Medical Board of California (MBC) survey findings published
in March 2008, from an analysis of survey responses from 61,861
physicians who are active in patient care in California and no
longer in training include:
1)Latinos constitute one-third of the state's population but
only 5% of its physicians.
2)California has very few physicians of Samoan, Cambodian, and
Hmong/Laotian ethnicity, and these ethnic groups should also
be recognized as underrepresented in medicine and more
actively recruited into the profession.
3)Minority physicians in California are much more likely than
white physicians to practice in Medically Underserved Areas,
Health Professions Shortage Areas, communities with high
proportions of minority populations, and low income
communities. This pattern is particularly true for the
traditionally underrepresented physician ethnic groups
(African Americans, Latinos, and Native Americans), but also
holds to a lesser degree for physicians from other non-white
ethnic groups.
4)Over 40% of minority physicians practice in generalist primary
care fields, compared with 30% of white physicians.
A June 2009 report published by the California HealthCare
Foundation (CHCF) based on the MBC survey found that the supply
of MD physicians estimated in California is 17% lower than that
estimated from the American Medical Association (AMA) Data File.
Of active patient care physicians in California, 34% reported
that they were in primary care, 20% fewer than the number
estimated from the AMA data. Only 16 of California's 58
counties fall within the needed supply estimate for primary care
physicians, and in eight counties the supply is less than half
this range. The number of specialists per 100,000 population is
well above the upper range of most assessments of need, and more
than half of the state's 58 counties are above the bottom
estimated need level for specialists. Rural counties have far
fewer physicians per capita than urban counties; counties in the
Central Valley and Inland Empire are particularly likely to have
a low supply of physicians, and also have higher proportions of
an aging physician primary care workforce.
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A June 2010 CHCF report indicates that although California's
supply of physicians has been growing faster than the overall
population rising 7% since 1998, demand is expected to rise as
the senior population grows, as more individuals obtain health
insurance because of the PPACA and because many current
physicians are nearing retirement age. Only Orange, Sacramento,
and Greater Bay Area regions currently meet the recommended
supply of primary care physicians. Nearly 30% of physicians are
over 60 years old - more than any other state. California draws
a substantial portion of physicians, especially primary care
physicians, from foreign and out-of-state medical schools.
Family and general practitioner compensation has been rising but
is only 88% of the national average.
California has received a $150,000 grant for health workforce
planning through the PPACA. The California Workforce Investment
Board and the Office of Statewide Health Planning and
Development have partnered to create the Health Workforce
Development Council to assess California's health workforce
needs and develop a comprehensive strategy to meet those needs.
California has also been awarded over $18 million for primary
care residency expansion, $5 million for health professions
education for low-income persons, as well as other grant
funding. This funding was already appropriated in Fiscal Year
2010 to support California's efforts to expand primary care.
However, residents enrolled in these programs are not guaranteed
to become primary care physicians and could go into
subspecialties after their family practice, general internal
medicine, and general pediatrics residencies and many later go
on to become cardiologists and pediatric rheumatologists.
Many of the grant funds for workforce in the PPACA have been
authorized, but not appropriated, and are vulnerable in the
budget discussions at the federal level. For example, the 2011
Federal fiscal year budget did not contain funding for state
workforce development grants, primary care training enhancements
or state health access grants.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
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