BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AJR 13|
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THIRD READING
Bill No: AJR 13
Author: Lara (D), et al.
Amended: As introduced
Vote: 21
ASSEMBLY FLOOR : Read and adopted, 6/20/11
SUBJECT : Graduate medical education
SOURCE : California Medical Association
DIGEST : This resolution 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 increases 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.
ANALYSIS :
Resolution findings:
1. Congress approved, and President Barack Obama signed,
the federal Patient Protection and Affordable Care Act
(PPACA) of 2010 (Public Law 111-148), to expand health
insurance coverage, reduce health care costs, and
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address the growing shortage of physicians.
2. The PPACA aims to specifically address shortages in
primary care through adjustments to the Medicare and
Medicaid fee schedules, reallotment of unused graduate
medical education slots, and a suite of grants,
scholarships, loans, and loan forgiveness programs.
3. Forty-two of California's 58 counties fall below the
Council on Graduate Medical Education's recommendations
for minimum primary care physician supply, and of these
42 counties, 16 have a Latino population that exceeds 30
percent.
4. The PPACA encourages more physicians to practice in
rural settings, where Latinos can constitute 50 percent
of the population, through Rural Physician Training
Grants for medical schools.
5. California's rural counties suffer from particularly low
physician practice rates, of the rural counties with the
lowest number of primary care physicians, three have a
Latino population over 50 percent.
6. Currently Latinos, African Americans, Samoans,
Cambodians, Hmong, and Laotians are underrepresented in
California's physician workforce. The
underrepresentation of Latino physicians is particularly
dire: Latinos represent over one-third of the state's
population, but account for only five percent of the
state's physicians.
7. The number of physicians retiring currently outpaces the
number of physicians entering the workforce in
California, where, in the last 15 years, the number of
medical school graduates in California has been at a
plateau even though there has been a population growth
in the state of 20 percent.
8. The magnitude of this physician shortage will only
increase the cost of public health care in the health
care institutions of the state given that Latinos will
constitute the majority of Californians by the year
2040. Currently, to reach parity with the non-Latino
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patient population, there would need to be approximately
27,309 more Latino physicians in California.
9. The PPACA reforms graduate medical education by
expanding the scope of Medicare-recognized patient care
settings, creating funding for community-based graduate
medical education training, and establishing Teaching
Health Centers development grants.
10.The increase of medical school debt is one of the
primary factors for a student not to pursue medical
school because the average medical student now graduates
with about $150,000 in debt. If that trend continues at
the average rate, medical school debt will amount to
$750,000 by 2033.
11.The expansion of health insurance coverage under the
PPACA will further increase the need for physicians.
Nearly 4.7 million nonelderly adults and children who
were uninsured in all or part of 2009 will qualify for
coverage under the PPACA.
Background
A June 2009 report published by the California HealthCare
Foundation based on the MBC survey found that the supply of
MD physicians estimated in California is 17 percent lower
than that estimated from the American Medical Association
(AMA) Data File. Of active patient care physicians in
California, 34 percent reported that they were in primary
care, 20 percent 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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FISCAL EFFECT : Fiscal Com.: No
SUPPORT : (Verified 7/12/11)
California Medical Association (source)
ARGUMENTS IN SUPPORT : According to the author's office,
in 2010, President Obama signed into law the Patient
Protection and Affordable Care Act 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's office cites findings
from multiple studies that suggest the supply of physicians
in California - especially in underserved areas serving
ethnic populations - is inadequate. The author's office
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.
CTW:do 7/12/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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