BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 589|
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THIRD READING
Bill No: AB 589
Author: Perea (D), et al.
Amended: 8/21/12 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 7/6/11
AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee,
De León, DeSaulnier, Rubio, Wolk
SENATE APPROPRIATIONS COMMITTEE : 7-0, 8/16/12
AYES: Kehoe, Walters, Alquist, Dutton, Lieu, Price,
Steinberg
ASSEMBLY FLOOR : 63-10, 6/1/11 - See last page for vote
SUBJECT : Medical school scholarships
SOURCE : California Medical Association
DIGEST : This bill establishes the Steven M. Thompson
Medical School Scholarship Program, and provides that the
Program is open to persons who agree in writing, prior to
completing an accredited medical or osteopathic school,
based in the United States, to serve in an eligible
practice setting, as defined, for at least three years, and
clarifies that funds for the loan repayment program will
not be used for purposes of the scholarship program.
ANALYSIS :
CONTINUED
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Existing law:
1. Establishes the Health Professions Education Foundation
(Foundation) within the Office of Statewide Health
Planning and Development (OSHPD).
2. Requires the Foundation to solicit and receive funds
from foundations and other private and public sources
and to provide financial assistance in the form of
scholarships or loans to students in the health
professions who are from underrepresented groups.
3. Provides that the Foundation is governed by a board
consisting of 13 members appointed by the Governor,
Speaker of the Assembly, and Senate Rules Committee.
4. Establishes, under the Foundation, scholarship, loan,
and loan repayment programs for registered nurses,
vocational nurses, geriatric nurse practitioners,
clinical nurse specialists, and mental health
professionals who agree to practice for specified
periods of time in underserved areas and in designated
practice settings, as specified.
5. Also establishes, under the Foundation, the Steven M.
Thompson Physician Corps Loan Repayment Program
(STPCLRP), which provides for the repayment of
educational loans for licensed physicians and surgeons
who practice in medically underserved areas of the
state, as defined. The STPCLRP is supported by a $25
licensure fee paid by physicians.
6. Requires the Foundation, in administering the STPCLRP,
to use and develop guidelines for applicants that give
preference to applicants who are best suited to meet the
cultural and linguistic needs of patients in medically
underserved populations, as specified, and who agree to
practice in geriatric care settings.
7. Allows the Foundation to appoint a selection committee
to provide policy direction and guidance to the STPCLRP.
8. Requires funds for loan repayment under the STPCLRP to
have a funding match from a foundation or other private
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source.
9. Limits loan repayment awards from exceeding $105,000 per
individual physician.
10.Establishes within OSHPD the Health Professions
Education Fund (Fund), to receive funds for scholarships
and loans to students from underrepresented groups who
are enrolled in or accepted to schools of medicine,
dentistry, nursing, and other health professions.
11.Provides that moneys in the Fund are continuously
appropriated.
12.Establishes a Medically Underserved Account for
Physicians within the Fund, the primary purpose of which
is to provide funding for the STPCLRP.
13.Establishes the Song-Brown Health Care Workforce
Training Act of 1973 (Song-Brown Act), administered by
OSHPD to provide financial support to family practice
residency programs, nurse practitioner and physician
assistant programs, and registered nurse education
programs to increase the number of students and
residents receiving education and training in family
practice and nursing. The Song-Brown Act also
encourages universities and primary care health
professionals to provide health care in medically
underserved areas.
This bill:
1. Establishes within the Foundation the Steven M. Thompson
Medical School Scholarship Program (Program).
2. Provides that the Program is open to persons who agree
in writing, prior to completing an accredited medical or
osteopathic school, based in the United States, to serve
in an eligible practice setting, as defined, for at
least three years.
3. Requires participants to commit to three years of
full-time professional practice once they have achieved
full licensure.
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4. Defines an eligible practice setting as either (a) a
community clinic or clinic owned and operated by a
public hospital or hospital that contracts to provide
services to county indigent patients that is located in
a medically underserved area, at least 50 percent of
whose patients are from a medically underserved
population, as defined; or (b) a medical practice that
is located in a medically underserved area, at least 50
percent of whose patients are from a medically
underserved population.
5. Limits the maximum amount per scholarship to $105,000.
6. Requires the funds to be distributed over the course of
a standard medical school curriculum, in increasing
amounts over the course of the curriculum, to ensure
that at least 45 percent of the total scholarship award
is distributed upon commencement of the final year of
school.
7. Provides that in the event the participant does not
complete the minimum three years of medical school and
service, pursuant to the contractual agreement, OSHPD
shall recover the funds plus maximum allowable interest.
8. Requires the selection committee that supports the
STPCLRP to use guidelines for selecting applicants that
give priority to applicants who speak a Medi-Cal
threshold language, come from an economically
disadvantaged background, have experience working in
medically underserved areas or with medically
underserved populations, and commit to practice primary
care.
9. Establishes the Steven M. Thompson Medical School
Scholarship Account (Account) within the Fund for the
purpose of receiving federal or private funds.
10.States the Account shall consist of private moneys
donated to the program for deposit into the Fund and any
interest that accrues on those moneys.
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11.Provides that funds in the Account are subject to
appropriation by the Legislature.
12.Limits the costs of administering, including promoting
the education of medical doctors and doctors of
osteopathy in an accredited school who agree to service
in an eligible setting and related administrative costs,
shall not exceed 10 percent of the total appropriation
for the program.
13.Provides that the bill shall be implemented only to the
extent that sufficient funds exist in the Account as
determined by the Foundation.
14.Directs the Foundation and OSHPD to provide the ongoing
program management for the Program.
15.Clarifies that funds for the loan repayment program will
not be used for purposes of the scholarship program.
Background
Current health workforce shortages . Statewide shortages of
health providers currently exist in several major health
professions, such as nursing, primary care providers, and
allied health. (Allied health professions are clinical
health care professions distinct from medicine, dentistry,
and nursing.) Health care workforce needs are projected to
increase dramatically due to the aging of the population
and the state's increasing diversity. In February 2009,
the Senate Health Committee held a hearing on California's
health care workforce. The background paper, prepared by
the Senate Office of Research (SOR), stated that the health
care worker shortage is defined in many ways, citing the
following:
The state will face a shortage of up to 17,000 physicians
by 2015.
The Center for California Health Workforce Studies
researchers indicate that the registered nurse shortage
is between 7,000 and 21,000. This shortage is expected
to grow due to both the aging of the general population
and the nursing workforce.
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It is projected that California will need a 26.1 percent
growth in the number of pharmacists from 2006 to 2016.
Fifty percent of the public health workforce and seventy
percent of community clinic administrators will retire in
the next five to 10 years.
Seventy-six percent of clinics report a staffing shortage
of allied health workers.
In addition to the shortages of certain health
professionals, SOR stated that California's health
professions workforce does not reflect the state's
demographic racial and ethnic composition and language
proficiency. According to research conducted by the Public
Health Institute and the University of California
Berkeley's School of Public Health, California's emerging
populations are underrepresented in all health professions
and in the health professions pipeline. A recent report by
the Institute of Medicine links poorer health outcomes for
minorities to the shortage of minority health care
providers. One reason for this is that persons of color
are less likely than whites to receive needed services due
to cultural or linguistic barriers between the health care
provider and the patient.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee, in
order to establish regulations and guidelines and to
administer such a Program, the Foundation would need at
least half a personnel year, approximately $50,000
annually. Since administrative funds are limited to 10
percent of the total Program appropriation, the Program
would require an account balance of at least $500,000
annually. Although this bill specifies that monies in
the Account would consist of federal and private funds,
no specific funding sources have been identified. Thus,
there would be General Fund cost pressure to fund this
program if federal and private monies do not materialize.
Program costs could increase depending on the number of
scholarships it chose to award.
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SUPPORT : (Verified 8/21/12)
California Medical Association (source)
Association of California Healthcare Districts
California Primary Care Association
Children's Hospital Central California
City of Kerman
Community Clinic Association of Los Angeles County
Medical Board of California
ARGUMENTS IN SUPPORT : The California Medical Association
states that the most conservative projections of the need
for physicians in California project a shortage of 17,000
physicians by 2015, which does not take into account the
increase in newly insured persons due to federal health
care reform. Exacerbating this problem is the extremely
high debt medical students incur, which now averages
$150,000 for graduating medical students. This bill will
supplement the STPCLRP and allow the state to address both
the problem of insufficient numbers of physicians and the
high cost of medical education.
The Medical Board of California states that this bill will
help make medical school more affordable for students
willing to pursue careers in primary care, as well as help
to address the geographical disparity of physician supply
in California.
ASSEMBLY FLOOR : 63-10, 6/1/11
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall,
Bill Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Charles Calderon, Campos,
Carter, Cedillo, Chesbro, Cook, Dickinson, Eng, Feuer,
Fletcher, Fong, Fuentes, Furutani, Beth Gaines, Galgiani,
Gatto, Gordon, Halderman, Hall, Harkey, Hayashi, Roger
Hernández, Hill, Huber, Hueso, Huffman, Lara, Bonnie
Lowenthal, Ma, Mendoza, Miller, Mitchell, Monning,
Nestande, Olsen, Pan, Perea, Portantino, Skinner, Smyth,
Solorio, Swanson, Torres, Valadao, Wagner, Wieckowski,
Williams, Yamada, John A. Pérez
NOES: Conway, Donnelly, Hagman, Knight, Logue, Mansoor,
Morrell, Nielsen, Norby, Silva
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NO VOTE RECORDED: Davis, Garrick, Gorell, Grove, Jeffries,
Jones, V. Manuel Pérez
CTW:m 8/21/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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