BILL ANALYSIS
AB 657
Page 1
Date of Hearing: April 14, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 657 (Hernandez) - As Introduced: February 25, 2009
SUBJECT : Health professions workforce: master plan.
SUMMARY : Requires the Office of Statewide Health Planning and
Development (OSHPD), in collaboration with the California
Workforce Investment Board (Board), to establish a task force to
assist OSHPD in developing a health care workforce master plan
for the state. Specifically, this bill :
1)Makes legislative findings and declarations that California
needs a skilled health professional workforce; changing
demographics, including aging and increasing diversity, are
causing gaps between health care workforce supply and demand;
and, a comprehensive approach to health professions workforce
development is needed.
2)Makes legislative findings and declarations that to prepare
the workforce and keep California's economy competitive,
maintain quality of life, and increase tax revenues,
California needs continuous health data collection and
reporting and a state-level public and private collaboration
of diverse stakeholders working together to forecast health
professions workforce demand and plan comprehensive health
workforce pathways.
3)Requires OSHPD, in collaboration with the Board and based on
information provided by the Health Care Workforce
Clearinghouse (Clearinghouse), to establish and lead in
coordinating the Health Professions Workforce Task Force (Task
Force) to assist in the development of a health professions
workforce master plan for the state. Specifies task force
membership is voluntary and without compensation. Requires
the task force to comprise not more than 21 members, including
the following, from both rural and urban areas:
a) Two members representing the Legislature, with the
Speaker of the Assembly and the Senate Committee on Rules
each appointing one member;
b) At the discretion of the Regents of the University of
California (UC), one member representing UC, appointed by
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the Regents of UC;
c) A member representing the California State University,
appointed by the Governor;
d) A member representing the California Community Colleges,
appointed by the Governor;
e) A member representing the State Department of Education,
appointed by the Superintendent of Public Instruction;
f) A member responsible for leading a health sciences
program in a school district, drawn from a pool of
candidates selected by the Superintendent of Public
Instruction and appointed by the Governor;
g) A member of the Board and a member of a regional
workforce investment board, both appointed by the Governor;
h) Three members representing key stakeholders from labor
and the health care industry, appointed by the Speaker of
the Assembly;
i) Three members representing multiple health professions,
including allied health, appointed by the Speaker of the
Assembly;
j) Three members representing the health care industry,
appointed by the Senate Committee on Rules; and,
aa) Three members representing community-based organizations
in the state, appointed by the Senate Committee on Rules.
4)Requires the task force to meet no later than October 31, 2009
and no less than three times per year to do all of the
following:
a) Report, assess impact, and review capacity and
effectiveness of existing state and private programs to
leverage funding and form new partnerships, foster shared
learning, identify best practices, and minimize duplication
of efforts;
b) Review local workforce investment plans and assess
progress toward meeting current health workforce needs;
c) Identify education and employment trends in the health
professions;
d) Identify the ten health care professions with the
highest demand and develop a plan to meet that demand;
e) Recommend state policies needed to address workforce
shortage and distribution issues;
f) Compile, assess, and align with other strategic plans
for developing California's workforce; and,
g) Submit to OSHPD, no later than October 31, 2013, a
completed report with recommendations for developing a
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master plan.
5)Requires OSHPD to seek and accept funds from the federal
government and private entities to support the activities of
the task force.
EXISTING LAW :
1)Establishes, by Executive Order, the Board to assist the
Governor in setting workforce development policy.
2)Establishes OSHPD to administer several programs as part of
its health manpower objectives, including the federal National
Health Service Corps Scholarship Program, the federal National
Health Services Corps Loan Repayment Program, and the
California Medical and Dental Student Loan Repayment Program
of 2002.
3)Establishes the Healthcare Workforce Policy Commission, which
identifies unmet needs for specified health care professionals
and establishes standards for training programs for family
practice physicians, registered nurses (RNs), physician
assistants (PAs), and nurse practitioners (NPs), including
requirements for training professionals to work in underserved
communities.
4)Creates the California Health Professions Education
Foundation, a nonprofit public benefit corporation established
by OSHPD, for the purposes of raising public and private
donations, assisting in the implementation of various health
professions scholarship and loan programs, and making
recommendations as to the expenditure of funds in the Health
Professions Education Fund.
5)Establishes, within the Healthcare Workforce and Community
Development Division of OSHPD (Workforce Division), the
Song-Brown Health Care Workforce Training Act that provides
grants to health professional training institutions for the
training and education of health professionals, for practice
in medically underserved, low income, and rural communities.
6)Establishes, within the Workforce Division of OSHPD, the
National Health Services Corps / State Loan Repayment Program
(SLRP). The SLRP assists with the repayment of educational
loans for select primary healthcare providers who make a
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commitment to practice in Health Professional Shortage Areas
(HPSAs), as determined by OSHPD, for a minimum of two years.
7)Establishes within OSHPD the Steven M. Thompson Physician
Corps Loan Repayment Program, which provides physicians up to
$105,000 in educational loan repayments if they serve in a
designated underserved area for a minimum of three years.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
needed because there is currently no statewide strategic plan
on the health care workforce. The author states that
demographic shifts are causing widening gaps between health
care workforce supply and demand, as seen in shortages of
primary care providers and other health professionals.
California's population is aging, growing, and increasing in
diversity, and California's workforce of health professionals
is ill-equipped to respond to new pressures on the health care
system. Additionally, the author is concerned that state and
private entities are working in silos, leading to duplication
of efforts and inefficiency.
2)BACKGROUND . California is facing a dramatic and pressing
challenge related to the supply and distribution of health
care professionals in many disciplines. The UC Office of the
President's Final Report of the Advisory Council on Future
Growth in the Health Professions (UC report) notes California
has more residents age 65 and older than any other state, and
more than one in four California residents is born outside the
U.S., compared to the national average of one in ten.
According to the report, by 2015, nearly 37% of California's
population will be of Hispanic or Latino origin, nearly 14%
will be of Asian or Pacific Islander heritage, and 6% will be
African-American. The report indicates that there are
shortages in nearly all the health professions, including the
approximately 200 allied health occupations. The UC report
projects that California will face a shortfall of
approximately 47,600 nurses by 2010, and shortfalls of 116,000
nurses and nearly 17,000 doctors by 2015. Further, California
ranks 49th in the nation in the number of nurses per capita,
and 43rd in the number of pharmacists per capita.
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In addition to the provider shortage, health care professionals
are not proportionately representative of the populations they
serve. According to the Sullivan Commission Report, "Missing
Persons: Minorities in the Health Professions" (Sullivan
Report), there is a diversity gap between health professionals
and their patients. The Sullivan Report states that
African-Americans, Hispanic-Americans, and American Indians
make up more than 25% of the U.S. population but only 9% of
the nation's nurses, 6% of its physicians, and 5% of dentists.
Similar disparities exist in faculties of health profession
schools. The Sullivan Report further links poorer health
outcomes for minorities to the shortage of minority health
care providers as highlighted in other significant studies.
California has limited capacity to educate and train health care
providers. The UC report indicates that California has a long
standing reliance on in-migration of physicians and other
health professionals trained in other states and countries.
According to the California Medical Association (CMA), there
are ten schools in California that offer medical education,
including five in the UC system. These ten schools admit an
average of about 1,340 first-year students each year.
Competition is fierce, and less than 5% of applicants are
enrolled. CMA also states that California ranks 39th in the
nation in the number of medical students per capita. The
national average is 27 medical school students per 100,000
people yet California has about 16 students per 100,000. UC
indicates that 60% of qualified nursing students were turned
away because of a lack of educational slots due in great part
to lack of faculty.
3)STATE EFFORTS RELATED TO THE HEALTH CARE WORKFORCE . The
Workforce Division of OSHPD states that it identifies and
shares innovative and comprehensive strategies to reduce
health care personnel shortages. The Workforce Division
administers the Song-Brown Program, which provides financial
support to family practice residency, NP, PA, and RN education
programs throughout California. Accredited training programs
must periodically apply for program funding, which comes from
health facilities fees. The Song-Brown Program currently
funds 26 California family practice residency programs, 15 PA
or family NP programs, and 28 RN education programs. In 2008,
OSHPD awarded $2.7 million to 26 family practice residency
programs and $1.5 million to 13 nurse and PA training
programs. Since 2003, OSHPD has awarded over $33 million for
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nearly 7,400 education and training slots for family medicine
residents, family NPs, PAs, and RNs. OSHPD also administers
the Steven M. Thompson program to repay educational loans for
primary care physicians who practice in underserved areas or
serve underserved populations.
SB 139 (Scott) Chapter 522, Statutes of 2007 created the
Clearinghouse within OSHPD to serve as the central source of
health care workforce and educational data in the state. SB
139 requires the Clearinghouse to be responsible for the
collection, analysis, and distribution of information on
educational and employment trends for health care occupations
in the state, with funds appropriated from the California
Health Data and Planning Fund. SB 139 also requires OSHPD to
prepare an annual report to the Legislature that identifies
education and employment trends in the health care
professions, reports on the current supply and demand of
health care workers in California and on gaps in the
educational system that produces workers in specific
occupations within different geographic areas, and recommends
state policy to address workforce shortages and distribution.
OSHPD began re-directing resources in January 2008 and has had
3.5 positions approved to begin implementing the
Clearinghouse, and a grant from The California Endowment (TCE)
for some of the work on the annual report.
In 2007, Governor Schwarzenegger convened the Healthcare
Workforce Diversity Advisory Council (Council) through OSHPD.
The Council was composed of diverse stakeholders and was
funded by a $120,000 grant from the California Wellness
Foundation (TCWF) for one year. The Council was charged with
providing short-term, actionable policy recommendations to
address shortages in health professions. The Council's final
report, released in May 2008, recommended that the State
develop a comprehensive, multi-year strategy and
implementation plan to develop health workforce diversity;
conduct a gap analysis to identify immediate opportunities to
enhance workforce diversity; and, facilitate the
implementation of the Clearinghouse Program.
The Board, established by former Governor Davis through an
Executive Order in response to the mandate of the federal
Workforce Investment Act (WIA) of 1998, assists the Governor
in setting and guiding policy in the area of workforce
development. Since the implementation of the federal WIA, the
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Governor has used discretionary funds (15% of the federal WIA
allocation) for statewide activities to provide incentives for
system-building. The Board and each Governor have fashioned
initiatives such as the Caregiver Training Initiative, which
encourage new local and regional partnerships to address a
statewide shortage of health care workers, and at least two
nurse workforce initiatives that rely on regional partnerships
to address statewide shortages of professional nurses.
4)PRIVATE FOUNDATION EFFORTS RELATED TO THE HEALTH CARE
WORKFORCE . TCE established the Work Force Diversity grants
program to increase the diversity and improve the distribution
of California's health work force by supporting approaches
that expand the number of underrepresented minorities in the
medical, oral health, and nursing professions who practice in
underserved areas. For example, in 2006, TCE awarded a grant
to the Public Health Institute and the UC Berkeley School of
Public Health to conduct a comprehensive study on health
professions workforce diversity for the state. This study,
called the Connecting the Dots (CTD) Initiative, examined
current and potential roles for all stakeholders, including
K-12 schools, local communities, health professions employers,
and the public sector at the local and state level. CTD
recommends, in part, the state develop a comprehensive health
workforce master plan, institutionalize the Council, and
improve health professions data collection through licensing
agencies. In February 2009, CTD and the Latino Legislative
Caucus, Legislative Black Caucus, and Asian Pacific Islander
Legislative Caucus held an intensive to inform and engage
legislators on CTD recommendations.
TCWF launched the Diversity in Health Professions program to
fund organizations that provide pipeline programs,
scholarships, outreach and retention programs, internships and
fellowships, and loan repayment programs for underrepresented
ethnic minorities. Careers in medicine, nursing, public
health, and other allied health professions are included.
Organizations that support leadership development for people
of color in the health professions are also eligible for
funding. In addition, TCWF funds organizations that educate
policymakers and advocate for public and institutional
policies that promote diversity in the health professions. In
2008, TCWF funded "Diversity and Demand: Addressing
California's Health Workforce Crisis," a series of regional
forums throughout California to discuss the benefits of a
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diversified health care workforce and the implications of
personnel shortages. Among the recommendations of the series
was to conduct an overall assessment of current programs and
partnerships, allocation of resources, and educational
programs for the purpose of developing a strategic master plan
that addresses California's workforce shortage areas.
5)ASSEMBLY HEALTH COMMITTEE HEARING . In May 2007, the Assembly
Health Committee held an informational hearing entitled,
"Developing the California Health Care Workforce of Tomorrow:
Addressing Shortages and Diversity." At this hearing, many
speakers spoke of the need for new programs to increase the
diversity of California's health care workforce. A speaker
representing TCWF pointed out that increasing diversity in the
health professions is not only an avenue for improving quality
of care and access to care, but also an important workforce
development strategy. TCWF noted that jobs in the healthcare
sector, particularly among the allied health professions, are
now among the fastest growing in the economy, and data
indicate that in the next 15 years the health care and social
services sector in California will grow by more than 50%,
requiring tens of thousands of nurses and other allied health
professionals to meet demand for healthcare.
6)SENATE HEALTH COMMITTEE HEARING . In March 2009, the Senate
Health Committee held an informational hearing entitled
"California's Healthcare Workforce - Toward a Comprehensive
Solution." Witnesses at this hearing highlighted California's
health workforce shortages and lack of diversity and described
state efforts to address the health workforce, innovative
programs within the state, and next steps, including the
recommendation that the state develop a comprehensive health
workforce master plan.
7)SUPPORT . The California Academy of Family Physicians (CAFP),
sponsor of this bill, writes the lack of an adequate primary
care workforce base has pushed the health care system to the
edge of crisis. CAFP also notes California has a substantial
number of medically underserved areas with primary care and
other provider shortages and that some 7 million Californians
live in (HPSAs with less than one primary care physician per
3,500 residents. HPSA residents suffer higher rates of
preventable diseases, poorly treated chronic conditions, and
preventable complications such as end-stage renal disease.
CAFP writes this bill will provide support for programs that
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increase financial support for primary care providers and
providers serving in underserved areas. The California Dental
Association writes in support that a workforce master plan
could produce findings for use by dental and other health
professions to develop policies on recruitment, retention,
training and educational programs to improve access to care in
the state. The California Pan-Ethnic Health Network writes in
support that California's efforts to develop its health
workforce have been piece-meal, with limited evaluation and
strategy, and California is missing an overarching vision,
action plan, and infrastructure to coordinate efforts. The
San Bernardino County Board of Supervisors (San Bernardino
County) writes in support that an adequate supply of
well-prepared public health professionals is essential to an
effective public health system, and cites concerns over
bioterrorism and infectious disease outbreaks. San Bernardino
County further writes that, like many counties, its Department
of Public Health has had continuing difficulties in hiring
qualified public health professionals, leading to chronic
understaffing, difficult working conditions, the loss of
population-based services and direct patient services, and
delaying the start-up of new programs. The American
Federation of State, County, and Municipal Employees, AFL-CIO
writes the state needs to have a skilled health professions
workforce in order to remain healthy, prosperous, and globally
competitive.
8)SUPPORT IF AMENDED . The United Nurses Association of
California/Union of Health Care Professionals writes it would
support his bill if amended to include one of its members on
the task force.
9)RELATED LEGISLATION .
a) AB 160 (Hayashi), pending in the Assembly, would expand
the Registered Nurse Education Program, which offers loan
repayment and scholarships, to include registered nursing
students who agree to serve in a school, as specified.
b) SB 606 (Ducheny), pending in the Senate, would make
osteopathic physicians and surgeons eligible for a
physician loan repayment program and would require the
Osteopathic Medical Board of California to assess an
additional fee for that purpose.
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10)PREVIOUS LEGISLATION .
a) AB 2375 (Hernandez) of 2008 was nearly identical to this
bill except that it also included provisions related to
data collection, and earlier versions also required OSHPD
to implement the master plan. AB 2375 was held under
submission on the Senate Appropriations Suspense File.
b) AB 2543 (Berg) of 2008 would have established the
Geriatric and Gerontology Workforce Expansion Act, which
would have provided loan repayment assistance to specified
health care professionals who work in a geriatric care
setting by raising professional licensing and renewal fees.
The Governor vetoed AB 2543, stating, in part: "[T]he
provisions of this bill place an additional licensing fee
on an entire profession to provide specialized loan
assistance grants beyond the $10 surcharge they already pay
for the Mental Health Service Provider Education Program.
Unfortunately, this bill is double-assessing the same
profession for similar programs."
c) AB 638 (Bass), Chapter 628, Statutes of 2008,
establishes a PA scholarship and loan repayment program, to
be administered by the Student Aid Commission, to provide
scholarships to pay for the educational expenses of
students enrolled in PA schools and to repay qualifying
educational loans of PAs who agree to practice in
designated medically underserved areas, as defined.
d) SB 139 (Scott), Chapter 522, Statutes of 2007,
establishes the Clearinghouse described in 3) above.
e) SB 764 (Migden) of 2007 would have required the Medical
Board of California (MBC) and Osteopathic Medical Board to
provide physician information to OSHPD and OSHPD to prepare
a report with projections concerning the primary care
physician workforce. SB 764 was vetoed by Governor
Schwarzenegger, who stated the bill's goals could be better
accomplished administratively, and efforts were already
underway in the context of the comprehensive health care
reform proposal.
f) AB 269 (Eng), Chapter 262, Statutes of 2007 requires the
Dental Board of California and the Committee on Dental
Auxiliaries to collect and aggregate information received
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from dentists and dental auxiliaries relating to cultural
background and foreign language proficiency, and creates
new reporting requirements for dentists and dental
auxiliaries.
g) AB 2283 (Oropeza), Chapter 612, Statutes of 2006,
requires MBC to annually aggregate existing data reported
to it by physicians on their cultural background and
foreign language proficiency, by the ZIP code of the
primary practice location and on a statewide basis, and
report such information on the MBC's Web site.
h) AB 938 (Yee), Chapter 437, Statutes of 2004, establishes
the Licensed Mental Health Provider Education Program
(LMHPEP) and the Mental Health Practitioner Education Fund
to increase the number of mental health professionals,
which includes a provision requiring LMHPEP participants to
serve in a publicly funded facility or a health manpower
shortage area that is multicultural and linguistically
diverse for at least one year in return for educational
loan forgiveness.
11)POLICY QUESTIONS .
a) Master plan . This bill requires the Task Force to meet
for three years and submit a completed report with
recommendations for developing a health professions
workforce master plan, rather than an actual master plan.
Given all the work that has already been done in this area,
should this bill specifically require the task force to
develop a master plan?
b) OSHPD Authority . It is unclear whether OSHPD has the
authority to collect the information needed to implement
this bill. The author may wish to address how and with
what authority OSHPD can collect the necessary information.
c) On page 3, line 7, clarify what "multiple target groups"
means.
d) On page 4, lines 12-13, this bill requires the task
force to meet no later than October 31, 2010. The author
may wish to clarify that the task force shall begin meeting
on or before October 31, 2010.
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12)Technical amendments .
a) On page 2, line 9, delete "more".
b) On page 3, line 16, delete "comprised" and insert
"composed".
c) On page 4, line 27, insert "health" after
"California's".
d) On page 4, line 22, delete "top".
13)Author's amendments . The author will offer the following
amendments in committee:
a) Task Force Membership . Replace "health care industry"
with health insurers and medical groups, and with community
clinics and hospitals in another line. Replace "Allied
Health" with nursing and allied health professionals.
b) On page 4, line 15, specify "workforce training"
programs.
c) On page 4, line 19, strike out "in" and insert
"towards".
14)DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to
the Assembly Labor and Employment Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
California Academy of Family Physicians (sponsor)
Latino Coalition for a Healthy California (sponsor)
Asian & Pacific Islander American Health Forum
American Federation of State, County, and Municipal Employees,
AFL-CIO
California Dental Association
California Pan-Ethnic Health Network
California Primary Care Association
California Society for Clinical Social Work
County Health Executives Association of California
Having Our Say
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San Bernardino County Board of Supervisors
Opposition
None on file.
Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097