BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 657
A
AUTHOR: Hernandez
B
AMENDED: June 2, 2009
HEARING DATE: June 25, 2009
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CONSULTANT:
5
Bain/
7
SUBJECT
Health professions workforce: master plan
SUMMARY
Requires the Office of Statewide Health Planning and
Development (OSHPD) to establish the Health Professions
Workforce Task Force (task force) to assist in the
development of a health professions workforce master plan
for the state.
CHANGES TO EXISTING LAW
Existing law:
Existing law requires the California Workforce Investment
Board to assist the Governor in the development, oversight,
and continuous improvement of California's workforce
investment system, and requires the Board to assist the
Governor in developing the State Workforce Investment Plan.
Existing law requires OSHPD to establish a health care
workforce clearinghouse to serve as the central source of
health care workforce and educational data in the state.
The clearinghouse is responsible for the collection,
analysis, and distribution of information on the
educational and employment trends for health care
occupations in the state.
Continued---
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Existing law also establishes the California Healthcare
Workforce Policy Commission (CHWPC) to identify specific
areas of the state where there are unmet priority needs for
dentists, physicians, and registered nurses.
Existing law establishes various health care provider loan
repayment programs funded by licensing fees paid by health
care providers who practice in specified locations, such as
underserved areas.
This bill:
This bill would require OSHPD, in collaboration with the
California Workforce Investment Board and based on
information provided by the health care workforce
clearinghouse, to establish the Health Professions
Workforce Task Force (task force) to assist in the
development of a health professions workforce master plan
for the state.
The task force would be composed of 21 members from both
rural and urban areas representing various educational
institutions (the University of California, California
State University, California Community Colleges, the
Department of Education, and a member responsible for
leading a health sciences program in a school district),
health care providers, labor, health insurers and medical
groups, health facilities, community-based organizations,
as well as two members representing the Legislature. The
bill would specify who appoints the various members, would
require the task force to meet at least three times a year,
and would require task force membership to be voluntary and
without compensation.
The task force would be required to assist OSHPD in the
development of a health professions workforce master plan,
and would be required to do all of the following:
Report, assess impact, and review capacity and
effectiveness of existing state and private workforce
training programs to leverage funding resources and form
new partnerships, foster shared learning, identify best
practices, and minimize duplication of efforts.
Review local workforce investment plans and assess
progress toward meeting current health professions
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workforce needs.
Identify education and employment trends in the health
professions.
Identify the 10 health professions with the highest
demand, and develop a plan to meet that demand.
Recommend state policies needed to address the issues of
health professions workforce shortage and distribution.
Compile, assess, and align with other strategic plans for
developing California's health care workforce.
This bill would require the task force, by October 31,
2013, to submit a complete statewide health professions
workforce master plan to OSHPD and the Legislature. OSHPD
would be the lead in coordinating the task force. The task
force would be required to seek funds, and OSHPD would be
required to accept funds from the federal government and
private entities in order to support the activities of the
task force.
FISCAL IMPACT
According to the Assembly Appropriations Committee, annual
costs in the range of $100,000 of federal or private
funding through 2013, if the task force succeeds in
securing such support.
BACKGROUND AND DISCUSSION
According to the author, there is no strategic plan related
to the sufficiency of the state's health professions
workforce. The author states that, although current law
somewhat addresses the need for workforce development
through the creation of a strategic workforce plan for all
fields, due to the complexities in the health sector, as
well as the significant growth and demand for health
services, there is a need for a separate, comprehensive
plan devoted specifically to the health care industry. The
author further argues that demographic shifts are causing
gaps between health workforce supply and demand, as seen in
the shortages of primary care providers and other health
professionals. California's population is aging, growing,
and becoming increasingly more diverse. Unfortunately, the
demographics of California's health professionals do not
reflect these changes. The author states that California
would be able to meet its health care demands by utilizing
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and educating its existing population, and that developing
California's workforce so that it better represents and
serves its consumer population will help to mitigate
increasing health care costs. The author states that, to
date, California's efforts to develop its health
professions workforce has been, at best, piece-meal,
focusing on data collection, loan repayment programs, and
funding for specific professions within health care,
without evaluation or strategy. Additionally, the author
argues that state and private entities are working in
silos, leading to duplication of efforts and inefficiency.
The author states that California is missing an overarching
vision, action plan, and infrastructure to coordinate
efforts to maximize efficiency and impact.
Background
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 of this year, 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 the health care worker
shortage is defined in many ways, citing as examples 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 current 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.
California presently ranks 48th in the nation in the
number of pharmacists per capita. 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 70
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percent of community clinic administrators will retire in
the next five to ten 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 California's health professions
workforce does not reflect the state's demographic racial
and ethnic composition and language proficiency.
Arguments in support
The Latino Coalition for a Healthy California (LCHC), a
co-sponsor of this bill, writes that demographic shifts are
causing gaps between health workforce supply and demand as
seen in the shortages of primary care providers and other
health professionals. LCHC states California's population
is aging, and is becoming increasingly more diverse, but
its health professionals have not reflected these changes.
LCHC states that California's efforts to develop its health
workforce have been piece-meal, and that California is
missing an overarching vision, action plan, and
infrastructure.
The California Academy of Family Physicians, which is also
a co-sponsor, argues the state is in dire need of immediate
and long-term action on health care workforce shortages,
and this bill takes an important step forward in beginning
to address these shortages.
Arguments in opposition
OSHPD writes that it agrees that a comprehensive approach
to health profession workforce development aimed at closing
the gap between workforce supply and demand and ensuring an
optimal mix of culturally competent health professions, is
an important means of addressing the health care workforce
shortages and disparities. OSHPD states that it currently
administers the Health Care Workforce Clearinghouse, which
serves as the central source of health care workforce and
education data in California, which it expects to be fully
operational by the summer of 2012. OSHPD argues the
workforce task force in this bill is duplicative of its
efforts currently underway and is therefore unnecessary.
Related bills
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SB 43 (Alquist) authorizes the healing arts boards within
the Department of Consumer Affairs to collect information
regarding the cultural and linguistic competency of persons
subject to regulation by those boards and requires the
information to be used to meet the cultural and linguistic
concerns of the state's diverse patient population. SB 43
also requires the Employment Development Department to
share that information with OSHPD to increase the amount of
data available for workforce policy and development
efforts. SB 43 is a two-year bill in the Assembly Business
and Professions Committee.
SB 620 (Wiggins) requires each licensed osteopathic
physician and surgeon to report to the Osteopathic Medical
Board (OMB), at the time of license renewal, any specialty
board certification that he or she holds and his or her
practice status, as specified. SB 620 would also authorize
a licensee to report to OMB his or her cultural background
and foreign language proficiency, and would authorize OMB
to make this information available on the board's Internet
Website. SB 620 is awaiting hearing in the Assembly
Appropriations Committee.
Prior legislation
AB 2375 (Hernandez) of 2007 was substantially similar to
this bill. It would have required OSHPD, in collaboration
with the California Workforce Investment Board, to
establish the Health Professions Workforce Task Force,
comprised of specified members, to assist in the
development of a health professions workforce master plan
for the state. AB 2375 would also have required the task
force to submit to OSHPD its recommendations for a
statewide health professions workforce master plan.
Finally, AB 2375 would have required OSHPD to determine
gaps in the health professions workforce data collection,
and to request the appropriate state entities to prepare
and collect the data required. The author's office
indicates this "gap analysis" provision was not included in
AB 657 to reduce the cost of the measure. AB 2375 was held
on the Senate Appropriations suspense file and then
subsequently referred to the Senate Rules Committee, where
it died at the end of session.
AB 2439 (De La Torre), Chapter 640, Statutes of 2008,
requires the Medical Board of California (MBC) to assess an
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additional $25 fee for the initial license and license
renewal of a physician to support the Steven M. Thompson
Physician Corps Loan Repayment Program. Fifteen percent of
the funds collected from the additional $25 fee are
dedicated to loan assistance for physicians who agree to
practice in geriatric care settings or settings that
primarily serve adults over the age of 65 or adults with
disabilities.
AB 638 (Bass), Chapter 628, Statutes of 2008, establishes,
until January 1, 2014, the California Physician Assistant
Loan Assumption Program, to assume the qualifying
educational loans of physician assistants (PAs) who agree
to practice in designated medically underserved areas
(MUAs) to the extent funding is provided in the annual
Budget Act.
AB 2543 (Berg) would have enacted the Geriatric and
Gerontology Workforce Expansion Act to provide grants for
loan repayment assistance, on or after January 1, 2010, to
licensed and associate clinical social workers, marriage
and family therapists, and registered marriage and family
therapy interns who provide geriatric services, as defined.
AB 2543 was vetoed by the Governor, who stated "?the
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. I would encourage the
stakeholders to consider the loan repayment funds they
currently receive though licensure assessments and discuss
how those funds can be redirected to address their policy
goals."
SB 764 (Migden) of 2007 would have required the MBC and the
OMB to provide physician information to OSHPD, and would
have required OSHPD to prepare a report with projections
concerning primary care physicians for the Legislature and
the Department of Health Care Services, as specified. SB
764 was vetoed by the Governor, who stated "?(the bill's)
goal can be more effectively accomplished administratively.
In fact, my Administration already has efforts under way,
in the context of my comprehensive health care reform
proposal to discuss and develop strategies to improve the
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diversity and capacity of this State's health care
workforce."
SB 139 (Scott), Chapter 522, Statutes of 2007, among other
provisions, establishes the Health Care Workforce
Clearinghouse under OSHPD.
AB 269 (Eng), Chapter 262, Statutes of 2007, creates new
reporting requirements for dentists and dental auxiliaries,
upon their application for initial licensure and renewal,
including reporting their completion of any advanced
educational program and their current employment status.
AB 269 also requires the Dental Board of California and the
Committee on Dental Auxiliaries to collect and aggregate
information received from dentists and dental auxiliaries
pursuant to this bill relating to cultural background and
foreign language proficiency.
AB 2283 (Oropeza), Chapter 612, Statutes of 2006, requires
the MBC to annually aggregate existing data reported to it
by physicians on their cultural background and foreign
language proficiency, as specified, and report that
information on their website.
AB 938 (Yee), Chapter 437, Statutes of 2004, establishes
the Licensed Mental Health Provider Education Program and
the Mental Health Practitioner Education Fund to increase
the number of mental health professionals.
PRIOR ACTIONS
Assembly Floor: 50-28
Assembly Appropriations: 12-5
Assembly Labor and Employment:5-2
Assembly Health: 12-4
POSITIONS
Support: California Academy of Family Physicians
(co-sponsor)
Latino Coalition for a Healthy California
(co-sponsor)
American Federation of State, County and Municipal
Employees, AFL-CIO
Asian & Pacific Islander American Health
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Forum
Association of California Healthcare Districts
California Commission on Aging
California Dental Association
California Pan-Ethnic Health Network
California State Association of Counties
California Society for Clinical Social Work
California WIC Association
Congress of California Seniors
County Health Executives Association of California
Greenlining Institute
Having Our Say
National Hispanic Medical Association
Osteopathic Physicians and Surgeons
San Bernardino County Board of Supervisors
Service Employees International Union
United Nurses Association of California/Union of
Health Care Professionals
Oppose: Office of Statewide Health Planning and
Development
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