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PD Editorial: California needs more doctors

There's been a lot of talk lately about “health care for all.” Democrats angling for their party's 2020 presidential nomination, including California Sen. Kamala Harris, are pitching variations of universal health care. One thing they don't explain is who will provide that health care when America already faces a critical shortage of doctors.

The Association of American Medical Colleges last year calculated that the United States could see a shortage of up to 120,000 physicians by 2030. The gap will be smaller with health care as-is and wider if there is a huge expansion.

California already is experiencing the effects of a doctor shortage, especially in low-income and rural communities. It's hard to attract highly educated physicians to remote areas or to Medi-Cal clinics where the pay might not be as high as private urban practice. According to the California Health Report, in 2013, there were 59 full-time primary care doctors per 100,000 Medi-Cal patients. Two years later, the most recent year for which data is available, the ratio had dropped to 39 doctors per 100,000 patients.

Even Sonoma County, an otherwise very attractive place to live, doesn't have enough docs. Local officials have warned about a shortage of primary care physicians here for years, and it was made worse when wildfires displaced many health care professionals.

California has taken some small steps to encourage more providers in different parts of the state. For example, a pilot program allows Healdsburg District Hospital to hire doctors directly. California hospitals typically may not do so, though some have found workarounds.

All is not lost. California can't produce doctors instantly, but if it invests and makes the right strategic decisions, it can expand the training pipeline for health care professionals.

Policy leaders don't need to start from scratch. The California Future Health Workforce Commission recently released a report with 10 recommendations to meet the demand for doctors and other health care workers. Those recommendations came out of a comprehensive analysis by a cross-disciplinary group of leaders co-chaired by University of California President Janet Napolitano and Lloyd Dean, the president and CEO of Dignity Health.

The recommendations focus not just on training more doctors, but training doctors from diverse backgrounds who can best serve diverse communities. A student from a rural community or the inner city is more likely to want to return there to practice.

The state also must support qualified students with scholarships. Medical school is expensive, and if California wants young doctors to practice in places that don't pay as much, they need to come out of school with a smaller debt burden.

The report also recommends measures to recruit and train nurses and psychiatrists.

Full implementation would cost an estimated $3 billion over 10 years, but with California forecast to spend trillions on health care over the same period, it's a surprisingly small amount to invest now to makes sure the state has enough providers in 2030.

It's easy to say, “Give everyone health care.” It's much harder to wade into the many facets of how that can happen. At least now California has a blueprint for addressing one part of the challenge.

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