State commission calls for $3 billion to avert health care worker crisis

Every Monday, the phone rings off the hook at Santa Rosa Community Health's dental clinic on North Dutton Avenue, as more than 500 people vie for an appointment - six weeks out. Outside the year-old clinic, the week starts out with a line of up to 20 people waiting for the same.

Because of a severe staff shortage, the clinic can only take between 50 and 55 new patients, most of them children and pregnant women.

“We have enough people to see. We just don't have the staff,” said Oana Mihaltan, the dental clinic's supervisor.

The state-of-the-art clinic, equipped with eight dental chairs, is operating at only 40 percent of capacity while it tries to recruit six dental assistants and two dentists.

Like many other health care providers in the North Bay, Santa Rosa Community Health has the funding, the facilities and the patient demand to bring on new staff. What it doesn't have are candidates to fill those positions.

It's a quandary that communities across California are facing, according to a new report released this week by a statewide task force that spent the past two years looking into health care staffing shortages. The report, by the California Future Health Workforce Commission, called for an investment of $3 billion over 10 years to address shortages in doctors, nurses, medical assistants, mental health care workers and home care workers.

The commission, led by Janet Napolitano, president of the University of California system, and Lloyd Dean, president and CEO of health care giant Dignity Health, included nearly two dozen prominent health, policy, workforce development and education leaders.

The report identified statewide workforce shortages in three medical areas: primary, dental and mental health care. It found that in some regions of the state, “this crisis is already at hand.”

The report pointed out that 7 million state residents, many of them minorities, live in Health Professional Shortage Areas, a federal designation for geographic areas, populations or health care facilities with a shortage of primary care, dental or mental health providers and services.

For example, in a portion of northern Sonoma County, nearly 14,000 residents in three census tracts live in an area with inadequate primary care services, according to federal data from the Health Resources & Services Administration and the U.S. Census Bureau.

In Sonoma Valley, including the communities of Boyes Hot Springs and Eldridge, some 42,000 residents in nine census tracts also live in a designated area with a shortage of primary care services. In a region that encompasses much of Santa Rosa, defined by 36 census tracts, nearly 200,000 residents live in a federally designated area with insufficient mental health care professionals, according to federal data.

The report identified 27 detailed recommendations to increase opportunities for people seeking a health care profession. They include expanding education and training while promoting greater racial and ethnic diversity in the state's health care workforce. The report pointed out that Latinos now make up 40 percent of the state's population but only 7 percent of physicians.

One of the report's key recommendations was expanding the number of residency programs to create 1,900 primary care doctors and 2,200 psychiatrists by 2030. Health care experts contend that many young doctors are likely to stay in the communities where they conducted their residency programs.

“It really paves the way to populate physicians in a community,” said Dr. Patricia Hiserote, program director of Kaiser Permanente's new Family Medicine Residency in Santa Rosa.

The program, which took in its first batch of six residents last summer, include doctors that grew up in the North Coast. Hiserote said that one of the main goals of the Kaiser residency program is to “match the diversity in our community.”

One of the main reasons for the shortage in primary care doctors is that many medical schools give lower priority to family medicine, focusing more on specialties, Hiserote said. Historically, primary care doctors often came out of medical schools' family medicine and internal medicine departments.

Students coming out of internal medicine departments are increasingly going into sub-specialties and not primary care. “Primary care overall has not been valued,” she said. “Some of the most elite medical schools don't have departments of family medicine.”

Dr. G. Richard Olds, founding dean of the UC Riverside Medical School, said many medical school faculty are themselves specialists and often discourage their students from going into primary care.

Olds, who is president of St. Georges University, a medical school in Grenada, said socioeconomic factors are contributing to the shortage of primary care doctors. Eighty percent of students in U.S. medical schools come from the top two-fifths of economic backgrounds, he said.

“We're basically training the sons and daughters of wealthy Americans and then we wonder why they don't want to go to poor rural areas,” he said.

One of the recommendations in the workforce report is to recruit and train students from such areas to practice in community health centers. To accomplish this, the report suggests providing medical students with full-tuition scholarships for medical school in exchange for practicing in underserved areas.

Such a strategy would also be a big help to low-income residents at the junior college level who have difficulty pursuing a health care career while working their way through school, said Jeannie Dulberg, director of a federally funded program at SRJC that provides support to students pursuing careers in health care. The program, she said, falls in line with the first recommendation in the report released this week - expanding the “pipeline” to recruit low-income and underrepresented students.

But Dulberg said the program, called Health Occupation Preparation Education, or HOPE, could use more funds to meet the demand. The HOPE program, through federal funding, serves 120 students and has a continuous waiting list of 75 students. It has a student completion rate of 100 percent, she said.

The report prioritizes scholarships for low-income and first-generation college students, potentially adding 25,500 new health care workers statewide by 2030.

“Scholarships are needed to support those who are in the pipeline,” Dulberg said.

Assemblyman Jim Wood, D-Santa Rosa, a dentist and one of the 24 members of the task force, said he is considering introducing legislation that would expand the role of nurse practitioners, one of the report's top recommendations. That proposal will likely run into resistance from physician groups who oppose expanding nurses' scope of practice outside the oversight of a doctor.

In Sonoma County, as well as many communities in the Bay Area, high-cost housing and rising rents has become one of the biggest obstacles in recruiting and retaining health care workers. That won't be completely resolved through scholarships and training programs, said Wood.

“It's really, really difficult. These are really complex problems to solve and the challenges are much broader than just training people to do the job,” Wood said. “We need a sustained investment over an extended period of time, to make up for the deficit we have in housing.”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @ renofish.

EDITOR'S NOTE: A previous version of this story incorrectly ascribed national statistics on student completion rates to the completion rate at the HOPE program at SRJC.