While California has an absolute shortage of primary care physicians, the real issue for California is the uneven distribution of those physicians.
According to the California HealthCare Foundation, more than two-thirds of California counties already have fewer than the minimum number of primary care physicians per capita considered adequate to meet demand. Predictably, those counties with the most severe shortages are either rural or in rapidly growing regions, such as Inland Southern California and the Central Valley.
Since the two principal determinants of where physicians practice are where they grew up and where they finished residency training, the most effective means of addressing California's primary care shortage is providing both medical education and post-graduate training in the areas of highest need.
The School of Medicine at UC-Riverside, the state's first public medical school in more than four decades, aims to do just that. Policymakers should find the will to help fund the start-up of this medical school as expeditiously as possible.
It takes a minimum of seven years to train a primary care physicianm, and the lack of sustained state funding for the UCR medical school already has pushed back the planned opening from 2012 to 2013. Inland Southern California's population will grow by an estimated 24% over the next decade, and many of the 44% of current physicians who are ages 55 and older will retire, further reducing health care access.
Policymakers also can support reforms in medical education that would encourage more students to pursue primary care medicine. These approaches include a greater emphasis upon clinical training in ambulatory settings, development of longitudinal patient experiences for medical students and innovative options for dealing with medical school debt on the front end of medical training.
The UCR School of Medicine will enact each of these reforms.
In both clinical rotations for medical students and residency training, we are developing affiliations with outpatient health care providers, including community clinics and federally qualified health centers, multi-specialty practice groups and HMOs. Medical schools traditionally have trained their students in tertiary care academic medical centers, which give trainees a skewed view of the medical profession. More training needs to occur in ambulatory settings where the vast majority of medical care is delivered.
Throughout the second and third years of medical school, UCR students will have continuity-based clinical experiences that enable students to establish more meaningful interactions with patients, thus inspiring more students to choose primary care specialties.
Additionally, we plan to establish an innovative loan-to-scholarship program where selected students who ultimately practice in primary care or high-shortage specialties have their loans converted to outright scholarships. If students can begin their medical education without the worry of accumulating debt, it will solidify their intended career goals to practice in primary care.
By supporting medical education approaches such as those we are developing at UC-Riverside, state policymakers can tangibly and positively affect the primary care physician work force in the high-need areas of California.