My turn: Here’s how to avert California’s next health care crisis

By Janet Napolitano and Lloyd Dean, Special to CALmatters

California has never been shy about taking bold steps to tackle the most pressing issues affecting our nearly 40 million residents—from efforts protecting and expanding health care coverage to paving the way for more affordable health services.

Now we must turn our attention to the next big health care challenge: a growing shortage of workers who provide care for Californians. This is the aim of the California Future Health Workforce Commission, which has released recommendations for closing the state’s health workforce gap by 2030.

Over the next decade, California will face a shortfall of 4,100 primary care physicians, nurse practitioners, and physician assistants, the commission found. A public health crisis of this magnitude will strain our families, health care systems, and economy.

After California leveraged the opportunities of the Affordable Care Act and extended health coverage to millions of Californians, it’s critical the state train and retain enough professionals to provide the care people need.

In some parts of California, this workforce gap is already upon us: Seven million Californians, the majority of them Latino, African American, and Native American, live in Health Professional Shortage Areas — a federal designation for counties experiencing shortfalls of primary care, dental care, or mental health care providers.

Our aging population, which is growing significantly, will require care in their homes and facilities, adding to the demand for skilled health workers.

As leaders of the University of California and Dignity Health, we understand the challenges and opportunities in training, recruiting, and retaining a robust and diverse health workforce. We see the growing mismatch between the state’s existing delivery of health services and an increasingly diverse population that needs consistent quality care close within their communities.

The good news: After spending more than a year co-chairing the California Future Health Workforce Commission, we are confident this problem can be solved. The commission, consisting of 24 experts from the health, education and labor sectors, is recommending 10 priority actions to eliminate the shortage in primary care by 2030, while increasing the supply of home care workers and behavioral health providers in regions where demand is greatest.

Implementing these actions will require support and commitment from the state, private and public partners, foundations and many others.

Our strategy is as ambitious as it is urgent. The 10 priority actions entail a $3 billion investment over 10 years, adding approximately 47,000 additional health workers—more than 30,000 of them from underrepresented communities.

The actions prioritize the type of workers and support where it’s needed most:

  • Accelerating training of primary care doctors and nurse practitioners and behavioral health providers;
  • Expanding college pipeline programs to bring more low-income and underrepresented minority professionals into the health workforce;
  • Increasing medical school enrollment and expanding the number of primary care and psychiatric residencies;
  • Maximizing the roles of nurse practitioners, home care workers, community health workers and promotores, and peer providers–all of them workers who have some of the most trusted relationships in their communities.

This will be a monumental undertaking, but we have witnessed our state’s resiliency to protect the well-being of Californians.

A decade ago, Dignity Health and the University of California were early supporters of California embracing the Affordable Care Act and expanding Medicaid coverage, also known as Medi-Cal. Thanks to the state’s leadership, the share of Californians without health insurance has dropped nearly 10 percent. Large-scale investments like the ACA have reduced health disparities among our communities, but it takes great planning.

This is why the commission is urging leaders across the state to plan now for the new generation of health care workers needed, especially in light of Gov. Gavin Newsom’s recent sweeping proposals to make sure more Californians can afford health care.

The commission has outlined the essential ingredients needed to achieve the state’s goals of increased health access and quality health care, and we ask leaders across the state to join us in the building the robust and diverse workforce every Californian deserves.


Janet Napolitano is president of University of California, [email protected]. Lloyd Dean is president and chief executive office of Dignity Health, [email protected]. They are co-chairs of the California Future Health Workforce Commission. 

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