California’s new budget invests in overlooked piece of health care puzzle: workers
Is this the start of a new era for California’s health workforce? It sure looks like it.
Gov. Gavin Newsom is poised to sign the largest, most comprehensive set of proposals in years to expand California’s health workforce pipeline—tapping $300 million in the 2019-20 budget to address an often overlooked threat to our health care system: a shortage of qualified health professionals.
Our state has been acting boldly for years now on a variety of fronts to improve health and health care—from cutting the uninsured rate in half to reducing medical costs.
But coverage is not care, and for millions of Californians to access the care they need, we are going to need more workers, particularly workers who represent the communities they serve.
If investments in our workforce pipeline continue to lag behind rising demand, California is projected to face a shortfall of 4,100 primary care clinicians and 600,000 homecare workers by 2030, and will have only two-thirds of the psychiatrists it needs.
These shortfalls are already being felt in regions like the Inland Empire, San Joaquin Valley, and Los Angeles, where 7 million people live in federally-designated Health Professional Shortage Areas.
With these workforce challenges in mind, we were proud to serve as two of the five funders of the California Future Health Workforce Commission, a blue-ribbon panel of 24 experts from across the health system who met in 2017 and 2018 to study this issue.
The Commission’s final report, released in February, offered a detailed set of recommendations for recruiting, training, and deploying a new wave of health workers, especially those coming from and committed to working in underserved communities.
The total cost of these priority actions was pegged at $3 billion over 10 years, roughly $300 million per year. The commission estimated these investments would entirely eliminate the state’s primary care shortage, while improving diversity and ensuring we have more of the right types of workers, with the right skills, in the right places to meet the needs of our growing, aging and increasingly diverse population.
As we’ve watched Gov. Newsom during his first few months on the job, it’s heartening to see how committed he is to this issue. Declaring that he wants to be known as California’s “health care governor,” Newsom has made it clear the state can’t achieve his increasingly ambitious goals for increasing coverage and expanding access, especially for behavioral health, without closing the workforce gap.
Gov. Newsom has made preventive care, behavioral health, and care for aging Californians, the commission’s three focus areas, all top priorities. He has embraced the task of bolstering an industry that employs 1.4 million skilled workers.
As he put it in May: “I want to lower the cost curve, I want to deliver broader access and I want to improve quality, particularly on wellness and prevention, and move away from acute care and emergency care. I want to see how far we can push it with the state.”
With the support of overwhelming majorities in the Legislature, the newly-approved budget certainly does that. The final spending plan includes more than $300 million in new funding to bolster residency programs, improve primary care education and training in areas of unmet need, and implement a five-year plan for expanding the pipeline of mental health providers.
There is new backing for expansions of medical school facilities at UC-Riverside and UC-Merced, two major potential sources of primary care physicians in parts of the state that need them most.
And the budget also boosts the Medi-Cal loan repayment program by $120 million, increasing our current workforce’s ability to provide care to Medi-Cal beneficiaries.
In addition to this new funding, legislators are advancing more than a dozen substantive bills to address California’s health needs and improve the diversity of the workforce pipeline.
These include proposals to expand eligibility for physician loan repayment, increase the rural health workforce, expand the contributions of nurse practitioners, promote hiring of physician assistants, and engage community health workers, among many other ideas.
All of this attention cannot come soon enough, and we hope this is the beginning of a new era for the state’s health workforce system, one that will require ongoing public and private commitments for years to come.
California’s health needs may be growing, but with the right investments and the right policies, in the right places, we can make sure every community has the people and systems it needs to be healthy.
Dr. Sandra Hernández is president and chief executive officer of the California Health Care Foundation, [email protected] Raymond Baxter is president and chief executive officer of the Blue Shield of California Foundation, [email protected] They wrote this commentary for CALmatters.