How to address California’s health care workforce shortages

The COVID-19 pandemic has shone a spotlight on our health care system. Often it has revealed heroics showing that California’s health care workers put themselves on the frontlines for their community, the industry came together to meet new and evolving challenges, and forged partnerships to innovate in double time.

The pandemic has also shone a bright light on many of the shortcomings in the system, like health care workforce shortages. Even before the pandemic, our nation was experiencing a growing shortage of health care professionals. 

In California, this issue resulted in an uneven distribution of providers that exacerbated existing inequities and a workforce that does not reflect our state’s diverse population. 

These challenges are most acutely felt in our state’s Medi-Cal system, which last year covered 1 in 3 Californians and is on pace to cover even more patients this year.

And while the California Future Health Workforce Commission met recently to discuss this issue, it is crucial that we establish a better and broader public understanding of the problem and potential solutions so that we can work together to tackle the challenge.

Over the last 10 years, Medi-Cal providers have struggled to keep pace with the program’s expansion. In 2013, there were 59 full-time primary care doctors per 100,000 Medi-Cal patients – by 2015, the ratio had dipped to 39 doctors per 100,000 patients – a 34% dip.

As one of the health plans with the longest history serving the Medi-Cal population, Health Net understands the disproportionate impact provider shortages have on patients, and we have worked with partners at the local and state level to address these issues head-on.

From these partnerships, we have seen what works and what does not, and three core areas of focus have emerged: the importance of identifying new talent pools, the need to provide upward mobility across all levels, and the critical role of cultural competency training and recruitment to build a more robust and diverse pipeline of health care professionals.

The first step to filling the gap is recruiting new talent. To do this, California should focus on identifying untapped talent pools – shifting recruitment to engage underrepresented professionals in underserved markets, like high schools and community colleges in safety net counties.

In San Joaquin, HealthForce Partners of Northern San Joaquin Valley identified the region’s barriers to entry for the field and now offers residents training opportunities and pathways to careers as nurses, lab technicians and medical assistants. The Greater Sacramento Urban League teamed with Health Net, WellSpace Health and Sacramento City College to establish the Community Health Worker Pathway Program, designing a curriculum and providing support for students to pursue careers as much-needed community health workers in the region. 

We also must recognize the need to build opportunities across all levels. By focusing on career ladders for community health workers and medical assistants, as well as primary care providers and doctors, we can increase clinic capacity and improve patient satisfaction. Investing in training and enabling all professionals to upskill is key to retention and augmenting shortages.

Finally, to foster more equitable health outcomes throughout California, we must make a more concerted effort to design a workforce ready to address disparities. This includes representative recruitment, investments in cultural competency training and the establishment of new professions focused on serving our most historically in-need patients. Partnering with public and private organizations on these efforts is key to building a more diverse pipeline and addressing the unacceptable inequities that exist today.

Building a health care workforce that works for every patient is one of the most important investments we can make in the future health and wellness of California and, as we have experienced firsthand, it requires collaboration. Now, as we grapple with the fallout of the pandemic, it is crucial that we come together to implement solutions on a statewide scale so that we can design a future workforce that serves all Californians.