California’s Health Care Workforce:

Are We Ready for the ACA?Overview: Physicians

Catherine Dower

Sacramento, March 14, 2012

http://futurehealth.ucsf.edu

2

California’s Health Care Workforce: Readiness for the ACA Era

Team:Tim Bates, MPP; Lisel Blash, MPA; Susan Chapman, BSN, MSN, PhD; Catherine Dower, JD;

and Edward O’Neil, FAAN, MPA, PhD.

Sponsor: Funded by The California Wellness Foundation

Impetus:PPACA and Governor’s taskforce

3

Methodology

• Literature review• Environmental scan• CA Department of Consumer Affairs

Professional License MasterFile• Key informant interviews

4

http://futurehealth.ucsf.edu

5

Key Findings

• Health workforce major part of labor sector

• Continued growth

• Significant maldistribution

• Growing population, more diverse population, aging population, changing disease burden

• ACA implementation will strain primary care providers first

6

7

Nursing386,041

Total = 840,900

Other27,740

California’s Licensed and Registered Health Care Workforce—February 2011

Source: California DCA Professional License Masterfile

8

9

10

11

Growth in US Primary Care Workforce

Years Average annual percent change per capita

Primary care physicians 1995-2005 1.1

Nurse practitioners 1999-2005 9.4

Physician assistants 1995-2007 3.9

12Robert Wood Johnson Foundation Synthesis Project. Primary care health workforce in the United States, 2011, based on GAO data.

• Total increase in primary care physicians per 100,000 population 1995-2005 was 12%, compared with 5% for other physician specialties.

• Decreased interest in primary care by US medical graduates more than outweighed by DOs and foreign trained doctors choosing primary care.

13

14

15

16

Distribution of Primary Care Physicians and Physician Assistants

17

Solutions: Improving Supply, Distribution, and Workforce Practice Models

• Increase training & residency opportunities in under-served areas

• Expand loan repayment programs for practicing in underserved areas

• Enhance telehealth

• Expand legal scope of practice for NPs & PAs

• Improve workforce data collection

• Strengthen the capacity of safety net providers

18

Solutions: Improving the Education Pipeline

• Encourage medical students to practice in primary care

• Refocus some education resources on NP & PA training and innovative education models

• Enhance retention in CC health careers programs

• Invest in primary and secondary (K-12) education programs

19

Racial and ethnic diversity:Challenges and Solutions

•Invest in interpretation•Train CHWs, health educators, promotorás•Build career ladders for the (diverse) allied health professions •Replicate models that work to keep URMs in training programs•Include communities of color in ACA implementation

20

California’s Health Care Workforce: Moving Forward

Challenge• Growing pressure on safety net providers• Geographic maldistribution of workforce• Diversity challenges

Promise• Continued job growth despite the recession • HIT leveraged to facilitate new models of care• Alternative training programs can scale up fast• New finance and delivery models may decrease

costs --improve access and quality of care

21

California’s Health Care Workforce: Readiness for the ACA Era

Contact: Catherine Dowercdower@thecenter.ucsf.edu

415-476-1894

http://www.futurehealth.ucsf.edu