California faces shortage of primary-care doctors
California is heading for a serious shortfall of primary care doctors, physicians’ assistants and nurse practitioners over the next few decades — a crisis that could force patients to seek medical help for routine illnesses at hospital emergency rooms instead, a new study released Tuesday warns.

Tracy Seipel

San Jose Mercury News

California is heading for a serious shortfall of primary care doctors, physicians’ assistants and nurse practitioners over the next few decades — a crisis that could force patients to seek medical help for routine illnesses at hospital emergency rooms instead, a new study released Tuesday warns.

That alternative is among the most troubling scenarios if a predicted shortage of 4,700 primary care clinicians occurs in California by 2025, according to authors of the UC San Francisco Healthforce Center report.

“We need to ask our (state) leaders: What can we do now to avoid a crisis in the future?’’ said Janet Coffman, associate professor of health policy at USCF, and one of the study’s authors.

The projected deficits come as more Californians have obtained health insurance since the Affordable Care Act kicked into gear in 2014. But the coming decades also will witness large numbers of primary care doctors and nurse practitioners reaching retirement age, the authors say.

Primary care clinicians are the front line in patient care, said Coffman, so when people with chronic conditions have good access to primary care, ”they tend to use the emergency room departments and the hospitals less.’’

The study forecasts that the state would need about 4,700 additional primary care clinicians in 2025 and about 4,100 more clinicians in 2030 to meet demand.

The Central Valley, Central Coast and Southern border regions — which Coffman said have fewer opportunities for primary care education and training — will experience the worst shortages, the study predicted.

Forecasts suggest the first two areas will have about 71 primary care clinicians per 100,000 residents, while the Southern border region will have 80 per 100,000 residents, compared to the state average of 86 clinicians per 100,000 residents.

By comparison, the greater Bay Area is expected to fare better than most other regions of the state, she said.

“We have more training programs for primary care clinicians,’’ Coffman said, including those at UCSF, Stanford, Kaiser Permanente and the Veterans Affairs, among others.

And evidence shows that most family physicians end up practicing within 100 miles of where they train by the time they graduate from residencies in their late 20s and early 30s.

“That’s a time you become more settled,’’ said Coffman.

Still, the biggest challenge continues to be drawing people into primary care careers, when specialty medicine careers usually pay better and may offer more flexible hours, she added.

The study suggests a number of strategies to address the coming shortage, including: actively recruiting primary care doctors to practice in California; expanding primary care residency programs, particularly in the regions at greatest risk for long-term shortages, and allowing nurse practitioners and physicians’ assistants to work at the highest level of their education and knowledge.

Nurse practitioners and physicians’ assistants, for example, make up a larger share of the primary care workforce in rural regions, where primary care doctors are in short supply.

At the California Academy of Family Physicians, Dr. Jeremy Fish said the group’s members are pleased to see the UCSF study is “taking seriously the issue of the primary care shortage’’ that the academy has warned about for years.

“The shortage of primary care clinicians likely will get worse unless the state remains committed to two specific initiatives it began this year,’’ said Fish.

That includes higher Medi-Cal reimbursements for doctors, and more funding for primary care and emergency medicine physician residency programs, generated by Proposition 56 revenue, which increased taxes on tobacco products. An additional $100 million appropriation by the state legislature will also help fund primary care residencies.

Tuesday’s report is the second in a series of three UCSF Healthforce Center reports assessing the adequacy of the state’s primary care workforce, and identifying policies that address the future employment gaps.

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