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Physician Need Still Outstrips Rising Supply In California

 |  By cclark@healthleadersmedia.com  
   July 26, 2010

The number of physicians in California has been increasing faster than the state's population, but not as fast as the state needs, especially as both state and federal legislation strive to increase the number of people who receive healthcare services.

And though the supply of physicians is increasing, the trajectory may be short-lived as the aging physician workforce continues to cut back on the number of hours worked, retires, or increasingly stops accepting new patients covered by Medicare or Medicaid.  What may be of special concern is that 29% of California’s doctors are older than age 59, more than in other states.  In New York and Florida, 28% and 27% of physicians are age 60 or older, but in Texas only 23% are near retirement. Nationally, 25% are at least 59 years of age.

These findings come from The California Healthcare Foundation’s July edition of Health Care Almanac, which took a snapshot of the physician supply issue as of 2008. Here are some of the findings:

  • California barely meets the nationally recognized standard for primary care physicians, and only Orange, Sacramento and San Francisco Bay area counties meet the mark.  It matches national physician supply numbers, but only because the state has attracted large numbers of specialists.
  • Of the licensed physicians (approximately 127,000 according to the Medical Board of California’s Annual Report) only half of them work full time in patient care.  The rest either treat patients part time, or spend all or portions of their time in research, teaching or administration. About 16% work fewer than 20 hours a week.
  • While 84% of primary care physicians are accepting new patients, nearly half are not.
  • Latinos make up 40% of the population, but only 5% of the state’s physicians listed that background with the California Medical Board.
  • California doctors don’t make as much money as doctors in the nation as a whole.  In fact, for family and general practitioners, compensation was 88% of the national average in 2008.
  • California relies on foreign medical school graduates for a substantial portion of its supply of physicians, especially those who choose primary care.
  • For every 100,000 people in the state, California’s physician supply grew from 245 to 262 between 1998 and 2008.
  • The Inland Empire of Riverside and San Bernardino counties has the lowest number of both primary care physicians and specialists in the state, 40 and 70 per 100,000 population. But counties that make up the San Francisco Bay area have the most, 78 primary care practitioners and 155 specialists.  The recommended supply of primary care doctors is between 60 and 80 and the recommended specialist number is between 85 and 105.

 

  • California doctors are less likely to see Medicaid patients or uninsured patients.  While 90% have patients with private insurance, 69% accept patients covered by Medicaid and 65% accept uninsured patients.
  • Pay for performance is a declining trend in the state. In 2005, P4P peaked, with 45,000 physicians participating, but in 2008, that number had declined to 35,000.
  • With respect to physician earnings, family and general practitioners in California earned 88% of what their counterparts across the country earned, and obstetrician/gynecologists earned 94%. On the higher end, anesthesiologists earned 106%, followed by pediatricians, 102% and psychiatrists, 101%.
  • One issue that is increasingly important is linguistic competence among the nation’s physicians. “Not having access to a provider who speaks their language can have a negative impact on quality of care,” the foundation report says.  Perhaps somewhat surprising, San Diego County, a major county closest to the border, has the lowest percentage of physicians who speak Spanish in the state, only 11% compared to the statewide average of 18%, and lower than other regions.
  • Another concern about physician supply is the numbers who now refuse new patients, especially if they lack health coverage.  While 84% of the state’s primary care providers and 94% of other physicians will accept new patients, only 64% of primary care providers accept new patients covered by Medicare, 54% will take new patients if they have Medicaid and 42% if they lack any coverage.  For non primary care providers, the numbers are slightly higher.  About 94% will accept new patients, but 79% will take new Medicare enrollees and 59% if covered by Medicaid and 47% if they are uninsured.
  • In 2008, California was best in the nation for retaining medical school students and was second in the nation for retaining residents.
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