California has nearly 20% fewer practicing physicians than was assumed, and not nearly enough active primary care providers to meet the state's needs, according to the 2008 Medical Board of California's database. Though it has an "abundance" of specialists, half the counties don't have nearly enough.
The report noted further deterioration in physician supply "poses a significant threat to health access" and risks "compromising the health of the state's residents."
The report said that the 66,480 active physicians is much lower than the American Medical Association's figure of 80,000, which was attributed to an AMA overestimation of the number of full-time physicians.
California has only 59 primary care physicians now practicing per 100,000 population, lower than the 60 to 80 needed. Adding the number of osteopaths, California has 63 primary care physicians in patient care per 100,000 population, "at the bottom end of the estimated need range," the report said.
The report, entitled "Fewer and More Specialized: A New Assessment of Physician Supply in California," was compiled by Kevin Grumbach, MD., chair of the University of California San Francisco Department of Family and Community Medicine, and colleagues, with support of the California Program on Access to Care. It was released by the California Healthcare Foundation.
The supply of primary care physicians is the most troublesome, with only 16 of the state's 58 counties reaching a threshold of 60 primary care physicians per 100,000 population, as recommended by the Council on Graduate Medical Education.
If current trends continue, The Golden State's primary care physician shortage is likely to worsen, the report said, "exacerbated by a shrinking interest in primary care nationally among graduates of U.S. medical schools."
The report added the distribution of physician practices throughout the state is problematic because it leaves rural and underserved counties with fewer doctors than they need. The report says the supply of primary care physicians in these low population areas is "diminishing."
An additional concern is the number of active physicians who are nearing the end of their careers, with one-third of those practicing having reached age 56 or older, and nearly 10% who are at least 66.
The team recommended that the state find a way to resolve the issue in at least four ways:
- Provide greater financial incentives to primary care physicians to set up practices in the state, especially in underserved areas, and pay more for patients covered by Medicaid and other government programs.
- Support special targeted training for medical students to practice in underserved areas.
- Provide more financial and technical assistance to modernize practices.
- Support practice redesign to increase shared decision-making and learning through information technology.
The survey was launched because of concerns that physician supply estimates relied too heavily on projections from the American Medical Association's Physician Masterfile data.
Over the last five years, many health and hospital officials and physicians groups complained that they witnessed firsthand an increasing exodus of the physician workforce. Many left the state to practice in an environment with fewer cost or reimbursement constraints from managed care organizations or reduced their hours. Many took early retirement or left for other pursuits, such as academic research, or other medical fields, such as full or part-time work with institutional review committees, court testimony or publications.
To get a better handle on the problem, the Medical Board of California, which licenses and disciplines physicians, sent out a survey as part of relicensure and now has enough responses for the report.
Indeed, although the survey shows that there are 118,883 physicians who had an active medical license in 2008, less than half were out of training and practicing within the state at least 20 hours per week. Of these 34% were in primary care while 66% were non-primary care specialists.
Conversely, the AMA has estimated that 80,000 active physicians practice in California, a discrepancy this report attributed to the fact that the AMA overestimated the number of hours physicians practiced and listed many physicians as practicing in the state, who in fact are not listed as having a California medical license.
By county, the survey found the greatest number of physicians per 100,000 population are in heavily urban and affluent counties, such as San Francisco, which has 370; Marin, 271; Santa Clara, 239; Napa, 231; San Mateo, 213; and Alamada, 211. The lowest number per 100,000 population practice were in rural counties, such as Alpine, which has none; Sierra, 27; Modoc, 28; Glenn, 43; Trinity, 47; Colusa, 53; Mariposa, 53; and San Benito, 58.
Specialist physician supply is adequate, the report said, but they are poorly distributed. For example, the highest ratio of specialists is located in San Francisco, 265 per 100,000; Marin, 191; Santa Clara, 160; and Napa, 157. But 11 counties have fewer than half the 85 specialists per 100,000 population.