As demand grows for quality health care, California does not have enough of the right type of health workers, with the right skills, in the right places to meet the needs of our state’s growing and increasingly diverse population.
In spite of everything California has done in recent years to improve health care delivery, the state will face a shortfall in the next decade of 4,100 primary care clinicians and 600,000 home care workers and will only have two-thirds of the psychiatrists we need.[i]
The California Future Health Workforce Commission has developed a plan for closing these gaps through a set of targeted investments that will strengthen the supply, distribution, and diversity of workers in primary care, behavioral health, and care for older adults — the fields that will be most impacted by the state’s changing demographics.
A closer look at the health workforce crisis facing California:
Millions of Californians still don’t have access to quality health care — because of where they live, how much they earn, or the health conditions they face.
- Seven million Californians, the vast majority of them Latino, black, and Native American, live in Health Professional Shortage Areas — a federal designation for counties experiencing shortfalls of primary care, dental care, or mental health care providers.[ii]
- Some of the fastest-growing regions of the state, such as the Inland Empire and San Joaquin Valley, have half as many doctors per resident as major metros like the Bay Area.[iii]
- In the Northern and Sierra regions, one in five adults say they find it difficult to get the care they need.[iv]
- For people who rely on the safety net, these challenges are even greater — with just over half as many doctors accepting Medi-Cal as those who accept private insurance.[v]
- Access to care is a major obstacle for those suffering from mental illness or drug and alcohol issues.
Complicating this challenge is the arrival of the “silver tsunami:” California is getting older — and more reliant on health and social services.
- Four million new Californians will turn 65 in the next 10 years.[vi]
- By 2030, one in five of the state’s residents will be of retirement age, when health care demands climb rapidly.[vii]
- Aging Baby Boomers, unlike previous generations, are more likely to be single, childless, and live alone or in poverty.[viii]
- And while more than 75% of seniors say they would prefer to age in place, a widening shortfall of home care workers will make that more difficult than ever.[ix]
Health care professionals aren’t exempt from these trends — with substantial portions of the workforce reaching retirement age.
- More than a third of California’s doctors and nurses are over age 55, and many physicians are already partially retired.[x]
- The California Department of Public Health expects two-thirds of its workforce will retire in the next five years.[xi]
Between now and 2030, the state is expected to grow by six million people — but California’s education system isn’t keeping pace.
- California’s medical school enrollment rate is the third lowest in the country.[xii]
- Facing a lack of available medical school seats, many Californians (60%) looking to pursue a medical degree have to move to other states for medical school—forcing California’s public and private health systems to compete to lure them back.[xiii]
- Students who stay and attend schools in the University of California system face an average student debt of $154,000 for med school grads and $72,000 for nursing grads.[xiv]
Today’s health workforce doesn’t current reflect the diversity of our state’s population.
- Given all of the cost associated with training, it’s no surprise that the majority of medical students in California come from families with incomes in the top 20%.[xv]
- Latinos are now nearly 40% of California’s population, but only 7% of doctors.[xvi]
- More than seven million patients have limited English proficiency and could benefit from access to multilingual providers. Yet, according to one study, the state has only 20% as many Spanish-speaking doctors as it needs.[xvii]
The California Future Health Workforce Commission has proposed a set of bold solutions to meet the demand for health
Leaders agree — it won’t be easy to solve the workforce crisis. But it is critical that California acts now. The Commission has developed three complementary strategies that include detailed recommendations for achieving the workforce California needs now and moving forward.
- Strategy 1: Increase opportunity for all Californians to advance in the health professions.
- Strategy 2: Align and expand education and training to prepare health workers with the right skills in the right places to meet California’s health needs.
- Strategy 3: Strengthen the capacity, effectiveness, well-being, and retention of the current health workforce.
Read more about the proposals of the California Future Health Workforce Commission at https://futurehealthworkforce.org.
[i] “4,100 primary care clinicians:” Joanne Spetz, Janet Coffman and Igor Geyn, California’s Primary Care Workforce: Forecasted Supply, Demand, and Pipeline of Trainees, 2016-2030, Healthforce Center at UCSF, https://www.ucsf.edu/news/2017/08/408046/california-demand-primary-care-providers-exceed-supply-2030;
“600,000 home care workers:” Sarah Thomason and Annette Bernhardt, California’s Homecare Crisis: Raising Wages Is Key to the Solution, Center for Labor Research and Education at UC Berkeley, November 2017, http://laborcenter.berkeley.edu/californias-homecare-crisis/.
“Two-third of psychiatrists of the psychiatrists…:” Janet Coffman et al., California’s Current and Future Behavioral Health Workforce, Healthforce Center at UCSF, February 12, 2018, https://healthforce.ucsf.edu/sites/healthforce.ucsf.edu/files/publication-pdf/California%E2%80%99s%20Current%20and%20Future%20Behavioral%20Health%20Workforce.pdf (PDF).
[ii]Designated Health Professional Shortage Areas Statistics, Health Resources and Services Administration (HRSA), last modified September 30, 2018, https://ersrs.hrsa.gov/ReportServer?/HGDW_Reports/BCD_HPSA/BCD_HPSA_SCR50_Qtr_Smry_HTML&rc:Toolbar=false
[iii] Janet M. Coffman, Margaret Fix, and Michelle Ko, California Physician Supply and Distribution: Headed for a Drought?, California Health Care Foundation, June 2018, www.chcf.org/publication/californias-physicians-headed-drought/.
[iv] Janet M. Coffman, Margaret Fix, and Michelle Ko, California Physician Supply and Distribution: Headed for a Drought?, California Health Care Foundation, June 2018, www.chcf.org/publication/californias-physicians-headed-drought/.
[v] Sandra Hernández, “The Big Shortage: What California Can Do Today to Build the Health Workforce of Tomorrow,” California Health Care Foundation PPT, https://chcf.app.box.com/s/0t3brmn2xl5apihxrmf0exdik8l3dlsb
[vi] Laurel Beck and Hans Johnson, Planning for California’s Growing Senior Population, Public Policy Institute of California, August 2015, www.ppic.org/publication/planning-for-californias-growing-senior-population/.
[vii] Laurel Beck and Hans Johnson, Planning for California’s Growing Senior Population, Public Policy Institute of California, August 2015, www.ppic.org/publication/planning-for-californias-growing-senior-population/.
[viii] Meeting the Demand for Health: Final Report of the 2019 California Future Health Workforce Commission. Calculations based on the American Community Survey and Decennial Census.
[ix] Joanne Binette and Kerri Vasold, “2018 Home and Community Preferences: A National Survey of Adults Age 18-Plus,” AARP, August 2018, www.aarp.org/research/topics/community/info-2018/2018-home-community-preference.html.
[x] Janet M. Coffman, Margaret Fix, and Michelle Ko, California Physician Supply and Distribution: Headed for a Drought?, California Health Care Foundation, June 2018, www.chcf.org/publication/californias-physicians-headed-drought/.
[xi] CDPH 2017 State Leadership Accountability Act Report, CA Dept. of Public Health (CDPH), January 10, 2018, www.cdph.ca.gov/Programs/OCOCR/Pages/Program-Landing1.aspx. Data provided by internal assessment from CDPH.
[xii] Joanne Spetz, Janet Coffman, and Igor Geyn, California’s Primary Care Workforce: Forecasted Supply, Demand, and Pipeline of Trainees, 2016-2030, Healthforce Center at UCSF, August 15 2017, https://healthforce.ucsf.edu/publications/californias-primary-care-workforce-forecasted-supply-demand-and-pipeline-trainees-2016.
[xiii] Applicants to U.S. Medical Schools by State of Legal Residence, 2009-2010 Through 2018-2019, American Association of Medical Colleges (AAMC), www.aamc.org/data/facts/applicantmatriculant/; Matriculants to U.S. Medical Schools by State of Legal Residence, 2009-2010 Through 2018-2019, AAMC, www.aamc.org/data/facts/applicantmatriculant/.
[xiv] James Youngclaus, Brief: An Exploration of the Recent Decline in the Percentage of U.S. Medical School Graduates With Education Debt, Association of American Medical Colleges, September 2018, www.aamc.org/download/492284/data/september2018anexplorationoftherecentdeclineinthepercentageofu..pdf (PDF).
[xv] Nina Bai, “Student Debt in the Health Professions Limits School Choice, Career Paths,” UCSF News Center, January 26, 2017, www.ucsf.edu/news/2017/01/405656/student-debt-health-professions-limits-school-choice-career-paths.
[xvi] Janet Coffman, Igor Geyn, and Kristine Himmerick, California’s Primary Care Workforce: Current Supply, Characteristics, and Pipeline of Trainees, Healthforce Center at UCSF, February 16, 2017, https://healthforce.ucsf.edu/publications/californias-primary-care-workforce-supply-characteristics-and-pipeline.