Confronting the Physician Shortage Head-On: A Health Plan Takes Action
The physician pipeline across the United States continues to diminish. Study after study for more than a decade has shown that the country is facing a serious physician shortage—one that poses a risk to the health of the population. Earlier this year, a study by the Association of American Medical Colleges predicted that the country will face a shortage of up to 121,000 physicians by 2030.
As a health plan serving the most vulnerable populations in Los Angeles County, L.A. Care Health Plan depends on physicians who work everywhere from South Los Angeles to the Antelope Valley. They are often working within the safety net, meaning they treat patients regardless of their ability to pay. These providers care for a substantial share of Medicaid beneficiaries, uninsured, and other vulnerable patients.
To ensure our members will never struggle to see a primary care physician, the L.A. Care Board of Governors earlier this year allocated $31 million of unassigned reserves to launch Elevating the Safety Net, an ambitious, long-term initiative starting with three grant programs to address this looming crisis.
The first program, which launched in September, will provide up to $125,000 to Los Angeles County safety net clinics and independent private practices to pay salary subsidies, sign-on bonuses, and/or relocation costs to physicians who are recruited to work in the safety net for the first time. It’s estimated that each new physician recruit could treat up to 2,000 new patients.
A second program supports medical school loan repayment for those new physician recruits. When surveyed, most medical students say they chose the field because they wanted to help people. But altruism often falls by the wayside when students leave medical school with a loan payment the size of a mortgage. Carrying that burden pushes physicians into higher-paying specialty fields. Our initiative will erase that burden for physicians working within the safety net.
The third program in the initiative is a scholarship program. In July, we awarded eight four-year medical school scholarships—four to students attending the David Geffen School of Medicine at the University of California-Los Angeles and four to students attending the Charles R. Drew University of Medicine and Science. Each student has described the scholarship as a life-changing opportunity that will allow them to pursue their desire to work with vulnerable communities.
A Pressing Need
California, the most populous state in the country, is especially vulnerable when it comes to the physician shortage crisis. Last year, the University of California San Francisco released a report showing California is expected to face a statewide shortfall of nearly 9,000 primary care providers by 2030—just 12 years from now. This shortage could force people to forgo needed care, or it could push them into emergency rooms for minor ailments.
A number of factors are compounding the problem. One is the aging population, which includes physicians who are reaching retirement age. Then there is the very real problem of physician burnout. Authors of an article for the American Journal of Medicine say their research found physician burnout jumped nearly 10 percent between 2011 and 2014. Furthermore, more patients have been seeking care since the Affordable Care Act expanded coverage.
The Department of Health and Human Services (HHS) recommends at least 60 primary care physicians per 100,000 people, and ideally closer to 80. Some counties in California have fewer than 40.
In Los Angeles County, the number is 56, with some areas facing a severe shortage. Martin Luther King, Jr. Community Hospital in South Los Angeles recently released a physician needs assessment showing a primary care physician shortfall of 500. This region also has a deficit of 700 specialists.
Answering the Call
Across the country, various entities have heard the call to action. In fact, this month New York University announced medical school would be free to all students, regardless of financial need. It was a bold move to address the high cost of medical school and the growing need for more physicians. There is speculation that other universities might follow, but here in Los Angeles County we can’t afford to wait.
With Elevating the Safety Net, L.A. Care is not waiting. Our commitment to the low-income members we serve is strong, and as a publicly operated health plan, we are proud that we can take action that will benefit our members now and in the years to come.
John Baackes is CEO, L.A. Care Health Plan, Los Angeles.
Read more posts on the Leadership Blog, including a previous post by John Baackes on a value initiative for independent practice associations.