In the recently approved state budget, Governor Jerry Brown and the Legislature took an important step to help recruit and retain the primary care workforce in underserved areas. As mentioned in a previous blog, the state budget plan appropriates $136.7 billion to Health and Human Services. Of the appropriated funds, approximately $8.8 million will go to the Office of Statewide Health Planning and Development (OSHPD) to expand the Song-Brown Program. For those unfamiliar with Song-Brown, it provides funding in the form of grants to accredited family physician residency programs, physician assistant programs, family nurse practitioner programs, and registered nurse programs. Funding can be used to support faculty training, resident stipends, and other activities that provide the opportunity to gain experience in primary care settings.
Under the budget plan, there are two proposals to augment the existing program. The first proposal will help Song-Brown expand to include additional primary care specialties. This proposal provides $2.84 million per year for three years to fund approximately 25 grants to internal medicine, obstetrics and gynecology (OBGYN), and pediatrics residency programs (for old and new residency slots). Grants will cover 159 primary care residents in underserved areas. The second proposal grants one-time funding of $4 million to support new residency slots. Preference will be given to California-trained physicians.
Additional residency slots are critical. There is an ongoing debate regarding the existence of a primary care workforce shortage in the U.S. Many argue that there are fewer and fewer doctors interested in primary care specialties, while others believe there is not a scarcity but a misdistribution of providers. Throughout California, especially in rural communities, stakeholders regularly express frustration about difficulty recruiting providers for their health centers and community clinics. Also, areas with high caseloads of Medi-Cal beneficiaries tend to have a dearth of providers. Medi-Cal providers receive lower payments than physicians who only accept other types of insurance, and certain areas and specialties are simply less desirable for medical students with substantial loan debt.
Workforce issues are also a cause for concern with approximately 4.1 million individuals now enrolled in coverage thanks to the ACA. Despite being enrolled in coverage, if a shortage truly exists, consumers could have real challenges accessing care. Furthermore, there has been quite a bit of talk about access issues potentially leading to enrollee retention issues. If consumers find it difficult to see providers, it is unlikely that they will continue to pay premiums. After all, who wants to continue making monthly payments, which may be very large relative to monthly incomes, if services are so difficult to obtain?
This is where the new Song-Brown residency slots become a factor. More residency slots dedicated to underserved areas, means more bodies (at least for now) in areas that need them most. Song-Brown grants also represent a financial incentive for medical students who are fearful of accumulated debt. So although these residency slots won’t single-handedly reverse workforce issues, they are a win for residency programs that are constantly seeking ways to fund additional primary care positions.
To learn more about workforce issues, click here.