California’s Health Care Workforce: Are We Ready for the ACA? Overview: Physicians Catherine Dower Sacramento, March 14,

2 California’s Health Care Workforce: Readiness for the ACA Era Team: Tim Bates, MPP; Lisel Blash, MPA; Susan Chapman, BSN, MSN, PhD; Catherine Dower, JD; and Edward O’Neil, FAAN, MPA, PhD. Sponsor: Funded by The California Wellness Foundation Impetus: PPACA and Governor’s taskforce

3 Methodology Literature review Environmental scan CA Department of Consumer Affairs Professional License MasterFile Key informant interviews

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Key Findings Health workforce major part of labor sector Continued growth Significant maldistribution Growing population, more diverse population, aging population, changing disease burden ACA implementation will strain primary care providers first 6

7 California’s Licensed and Registered Health Care Workforce—February 2011 Source: California DCA Professional License Masterfile

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Growth in US Primary Care Workforce YearsAverage annual percent change per capita Primary care physicians Nurse practitioners Physician assistants Robert Wood Johnson Foundation Synthesis Project. Primary care health workforce in the United States, 2011, based on GAO data. Total increase in primary care physicians per 100,000 population was 12%, compared with 5% for other physician specialties. Decreased interest in primary care by US medical graduates more than outweighed by DOs and foreign trained doctors choosing primary care.

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16 Distribution of Primary Care Physicians and Physician Assistants

17 Solutions: Improving Supply, Distribution, and Workforce Practice Models Increase training & residency opportunities in under-served areas Expand loan repayment programs for practicing in underserved areas Enhance telehealth Expand legal scope of practice for NPs & PAs Improve workforce data collection Strengthen the capacity of safety net providers

18 Solutions: Improving the Education Pipeline Encourage medical students to practice in primary care Refocus some education resources on NP & PA training and innovative education models Enhance retention in CC health careers programs Invest in primary and secondary (K-12) education programs

19 Racial and ethnic diversity: Challenges and Solutions 5% of MDs, 21% of PAs; 37% of population Latino repre- sentation 50%+ will be people of color 30%+ of adults speak English less than well Newly eligible for subsidies or MediCal (CPEHN 2010) Invest in interpretation Train CHWs, health educators, promotorás Build career ladders for the (diverse) allied health professions Replicate models that work to keep URMs in training programs Include communities of color in ACA implementation

20 California’s Health Care Workforce: Moving Forward Challenge Growing pressure on safety net providers Geographic maldistribution of workforce Diversity challenges Promise Continued job growth despite the recession HIT leveraged to facilitate new models of care Alternative training programs can scale up fast New finance and delivery models may decrease costs --improve access and quality of care

21 California’s Health Care Workforce: Readiness for the ACA Era Contact: Catherine Dower