California needs more health care providers

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MARCH 11, 2019

Most students at universities like UC Berkeley have already seen the warning signs. You’re home for break or have an issue at school and you need to see a doctor, but when you get there, you spend most of the visit in a waiting room. Sometimes for 30 minutes, sometimes an hour before getting admitted to an office with a clinician or a specialist who barely has time to look at you or listen to what the problem is. That’s when you even get that far, of course. A lot of doctors don’t have appointments available for months.

These are the early symptoms of a much larger crisis in California’s health care system. Seven million Californians currently live in Health Professional Shortage Areas — a federal designation for communities that lack adequate primary care, dental care or mental health care providers. By 2030, as millions of baby boomers move into retirement — increasing the demand for care while simultaneously taking a significant number of experienced professionals out of the workforce — the state is projected to face a shortfall of 4,100 primary care physicians and 600,000 homecare workers and will have only two-thirds of the psychiatrists it needs.

The good news is, these growing workforce challenges are eminently treatable — especially if young Californians are willing to be part of the solution.

In February, a group called the California Future Health Workforce Commission released a comprehensive plan ensuring the state will have enough of the right types of health workers in the right places to meet the needs of its growing, aging and increasingly diverse population. I served on the commission, which was led by co-chairs Janet Napolitano, University of California president and Lloyd Dean, president and CEO of Dignity Health, along with a group of 22 experts from the health, education and labor sectors.

After more than a year of deliberation, the commission identified 10 priority actions — with a total cost of $3 billion — that will completely eliminate the state’s primary care shortage over the next decade and nearly eliminate shortfalls in other key fields. The commission proposals can increase the number of health workers by over 47,000 people and improve diversity by producing approximately 30,000 workers from underrepresented communities.

The key to success will be to act swiftly to build California’s health workforce pipeline, while also addressing existing mismatches between today’s workforce and the state’s increasingly diverse population. If you’ve been to a doctor’s office recently, you know what this looks like: People of color will make up the majority of Californians by 2030, but they remain severely underrepresented in the health workforce. While Latinx people now make up nearly 40 percent of the state’s population, they compose only seven percent of physicians. More than seven million Californians have limited English speaking skills and would benefit from multilingual providers yet few are available.

We should target all of these issues at once, starting with recruiting more college students interested in health professions and supporting them with tailored scholarships and increased financial aid, especially when they commit to practicing in underserved communities. This is critical if we hope to meet the needs of over seven million Californians who live in areas without enough health professionals.

We should also expand the size of California’s medical school and residency programs which are not big enough today to match growing health demand. Facing a lack of seats, many Californians seeking medical degrees move out of state for medical school — forcing our health systems to compete with one another in luring them back.

With a new generation of professionals moving into the workforce, we should maximize the roles of skilled workers across the health profession — from those who care for the most sick to those who keep people healthy in the first place. This means expanding the effectiveness and reach of public health teams as well as clinical care teams by creating new career ladders and practice opportunities for community health workers and in-home health workers and nurses, in particular. Paired with more diverse clinicians, these professionals will be especially critical to advancing prevention and providing care.

As a commissioner and practicing physician, I have no doubt these recommendations will allow California to build the health workforce we need. The group of experts on the Health Workforce Commission have done their research, and they have produced a workable plan. It will require some new investments, along with commitments from a range of key health care and public health stakeholders, from state and federal government to philanthropy, health sector employers, universities, health plans and business.

Now it’s time to get to work — to get more Californians out of the waiting room, so everyone has access to a health professional with the right skills, in the right places, right when they need it.

Contact Rishi Manchanda at 


MARCH 12, 2019