CPCA Continues Work to Address Primary Care Workforce Shortage
The California Primary Care Association (CPCA) continues to focus strongly on identifying and raising innovative solutions to close the primary care workforce gap in 2018. Much of our work has centered on building continued partnerships with local, statewide and national partners in order to leverage the amazing efforts happening in our health centers and across the country. From continued research to defining policy solutions to providing specific technical assistance – CPCA continues to prioritize the need to address healthcare access inequities through innovative healthcare workforce solutions.
BEHAVIORAL HEALTH WORKFORCE RESEARCH
New data from California’s Current and Future Behavioral Health Workforce, a report released in collaboration with the Healthforce Center at UCSF, the California Health Care Foundation, and CPCA, shows that substantial investments are needed. California has more than 80,000 licensed behavioral health professionals, but they are not geographically dispersed or demographically reflective of our population. It is also concerning is that only 55 percent of practicing psychiatrists served any Medicare patients and only 46 percent served any Medi‐Cal patients in 2015. Forecasts for demand based on current service utilization, plus the unmet need for services indicate that by 2028 California will have 50 percent fewer psychiatrists and 28 percent fewer psychologists, LMFTs, LPCCs, and LCSWs than are needed.
STATEWIDE WORKFORCE POLICY COALITION
The Workforce Policy Coalition successfully ended 2017 by prioritizing the following three policy areas:
- Equity in Education: California’s diverse, low-income, and rural populations experience many challenges in navigating the higher education system. By creating a more accessible educational pipeline, we can better guarantee that diverse students are able to continue in their health professions journey.
- Continued Primary Care Residency Funding (Song Brown): Residency has the single greatest impact on practice. In FY 18-19, advocacy must continue to guarantee the full $100 million commitment of the legislature is allocated to the Song-Brown Commission.
- Primary Care Tax Incentive: It is difficult to recruit/retain providers who provide care to underserved communities. A number of states, through waivers & legislation, are turning to tax incentives as a way to incentivize care and drive training. Tax incentives can be provided based on practice setting, type of practice, years of service, or commitment to train (preceptor tax credit).
In January of 2018, CPCA compiled a comprehensive list of workforce legislation and is scheduled to discuss and prioritize joint advocacy efforts with the larger Coalition in spring. CPCA will also work to align these priorities with the overall efforts of the California Future Health Workforce Commission’s efforts, which are to be finalized by the end of 2018.
RESIDENCY REDESIGN: PROVIDING ADMINISTRATIVE ADVOCACY & TECHNICAL ASSISTANCE
CPCA, along with the California Academy of Family Physicians and the California Medical Association, conducted administrative advocacy at the February 2018 Song Brown Commission meeting to adjust award levels and funding structures for New and Expanding Primary Care Residency Programs. Our three organizations worked together to create a joint letter, which was then used during public comment at the February meeting. We successfully advocated for the following:
New Primary Care Residency Program Awards
- Item #1: Programs accredited after July 1, 2016 should continue to be able to apply for funding.
- Item #2: Programs should continue to receive up to $800,000 per award.
- Item #3: Programs should be able to apply multiple times until receiving the maximum amount.
- Item #4: Programs should continue to be allowed to apply if they are not accredited at the time of application.
Expansion Primary Care Residency Program Awards
- Item #1: An eligible program should demonstrate that it is meeting Song Brown’s goals and will use the award to help fund training for an additional resident, even if the slot was approved by ACGME several years ago.
- Item #2: If the existing primary care residency program does not receive official expansion approval from ACGME prior to subsequent Song‐Brown funding, it should be required to reapply.
- Item #3: The maximum funding amount for expansion slots should be adjusted to $300,000 per three‐year cycle to more closely reflect the true cost of PCR program expansion.
While CPCA advocated just as strongly for items #3 and #1 in new and expanding programs respectively, the Song Brown Commission implemented the following changes:
- New Primary Care Residency Program Awards - Item #3: A new program can only receive new program funding one time. A new program is a program that will receive accreditation after July 1, 2016, but has not enrolled its first cohort. Programs cannot apply for existing programs and new programs in the same application cycle.
- Expanding Primary Care Residency Programs - Item #1: The ACGME letter demonstrating approval for expansion must be dated after July 1, 2016. The letter must state how many slots the program is currently approved for, how many expansion slots the program is approved for, and the effective date of expansion.
In addition to continued Song Brown advocacy and partnership, CPCA plans to develop and provide technical assistance and training to support residency program development and implementation to interested health centers. The goals of this technical assistance program project are to develop a comprehensive curriculum and training program for community health centers wanting to implement or sustain residency training programs and partnerships; to increase the number of new CHC residency partnerships and accredited programs to expand primary care graduate medical education training in California; and to strengthen and sustain existing CHC residency partnerships and accredited programs to maximize ongoing efforts that train primary care residents in community-based settings and underserved areas.
To learn more about this developing technical assistance opportunity or to ask questions about the Song Brown application process, please contact Nataly Diaz.