Redesigning the Health System / Increasing Access to Primary Care Providers

Redesigning the Health System / Increasing Access to Primary Care Providers2020-09-19T15:08:22+00:00

In the next decade, California will need an additional 4,100 primary care providers to meet projected demand.1

Although insurance provides access to care, it does not ensure that everyone receives appropriate or high-quality care at the right time.2 An estimated 7 million Californians live in provider shortage areas, with shortfalls in access to primary, dental or mental healthcare providers.3 The shortage of health professionals impacts access to care, causing a significant delay in obtaining timely health services and resulting in barriers which negatively affect health outcomes. Access to comprehensive and quality healthcare services is important for physical, social, mental health, and overall quality of life.4 Access to care also promotes preventative measures, managing disease, and reducing unnecessary disability and premature death.4

This indicator tracks access to primary care providers based on the ratio of health professionals to population size. A primary care shortage area is defined as having a population greater than 2,000 per provider.

Indicator Highlights

Access to Health Services

California faces a statewide shortfall for primary care providers:

Mid-range forecasts indicate the state would need about 4,700 additional primary care clinicians in 2025 and about 4,100 additional primary care clinicians in 2030 to meet demand.1

In 2030, California is projected to have 78,000 to 103,000 primary care clinicians, with NPs and PAs composing nearly half of the total.1

Mental Health and Dental Providers

In addition to shortages of primary care physicians, California also faces shortages for mental health and dental providers:

Based on current utilization, patterns indicate that by 2028 California will have 41% fewer psychiatrists than needed. This shortfall increases to 50% when accounting for current utilization plus unmet need.5

To meet needs of the State’s aging population California will need 600,000 more home care workers by 2029.1

In California, there are 446 areas identified as dental care provider shortage areas.6

Innovative healthcare workforce development approaches identified by the California Future Health Workforce Commission include:

Creating more primary care and mental health residency slots

Increasing the use of nurse practitioners

Boosting scholarships for low-income students who agree to work in underserved area

Expanding the supply and training of home care workers7

Data Snapshot: Trends & Disparities

California’s healthcare workforce is not evenly distributed across the state.

Areas experiencing high levels of shortage are the San Joaquin Valley and the Inland Empire, as well as the rural northern and Sierra regions.1

There is notable variation in levels of shortage across counties. For examples in Colusa County, 64% of the population live in a primary care shortage area, in comparison to 7% of Kings county.

Latino, black and Native American populations make up the majority of residents of health professional shortage areas.3

For people who rely on the safety net, these challenges are even greater — with just over half as many doctors accepting Medi-Cal as those who accept private insurance.3

Percent of Population Without Sufficient Access to Care
(Less than 1 Provider per 2000 People), by County

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Population per Primary Care Physician FTE (Lower is Better), by Medical Service Study Area

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Indicator Name: Access to Primary Care

Indicator Description: Ratio of primary care physician full time equivalent (FTE) to the civilian population in each Medical Service Study Area (MSSA). State indicator is the percent of MSSAs with a provider ratio worse than 2,000:1.

Data Limitations: Provider ratios should not be compared across shortage designations. Each designation includes, excludes, and weights providers according to different methodologies. Access to primary care is defined by physician FTE and does not consider other primary care related disciplines.

Indicator Source: Office of Statewide Health Planning & Development

Indicator Calculation Methodology: Primary care physician counts from the 2018 National Provider Identifier file matched with FTE estimates from survey responses collected at the time of license renewal. Population estimates from the 2016 U.S. Census Bureau 5-Year estimate.

Data Collection Methodology: Providers with no survey data are assumed to be 1 FTE. When providers have mutiple practice locations, their FTE is split evenly amongst the locations.

Program URL Link: https://oshpd.ca.gov/workforce-capacity/california-primary-care-office/

Reporting Cycle: Annually

Reporting Lag: 1-year

1. Healthforce Center at the University of California, San Francisco. California’s Primary Care Workforce, 2017. https://healthforce.ucsf.edu/sites/healthforce.ucsf.edu/files/publication-pdf/UCSF%20PCP%20Workforce%20Study_Rpt%202%20-%20Final_081517.pdf

2.California Health and Human Services Open Data Portal https://data.chhs.ca.gov/dataset/health-professional-shortage-area-primary-care

3. California Future Health Workforce Commission, Meeting the Demand for Health: Fact Sheet on California’s Looming Workforce Crisis, 2019. https://futurehealthworkforce.org/2019/02/04/ca-looming-workforce-crisis/

4. Starfield, Barbara et al. “Contribution of primary care to health systems and health.” The Milbank quarterly 83,3 (2005): 457-502. doi:10.1111/j.1468-0009.2005.00409.x; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690145/

5. Healthforce Center at the University of California, San Francisco. California’s Current and Future Behavioral Health Workforce 2018. https://healthforce.ucsf.edu/sites/healthforce.ucsf.edu/files/publication-pdf/California%E2%80%99s%20Current%20and%20Future%20Behavioral%20Health%20Workforce.pdf

6.Kaiser Family Foundation; https://www.kff.org/other/state-indicator/dental-care-health-professional-shortage-areas-hpsas/?activeTab=map&currentTimeframe=0&selectedDistributions=total-dental-care-hpsa-designations&sortModel=%7B%22colId%22:%22Total%20Dental%20Care%20HPSA%20Designations%22,%22sort%22:%22asc%22%7D

7. California Future Health Workforce Commission, Meeting the Demand for Health, 2019. https://futurehealthworkforce.org/wp-content/uploads/2019/03/MeetingDemandForHealthFinalReportCFHWC.pdf

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