The Staggering Crisis: Confronting the Health Care Workforce Shortage in California

Posted: March 28, 2016

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Carmela Castellano-Garcia, President and CEO of the California Primary Care Association

By Carmela Castellano-Garcia
President and CEO of the California Primary Care Association

Community clinics and health centers (CCHCs) will be the backbone of primary care in California well into the future. The Affordable Care Act has provided coverage options for millions of Californians and many of the newly-insured are choosing health centers as their health homes. According to a recent study by the California Health Care Foundation, safety-net clinics are providing care to 54 percent, or 1.3 million, of new Medi-Cal patients who are enrolled in managed care plans. This is great news and something we all knew would happen, but it has also shined a bright light on the primary care workforce shortage.

The United States is facing an unprecedented healthcare workforce crisis that touches every aspect of care in CCHCs. Postings for physicians, mental health professionals, nurses, health information technology staff, and more go unfilled for months and years on end.

The Crisis On the Horizon

California currently ranks 32nd in physician access and our ratio of primary care physicians in Medicaid is half the federal recommendation. According to the California Primary Care Association’s (CPCA) recently released report, Horizon 2030: Meeting California’s Workforce Needs, we will need 8,243 additional primary care physicians in California, or an additional 32 percent of our current workforce, by 2030.

The crisis is staggering.

This is not a new issue to those of us in health care and one we have been addressing for many years, but it has now reached a crisis point. We can no longer rely incremental progress or on others to fix the problems we are facing. As Gandhi said, “we must become the change we want to see.” To that end, we have already started taking our workforce efforts to another level. The Horizon 2030 report provides a roadmap with specific recommendations that will guide our work moving forward. Findings and recommendations in Horizon 2030 focus on five components of the model:

  • Career Awareness and Education
  • Residencies and Graduate Medical Education Funding
  • Primary Care Transformation and Financing Innovations
  • Recruitment and Retention
  • State and Regional Strategies and Infrastructure

Taking Action to Address the Crisis

California’s CCHCs have already started to employ a variety of strategies to address these components and associated recommendations, including the introduction of four pieces of legislation, which we will sponsor this coming year. Each of these bills tackles a different aspect of the workforce crisis including provider type diversification (AB 1863 and SB 1335), graduate medical education in health centers (AB 2216), and provider recruitment incentives (AB 2048).

  • AB 1863 by Assembly member Jim Wood (D-Healdsburg) expands access to culturally appropriate behavioral health services in vulnerable communities by allowing Marriage and Family Therapists (MFT) the ability to provide care, and receive reimbursement, in community health centers and rural health centers. CPCA is co-sponsoring this legislation with the California Association of Marriage and Family Therapists.
  • AB 2048 by Assembly member Adam Gray (D-Merced) will support community health centers ability to recruit and retain providers by strengthening the State Loan Repayment Programs, a loan repayment program that, parallel to the National Health Service Corp, requires service to underserved communities.
  • AB 2216 by Assembly member Rob Bonta (D-Alameda) will support community health centers ability to educate and train providers in California, specifically as it relates to graduate medical education in communities with the greatest need.
  • SB 1335 by Senator Holly Mitchell (D-Los Angeles) will improve Californians’ access to substance use disorder treatment by eliminating a barrier that prevents community health centers from participating in the Drug Medi-Cal and specialty mental health programs. Specifically, it would allow Federally Qualified Health Centers to contract with their counties for these services and be reimbursed on par with other health care providers. CPCA is co-sponsoring this bill with the Community Clinic Association of Los Angeles County (CCALAC).

California’s CCHCs have made these issues a top priority and ask that you join them in efforts to create solutions.  It’s not going to be easy, and it won’t happen overnight, but working together we can make a positive impact on our workforce shortage and the impact that shortage is having on patient access to care.

Carmela Castellano-Garcia is President and CEO of the California Primary Care Association, representing the state’s more than 1,100 community health centers who provide care to 1 in 7 Californians. To find out more about CPCA, please visit To learn more about Carmela and read additional blogs, please visit

5 thoughts on “The Staggering Crisis: Confronting the Health Care Workforce Shortage in California”

  1. There are a number of PA and NP programs in LA county receiving funds from the California Office of Statewide Health Planning and Development, specifically to train non Physician providers to serve with Physicians in medically underserved areas in Primary Care. While this does not address the 8,243 Physicians mentioned, there is an argument to be made to better utilize all possible providers to provide care. CCALAC member programs may want to reach out to the training programs in an effort to recruit those future primary care providers as well.

    1. CPCA absolutely agrees that utilizing NPs and PAs is key to successful team based care and to helping alleviate the primary care workforce shortage. Many CHCs have been utilizing these providers for decades. We agree that more training programs need to be available for growing this pool of providers.

  2. Another under recruited group of primary care providers and workforce pool may be our military veterans. These men and women have excellent training and experience and, most importantly, a “spirit of service”. As a veteran myself, I was lucky enough to obtain a position in a community clinic soon after my discharge. I found it just as rewarding as my service and I was able to apply all of the skills I gained in the Navy, in my civilian role as a nurse. More should definitely be done by the community and primary healthcare organizations to reach out to this group of talented individuals.

  3. In California, new nurses, specifically licensed vocation nurses are in demand to work in home health care with developmentally disabled children, teens and adults. You must have a clean record. You can apply as an independently vendored LVN through one of California’s 21 Regional Centers. They pay 29 dollars an hour. You have to have your own liability insurance to work. Go through orientation. Have a heart for disabled. Not be a freak, weirdo or pervert. Or abuser. Pretty basic requirement for nursing anywhere, but just a friendly reminder for those who think they may slip into the fold and prey on more vulnerable patients. You will be caught. If you can handle this population and are a safe, truthworthy, caring, mentally tough, decent LVN/human being, go here to contact the regional center in your area.

    There is a chronic nursing respite crisis in California for regional center consumers. The home health agencies are failing to provide consistent services to consumers. They can’t keep nurses because they pay so little. The home health agencies take the 29 bucks and then pay the LVN about 16 to 18 an hour. It leads to high turnover and often, the bottom of the barrel nurses. It is time for all the California Regional Centers to invest time and energy into providing adequate and sufficient nursing services by allowing more independently vendored LVNs to join their team. These LVNs can get the 29 bucks an hour the regional centers are wasting on home health agencies that can’t produce respite nursing services on a consistent basis. Regional Centers should also require all LVN independent nurses to go through criminal background checks. Don’t rely on a clear nursing license if it’s a nurse who has been around for a long time. They can commit crimes long after they got their license. And it won’t show up on the California Nursing board check. And ask them if they’ve ever had a crime against a vulnerable adult “expunged” in California. If they did, you won’t see the crime.

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