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Lawmaker seeks to expand medical provider services

Posted: June 23, 2013 7:00 a.m.
Updated: June 23, 2013 7:00 a.m.
 

SACRAMENTO (AP) — California is projected to face a shortage of as many as 17,000 doctors within two years, a problem that is especially acute in rural areas and minority communities.

One Democratic lawmaker has proposed a package of bills intended to fill that provider gap by expanding the health services that can be provided by nurse practitioners, optometrists and pharmacists. Sen. Ed Hernandez of West Covina says his bills would help California's doctor shortage as millions of new patients become eligible for health insurance under the federal Affordable Care Act.

His bills, SB491, SB492 and SB493, are currently moving through the Assembly.

"The system right now is strained, and in 2014 we're expected to add 4.5 million to 5 million new Californians that will have access to insurance," Hernandez said in an interview. "This is one part; this is not going to solve the problem."

Opponents, including the California Medical Association, say the state should instead focus on building more medical schools, adding residency slots and expanding programs that help doctors pay off student loans in exchange for working in underserved communities.

California has roughly 30,000 primary care physicians for a state with more than 37 million residents. That ranks the state 26th in the ratio of primary doctors to residents, according to the Association of American Medical Colleges.

The problem is not so much the overall number of doctors but how they are distributed throughout the state, said Marian Mulkey, director of health reform and public programs at the nonprofit California HealthCare Foundation, based in Oakland.

While the state's more affluent areas have an adequate number of doctors and other health providers, other regions need more.

"Overall, in the aggregate, California doesn't have as much of a worry about physician shortage as some states, but we have big distribution issues, particularly in rural areas," she said.

That's not just a shortage of primary care physicians but also specialists. Mulkey said a lack of diversity among doctors and California's history of low Medicaid reimbursement rates further exacerbate the shortage in underserved regions.

According to medical association, California's population is growing at the same time many doctors are nearing retirement age. The doctors group projects the state faces a shortage of as many as 17,000 physicians by 2015, with the Inland Empire and Central Valley among the most medically underserved. Its report from 2011 did not break down the shortage by medical specialty.

Hernandez, an optometrist by training, said his bills should be part of a broader solution that includes encouraging math and science education, increasing medical school capacity, using technology to reach more patients outside the traditional doctor's office visit and improving coordinated care.

A coalition of doctors, hospitals and other health providers have been pressing Gov. Jerry Brown and state lawmakers to rescind a 10 percent Medicaid provider rate cut that they say will ultimately harm low-income people by reducing access to medical care.

One of Hernandez's bills granting greater independence to nurse practitioners has gained the most opposition. It would give them greater flexibility to treat Medicaid patients even if the doctors they work for do not. Medicaid is known as Medi-Cal in California.

"By being independent, then you can now take Medi-Cal," he said. "And you have an ability to go to those communities or those areas."

Another of his bills would allow optometrists to check for high blood pressure, cholesterol and even administer specific immunizations, while the third would let pharmacists order laboratory tests, such as checking for diabetes.

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