Health care workforce crisis: Need more diversity, access to care

California has a healthcare workforce crisis.

Over the next decade, this state’s 39 million residents face a health worker shortfall of 4,100 primary care physicians and 600,000 home care workers, and we will have only two-thirds of the psychiatrists and mental health providers needed. This is happening as our population is growing, aging and becoming more diverse, which only exacerbate the situation.

And the problem isn’t only limited to under-resourced rural or urban communities of color, though health disparities are certainly more evident and acute in those areas.

California is already a majority-people of color state; by 2030, communities of color will make up over 65% of our population.

The California Future Health Workforce Commission, on which I serve, was created to analyze the state’s healthcare workforce needs and develop a blueprint to address it.

After a year of study, our report was released in February. (Disclosure:  The Commission recommends apportioning $1 million to develop a four-year medical education program at the institution I lead, Charles R. Drew University of Medicine and Science.) It identifies three strategies and 27 priorities.

But two themes emerge as the keys to California’s healthcare workforce of the future:  the need for a workforce that reflects the diversity of our population, and increased access to primary care.

California is already a majority-people of color state; by 2030, communities of color will make up over 65% of our population. However, the state’s healthcare workforce does not reflect those changing demographics. For instance, only 7% of California’s physicians are Latino; only 3% are African-American.

Yet under-served, low-income communities of color — in both rural and urban areas — have the greatest healthcare needs. Seven million Californians — 18% of our population, and the majority of them African-American, Latino and Native American — live in federally designated Health Profession Shortage Areas, which means they lack adequate numbers of primary care, dental care and/or mental health providers.

Our state has only 50 primary care physicians per 100,000 people; we should have 60-80.

They are also disproportionately affected by many chronic ailments, such as diabetes, kidney disease and hypertension, as well as the social determinants of health (the “non-medical” factors that contribute to illness, such as poverty, lack of healthy food options, lack of transportation, crime, etc.).

Having a workforce that reflects the diversity of these communities is more than just a culture match. Studies show that patients prefer healthcare providers who look and sound like them. Studies also show that patients are more likely to feel a sense of inclusion, feel more satisfied and, most important, follow medical instructions if they receive them from a physician or other provider who shares their race, language, ethnicity, sexual orientation or religious views.

Put simply, this type of encounter is more likely to produce a healthier patient.

We also need to get serious about increasing access to primary care, because currently, our state has only 50 primary care physicians per 100,000 people; we should have 60-80. So, we have a shortage even before we factor in a growing population (an additional six million by 2030) and an aging healthcare workforce (more than one-third of physicians and nurses are 55 or older).

For all the technological advances and miracles of modern medical science, ready access to high-quality primary care is still critical to personal health.

We certainly need more primary care physicians in California, but we also need to optimize the role of the entire primary care team, which includes not only primary care physicians but also nurse practitioners, physician assistants, RNs and medical assistants. This team can work proactively, focusing on prevention and wellness and providing regular check-ups. They can diagnose and treat conditions before they become chronic and/or more serious.

A primary care team comes to know you as a person. They learn your medical history and preferences; often even your fears and concerns (more than half of all mental health treatment is rendered by a primary care physician).  They function as healthcare advocate and point of entrée to the rest of the healthcare system: specialty and sub-specialty care, hospitalization, etc.

Having a regular source of primary care has been proven to produce not only better health for the individual but also lower costs for patients and for the entire health care system.

We need deliberate policies and practices to ensure that California’s residents receive the right care at the right time in the right setting. This means ready access to primary care and a culturally appropriate provider—for everyone. The California Future Health Workforce Commission report is a blueprint to achieve that.

Read the Commission’s full report and recommendations at https://futurehealthworkforce.org/.
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Editor’s Note: David M. Carlisle, MD, PhD, is the President and CEO of Charles R. Drew University of Medicine and Science in Los Angeles.  He is a member of the California Future Health Workforce Commission and a former director of California’s Office of Statewide Health Planning and Development (OSHPD).