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building the pipeline


Funding in State’s 2016-2017 Budget will save family medicine residency slots that would have been lost due to funding lapses and help address primary care physician shortage

On June 15, 2106, the California Academy of Family Physicians (CAFP), CaliforniaHealth+ Advocates, and the California Medical Association (CMA) and other statewide healthcare organizations cheered the historic support the Legislature and Governor have shown for their comprehensive budget proposal that will not only backfill the tens of millions of dollars in cuts facing primary care residency programs but also begin to address California’s primary care physician shortage in some of our most underserved areas.


“We cannot thank legislative leaders enough for the action they’ve taken today,” said CAFP President Lee Ralph, MD. “Their support of our proposal will ensure that California doesn’t fall off the primary care cliff. We’ve all worked hard to expand insurance coverage and we can now start building the primary care workforce needed to provide important, preventive and patient-centered care to the newly and currently insured.”


The $100 million appropriation in the 2016-17 State Budget will support and expand primary care residency training and programs in medically underserved areas through the Song-Brown Workforce Training Program and targeted investment in Teaching Health Centers. The Legislature’s budget proposal, which was approved and sent to the Governor today, will be appropriated over six years to create a reliable and continuous funding stream that primary care residency programs in California so desperately need.


Without this appropriation, California primary care training programs would face nearly $60 million in cuts as significant federal and private foundation grants have recently expired or are set to expire this year, including $18 million in federal Health Resources and Services Administration funding for the Primary Care Residency Expansion program, a $21 million California Endowment grant to the Song-Brown Program, and a one-time $4 million California Health Data and Planning Fund appropriation to Song-Brown. In addition, the federal Teaching Health Center program, which has already distributed more than $15 million to California primary care training programs, has cut grants by 40 percent and is set to expire in 2017.


Even if these cuts were replaced dollar for dollar, California would struggle to provide sufficient access to primary care. Only 36 percent of California’s active patient care physicians practice primary care and, according to the Council on Graduate Medical Education (COGME), 23 of California’s 58 counties fall below the minimum required primary care physician-to-population ratio. That is why this new appropriation is so timely.


“The primary care workforce shortage has reached epic proportions in many areas of the state and a significant investment is necessary to ensure we don’t fall further behind, negatively impacting our ability to provide needed care to millions of Californians,” said Carmela Castellano-Garcia, President and CEO of CaliforniaHealth+ Advocates. “We applaud the Legislature for their commitment to our state’s primary care workforce with the inclusion of this ongoing investment. This will not completely address our state’s healthcare workforce shortage, but it is a significant step in the right direction.” To receive Song-Brown Workforce Training program grants, residencies must demonstrate their commitment to recruiting diverse, culturally competent physicians and underrepresented minorities to their programs, providing care to a high uninsured, underinsured or Medi-Cal population, and placing graduates in areas of unmet need.


“In 2013, the last year for which we have data, 73 percent of physician graduates of Song-Brown-funded programs went on to practice in areas of unmet need,” Dr. Ralph said. “With this critical investment in Song-Brown, California will realize an immediate return on investment as each primary care resident will provide an average of 600 additional patient visits per physician per year during training alone. Our long-term workforce also will grow significantly as the vast majority of physicians who train in a region stay there to practice. California leads all fifty states in the percentage of residency program graduates who stay in the state in which they trained. Nearly 70 percent of medical residents who train in California residency programs stay in California.”


“A robust, well-trained primary care workforce is essential to meeting the health care demands of all Californians,” said CMA President Steven Larson, MD, MPH. “The Legislature’s move to restore and stabilize funding for these programs is an important first step toward reversing the state’s shortage of primary care physicians, particularly in the underserved communities that need it the most.”


CAFP, CaliforniaHealth+ Advocates and CMA look forward to working with the Legislature and Governor Brown’s administration to implement this critically important workforce investment.