May 18, 1999 - In many inner-city and rural communities, an inadequate supply of primary care physicians compounds the difficulties millions of Californians face in obtaining needed care. A new report from the California Policy Research Center (CPRC) in Berkeley, which is a UC system-wide center, offers suggestions on how to attract doctors to California's chronically underserved communities.

At least 4 million Californians live in federally designated "Health Professional Shortage Areas," areas within the state that have fewer than one primary care physician for every 3,500 persons. Rural and inner-city communities with high proportions of African Americans and Latinos tend to have the lowest supplies of physicians. People who lack convenient access to primary care providers often do not receive adequate preventive and primary care which can compromise their health, the researchers reported.

"Physician shortages continue to plague many communities in California, especially rural areas and inner cities with large minority populations," said Kevin Grumbach, MD, associate professor of family and community medicine at the University of California San Francisco and director of the UCSF Center for California Health Workforce Studies (CCHWS), which conducted the study for CPRC. "This problem can be solved, but it will require more concerted efforts by state policymakers. There is good evidence that a comprehensive state strategy can alleviate these shortages."

The report, titled "Strategies for Increasing Physician Supply in Medically Underserved Communities in California," offers recommendations that the California legislature and state agencies can take to increase the number of physicians in medically underserved areas. Most of the recommendations involve a greater commitment of resources to successful programs currently in place or a refinement of current program objectives.

"California already has a number of successful programs that encourage doctors to practice in underserved communities, but these programs need more resources" said Janet Coffman, MPP, manager of the UCSF Center for California Health Workforce Studies and co-author of the report. "Better coordination among programs is also needed."

Primary care physicians tend to shy away from inner-city and rural practices for a variety of reasons. High rates of violence, poor quality medical facilities, and inadequate reimbursement pose significant obstacles to retaining physicians in inner-city practices while professional isolation and lack of urban amenities tend to drive rural doctors away, the researchers reported.

The report identifies three areas of intervention that have been proven to improve physician supply in underserved areas of California and other states. These include making practicing in shortage areas more attractive, providing educational opportunities in rural and inner-city areas during medical school and residency, and encouraging minorities from disadvantaged backgrounds to develop career interests in health care.

Financial incentives, such as scholarships and loan repayments, and other interventions can make practicing in underserved areas more attractive relative to other opportunities. However, efforts to improve the practice environment must be complemented by longer term strategies, said Grumbach. Medical students and residents need educational experiences in underserved areas and medical school classes need to include more students interested in serving rural and inner-city areas, said Grumbach.

Specific recommendations for state government and higher education made by the authors include:

• Match federal funding to expand the National Health Service Corps State Loan Repayment Program;
• Fund the Rural/Underserved Provider Opportunity Program's temporary placement network in rural California;
• Provide additional appropriations for the Song-Brown Family Physician Program to fund recruitment of graduating medical students from disadvantaged groups;
• Convene a task force to develop a statewide plan for rural medical education;
• Establish a comprehensive health professions enrichment program modeled on the federal Health Careers Opportunity Program at every campus in the UC, CSU, and community college systems; and
• Develop medical school admissions policies that are sufficiently flexible and individualized to consider the variety of characteristics and life experiences, such as rural upbringing or being of minority race/ethnicity, that may predict an applicant's success in medicine and service to underserved populations.

In addition to Grumbach and Coffman, authors of the report include Ruth Liu, a former UCSF graduate student intern at CCHWS, and Beth Mertz, MPA, a UCSF research associate at CCHWS.

The California Policy Research Center (CPRC) applies the extensive research expertise of the UC system to the analysis, development, and implementation of state policy. Funding for the report was provided by CPRC's California Program on Access to Care and the US Bureau of Health Professions.

A free copy of the summary and information about obtaining the complete report are available on CPRC's website (http://www.ucop.edu/cprc/MDsupply.html) or by calling CPRC at (510) 643-9328.