Influencers Opinion

The California health care system is in crisis. Here’s how we help fix it

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The health care system in California is in “crisis” in every important measurement: cost and affordability, the outrageous number of people who still are uninsured, and the quality of care, which is subpar at best. We also must add the state of the health workforce to this unfortunate list.

With a generation of baby boomers retiring – including a large percentage of the state’s health workers – millions of Californians will find it difficult to access quality, affordable care in large part to a healthcare workforce that is stretched thin due to a combination of worker shortages and an increased demand for services.

In 2017, a group of California’s leading health philanthropies collaborated to spearhead the formation of the California Health Workforce Commission to address this looming health care worker shortage. The commission – made up of 24 leaders in health care delivery and primary care, academia and research – developed a comprehensive report and action plan for meeting the health workforce needs of the state and addressing key workforce gaps by 2030.

The commission identified three core strategies with specific recommendations for each.


First, Californians must have enhanced opportunities to advance in the health professions. This can be done by expanding health career pipeline programs to prepare students from underrepresented and low-income backgrounds. If done correctly, California could have as many as 5,700 low-income, minority professionals join the healthcare workforce by 2030 at a relatively modest cost of $11,000 per student. If we recruit and support college students – with an emphasis on community college students from underrepresented populations – and provide them with academic, advising and health career development support, we can add at least 25,500 new healthcare workers by 2030.

Expanding a new Emerging California Health Leaders Scholarship Program has the potential to help more than 3,800 low-income students seeking to be physicians, nurses and public health professionals over the next 10 years. The beauty of this program is that these scholarship recipients are committed to serving in the very communities they graduate from, stemming the tide of talent drain from underserved regions like the Central Valley and other rural communities.

Second, health career education and training must be aligned. This can be done by sustaining and expanding the PRIME program across all University of California campuses. PRIME works with socially-conscious, primary care-oriented graduates to become licensed physicians serving underserved areas of the state, and currently has 354 students enrolled. The program must add an additional 40 students per year over 10 years to meet future demand. And in rural areas where health worker shortages are common, we need to provide medical scholarships to those who agree to work in their local community health centers. Such a partnership with 10 California medical schools would increase the number of medical students by as many as 480 annually. The number of primary care physician and psychiatric residency positions must be expanded by more than 1,800 and 2,200 slots, respectively, in the coming years. This strategy would help eliminate California’s projected shortage of primary care physicians and psychiatrists.


To meet California’s future behavioral health demands, a psychiatric nurse practitioner program that recruits from and trains providers to serve in underserved rural and urban communications is a must. This will help eliminate gaps in services by expanding those services to more than 350,000 patients over five years.

And last, a strong focus on prevention. Community health workers, also known as promotores, are our frontline health workers trained in culturally-relevant prevention strategies. They play a critical role by providing health education in community settings and navigating referrals to health and social services in underserved communities. The number of community health workers must be increased, and strengthening certification, training and reimbursement for their services requires policy attention in Sacramento.

And while some may balk at the $3 billion price tag to achieve this, the reality is it’s less than 1 percent of what California taxpayers will spend across the health care system in this year alone. So, considering that health workforce investments carry both a health improvement benefit and an economic, jobs-creation benefit, this falls in the category of very smart spending of the public dollar.

It’s time for us to implement the recommendations of this 24-member commission. It also will take a coalition of leaders in the health system, higher education and philanthropy working with the governor and our state Legislature to implement this crucial roadmap.

Our future health depends on it.

Robert K. Ross is the president and CEO of The California Endowment. He is also a Health Care Influencer for McClatchy’s California Influencers series.
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