BILL ANALYSIS
AB 2375
Page 1
Date of Hearing: April 17, 2008
ASSEMBLY COMMITTEE ON LABOR AND EMPLOYMENT
Sandre Swanson, Chair
AB 2375 (Hernandez) - As Amended: April 10, 2008
SUBJECT : Health care workforce; master plan.
SUMMARY : Requires the Office of Statewide Health Planning and
Development (OSHPD), in collaboration with the California
Workforce Investment Board (Board), to establish a task force to
assist OSHPD in developing a health care workforce master plan
for the state. In addition, requires the Legislative Analyst's
Office (LAO) to prepare a report on health workforce data and
data collection capacity. Specifically, this bill :
1)Makes legislative findings and declarations, as specified.
2)Requires OSHPD, in collaboration with the Board, to establish
a task force to assist in the development of a health
professions workforce master plan for the state and directs
OSHPD and the Board to select task force members, as
specified.
3)Establishes the objectives and duties of the task force and
requires the task force to meet no later than October 31,
2009.
4)Requires the task force to submit a completed report to the
OSHPD with recommendations for a statewide health professions
workforce master plan not later than October 31, 2012 and for
the OSHPD to implement the master plan no later than October
31, 2014.
5)Requires the LAO to work with the Employment Development
Department (EDD), state licensing boards, the Department of
Consumer Affairs, state higher education entities, and OSHPD
to assess and report to the task force by October 31, 2009 on
the state's health workforce data collection capacity.
EXISTING LAW:
1)Establishes the Healthcare Workforce Policy Commission, which
identifies unmet needs for specified health care professionals
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and establishes standards for training programs for family
practice physicians, registered nurses, physician assistants
(PAs), and nurse practitioners, including requirements for
training professionals to work in underserved communities.
2)Establishes by Executive Order the Board in response to the
mandate of the federal Workforce Investment Act (WIA) of 1998,
to assist the Governor in setting workforce development
policy.
3)Creates the California Health Professions Education Foundation
(Foundation), a nonprofit public benefit corporation
established by OSHPD, for the purposes of raising public and
private donations, assisting in the implementation of various
health professions scholarship and loan programs, and making
recommendations as to the expenditure of funds in the Health
Professions Education Fund.
4)Establishes OSHPD to administer several programs as part of
its health manpower objectives, including the federal National
Health Service Corps Scholarship Program, the federal National
Health Services Corps Loan Repayment Program, and the
California Medical and Dental Student Loan Repayment Program
of 2002.
5)Establishes, within the Healthcare Workforce and Community
Development Division of OSHPD (Workforce Division), the
Song-Brown Health Care Workforce Training Act that provides
grants to health professional training institutions for the
training and education of health professionals, for practice
in medically underserved, low income, and rural communities.
6)Establishes, within the Workforce Division of OSHPD, the
National Health Services Corps/ State Loan Repayment Program
(SLRP). The SLRP assists with the repayment of educational
loans for select primary healthcare providers who make a
commitment to practice in Health Professional Shortage Areas
(HPSAs), as determined by OSHPD, for a minimum of two years.
7)Establishes the Steven M. Thompson Physician Corps Loan
Repayment Program in the California Physician Corps Program
within the Foundation whereby physicians may receive up to
$105,000 in exchange for their service in a designated
underserved area for a minimum of three years.
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FISCAL EFFECT : Unknown
COMMENTS : According to the author, this bill is needed because
there is currently no statewide strategic plan on the health
care workforce. The author states that demographic shifts are
causing widening gaps between health care workforce supply and
demand, as seen in shortages of primary care providers and other
health professionals. California's population is aging,
growing, and increasing in diversity, and California's workforce
of health professionals is ill-equipped to respond
to new pressures on the health care system. Additionally, the
author is concerned that state and private entities are working
in silos, leading to reduplication of efforts and inefficiency.
BACKGROUND
California is facing a dramatic and pressing challenge related
to the supply and distribution of health care professionals in
many disciplines. The UC Office of the President's Final Report
of the Advisory Council on Future Growth in the Health
Professions (UC Report) notes California has more
residents age 65 and older than any other state, and more than
one in four California residents is born outside the U.S.,
compared to the national average of one in ten.
According to the report, by 2015, nearly 37% of California's
population will be of Hispanic or Latino origin, nearly 14% will
be of Asian or Pacific Islander heritage and 6% will be
African-American. The report indicates that there are shortages
in nearly all the health professions, including the
approximately 200 allied health occupations. The UC report
projects that California will face a shortfall of
approximately 47,600 nurses by 2010, and shortfalls of 116,000
nurses and nearly 17,000 doctors by 2015. Further, California
ranks 49th in the nation in the number of nurses per capita, and
43rd in the number of pharmacists per capita.
In addition to the provider shortage, health care professionals
are not proportionately representative of the populations they
serve. According to the Sullivan Commission Report,
Missing Persons: Minorities in the Health Professions, there is
a diversity gap between health professionals and their patients.
The report states that African-Americans, Hispanic-Americans,
and American Indians make up more than 25% of the
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U.S. population but only 9% of the nation's nurses, 6% of its
physicians, and 5% of dentists. Similar disparities exist in
faculties of health profession schools. The report links poorer
health outcomes for minorities to the shortage of
minority health care providers as highlighted in other
significant studies.
California has limited capacity to educate and train health care
providers. The UC report indicates that California has a long
standing reliance on in-migration of physicians and other
health professionals trained in other states and
countries. According to the California Medical Association
(CMA), there are ten schools in California that offer medical
education, including five in the UC system. These
ten schools admit an average of about 1,340 first-year students
each year. Competition is fierce, and less than 5% of
applicants are enrolled. CMA also states that California ranks
39th in the nation in the number of medical students per capita.
The national average is 27 medical school students per 100,000
people yet California has about 16 students per 100,000. UC
indicates that 60% of qualified nursing students were turned
away because of a lack of educational slots due in great
part to lack of faculty.
In May 2007, the Assembly Health Committee held an informational
hearing entitled, Developing the California Health
Care Workforce of Tomorrow: Addressing Shortages and Diversity.
At this hearing, many speakers spoke of the need for new
programs to increase the diversity of California's health care
workforce. A speaker representing TCWF pointed out that
increasing diversity in the health professions is not only an
avenue for improving quality of care and access to
care, but also an important workforce development strategy.
TCWF noted that jobs in the healthcare sector, particularly
among the allied health professions, are now among
the fastest growing in the economy, and data indicate that in
the next 15 years the health care and social services sector in
California will grow by more than 50%, requiring tens of
thousands of nurses and other allied health professionals to
meet demand for healthcare.
ARGUMENTS IN SUPPORT
The sponsor of this bill, the Latino Coalition for a Healthy
California and numerous other supporters, including the
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California Hospital Association, the Association of California
Healthcare Districts, and the Greenlining Institute state that
to date, California's efforts to develop its health workforce
have been piece-meal, focusing on loan repayment programs and
funding for specific professions, with little or no evaluation
and strategy. Supporters contend that California is missing an
overarching vision, action plan, and infrastructure to
coordinate efforts in order to maximize efficiency and impact.
Supporters highlight the fact that the Healthcare
Workforce Diversity Advisory Council identified the need for a
master plan on the health professions.
The American Federation of State, County, and Municipal
Employees states that this bill will help identify critical
health and staffing issues so policymakers can address them.
The California Academy of Family Physicians (CAFP)
states that California has only 46 primary care physicians per
100,000 Medi-Cal beneficiaries, whereas 60-80 are recommended,
and more than 7 million Californians live in federal HPSAs with
primary care physician shortages. CAFP notes that these
Californians suffer high rates of preventable diseases as a
result of poor access to care.
The California State Association of Counties notes that medical
personnel shortages threaten hospitals' ability to meet
mandatory staffing ratios and contribute to long emergency room
waits, and limit access to care in rural counties. Some
supporters, such as the Service Employees International Union
(SEIU) and the Latino Issues Forum, note that health care has
not kept up with the diversity of California. SEIU also states
that the shift in technology in health care has increased demand
for a broad range of professional and technical workers, leading
to chronic staffing shortages and threatening the ability to
deliver safe, timely, and appropriate care.
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County, and Municipal Employees
Association of California Healthcare Districts
California Academy of Family Physicians
California Center for Public Health Advocacy
California Dental Association
California Hospital Association
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California Optometric Association
California State Association of Counties
California State Rural Health Association
California WIC Association
City of Hope
Congress of California Seniors
Gray Panthers
Greenlining Institute
Having Our Say
Latino Coalition for a Healthy California (sponsor)
Latino Issues Forum
Northeast Valley Health Corporation
Northern Sierra Rural Health Network
San Francisco Community Clinic Consortium
Service Employees International Union
Opposition
None on file
Analysis Prepared by : Lorie Erickson / L. & E. / (916)
319-2091