The legislation creating the Affordable Care Act (ACA) was crafted to address multiple aspects of healthcare access and delivery.
On the issue of access to care, a concern over the shortage of physicians, especially here in California, has been part of the conversation for some time. A 2017 study by UCSF Healthforce Center found that California does not have enough primary care physicians in most regions of the state and the situation will only grow more acute from an aging physician workforce, a growing population, and expanded coverage through the ACA. The UCSF study estimates that California will need an additional 8,243 primary care physicians by 2030 — a 32 percent increase. One avenue for relief could come from increasing residency slots in the state.
The California Medical Association (CMA) has been very active in helping to secure greater state and federal funding for primary care graduate medical education. From its vantage point, CMA sees hundreds of graduating medical students not able to find residency slots in California to continue their training, forcing these young and talented doctors to move away. Policymakers say this is important because there is evidence showing new doctors are likely to continue their practice in communities where they complete their residency.
The Teaching Health Center Graduate Medical Education (THCGME) program was established under the ACA to help alleviate primary care physician shortages in underserved areas. The program currently supports 742 physician residents at 59 teaching health centers, eight of which are in California. A very important step to secure funding occurred in early December as the U.S. House of Representatives, with the leadership of California Congressman Jeff Denham (R-Modesto), passed HR 3922, the Community Health and Medical Professionals Improve Our Nation (CHAMPION) Act of 2017. The passage of HR 3922 reauthorizes the THCGME for another two years. During intense negotiations prior to the bill’s passage, CMA successfully advocated to double the funding from $60 million to $126 million for this program. In a letter to the California Congressional Delegation expressing support for passage of HR 3922, Dr. Ted Mazer, president of the California Medical Association, emphasized: “Data show that when compared to traditional postgraduate physician trainees, residents who train at teaching health centers are more likely to practice primary care (82 percent vs. 23 percent) and remain in underserved communities (55 percent vs. 26 percent).”