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5. Infrastructure Reform Objectives

5-A. Address Workforce Shortages

The U.S. currently faces a healthcare workforce shortage, which is projected to grow in the coming decades.  The shortage of physicians is projected to be as high as 124,000 full-time physicians by 2025.34  The nursing shortage is estimated to reach between 400,000 and 800,000 full-time equivalent nurses by 2020.35  The shortage of pharmacists is expected to rise from the current shortfall of 10,400 pharmacists to 38,000 by 2030.36  These shortages are more acute among primary care physicians and in rural areas.  

Public programs such as Medicaid and Medicare face an even greater challenge in ensuring beneficiaries have access to physicians and other healthcare providers.  Medicare payment rates are 80 percent of private insurance reimbursement rates,37 and Medicaid provider payment rates in 2008 were just 72 percent of Medicare rates.38  Low provider rates, combined with delays in receiving reimbursement, have discouraged physicians from choosing to participate in Medicaid.39   In addition, Medicare and Medicaid payment rates tend to reimburse specialists at higher rates than primary care providers, contributing to the primary care workforce shortage.  

Current Status of California

Like the nation, California faces a shortage of healthcare professionals today and in the foreseeable future.  California is estimated to need 43,000 additional registered nurses by 2010 – and another 74,000 by 2020 to meet the healthcare needs of the population.40  In 2008, California had just 55 primary care physicians per 100,000 people, less than the rate

34 Dill, Michael J. and Edward S. Salsberg, “The Complexities of Physicians Supply and Demand: Projections Through 2025,” Center for Workforce Studies at the American Association of Medical Colleges, November 2008.  Available at https://services.aamc.org/publications/index.cfm?fuseaction=Product.displayForm&prd_id=244.

35 Keenan, Patricia, “The Nursing Workforce Shortage: Causes, Consequences, Proposed Solutions,” The Commonwealth Fund, April 2003.

36 Health Resources and Services Administration, “The Adequacy of Pharmacist Supply: 2004 to 2030,” December 2008.  Available at http://bhpr.hrsa.gov/healthworkforce/pharmacy/.

37 Hackbarth, Glenn M., “Report to the Congress: Medicare Payment Policy,” Medicare Payment Advisory Commission, March 17, 2009.

38 Zuckerman, Stephen, Aimee F. Williams and Karen E. Stockley, “Trends in Medicaid Physicians Fees, 2003-2008,” Health Affairs, 28 no. 3 (2009) web 510.  See also: Colby D.C., “Medicaid Physician Fees, 1993,” Health Affairs 13, no. 2 (1994) 255-263; S.A. Norton, "Medicaid Fees and the Medicare Fee Schedule: An Update," Health Care Financing Review 17, no. 1 (1995): 167-181; and S. Norton and S. Zuckerman, "Trends in Medicaid Physician Fees, 1993-1998," Health Affairs 19, no. 4 (2000): 222-232.

39 Cunningham, P.J. and A.S. O'Malley, "Do Reimbursement Delays Discourage Medicaid Participation by Physicians?" Health Affairs 28, no. 1 (2009): w17-w28 (published online 18 November 2008; 10.1377/hlthaff.28.1.w17).

40 The Center for Health Professions, “Nurse Shortage Looms in California and Nationwide According to UCSF Study,” University of California San Francisco News Release, available at http://www.futurehealth.ucsf.edu/press_releases/rnshortage.html.

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