AB 2458: Increasing Primary Care Practitioners Summary: Assembly Bill 2458 establishes the Graduate Medical Education Fund to finance additional positions at residency programs in California hospitals and health centers. In addition, the bill allocates an additional $25 million dollars to residency programs from the State s General Fund, plus $2.84 million dollars annually for three years from the California Health Data and Planning Fund. Background: Primary care physicians are the backbone of our health care system, ensuring that our families get the care they need to be healthy and successful. Communities with more family physicians have been shown to have better health outcomes, including fewer deaths from cancer, heart disease, and stroke. Unfortunately, California has a shortage of primary care physicians - and many of our current practitioners are close to retirement. The majority of California counties have less than the recommended number of primary care practitioners. To meet our need, we will need to educate an estimated 515 new family practitioners every year. One large challenge is providing residency slots in California. Last year, 100% of California residency slots in Family Medicine were filled. Having ample residency positions is especially important because after residency is concluded, doctors tend to settle in the areas where they complete their training. Nearly 70% of residents who train in California remain here to practice after graduation. Unfortunately, we are training doctors at California universities, however due to lack of residency slots, they are forced to leave California to complete their medical residency - and that is where they stay. The average cost of a residency program slot is estimated at $100,000. The Governor s 2014-15 proposed budget includes an allocation of $2.84 million dollars for a term of three years to expand the Song- Brown Primary Care Residency Program. This is a repayment from funds borrowed from the California Health Data and Planning Fund. AB 2458 builds on this proposed investment by calling for an additional infusion of money from our state s general fund. AB 2458 takes a big step to address our lack of primary care practitioners by increasing our ability to train California physicians in this field. Without primary care residency slots, we cannot hope to train more primary care physicians and meet the needs of our state. This Bill: Specifically, this bill: Establishes the Graduate Medical Education Fund (GMEF) Directs the Office of Statewide Health Planning and Development to develop criteria for the distribution of monies in the fund Specifies that monies from the fund will be used for new graduate medical education residency positions Appropriates $2.84 million dollars annually for a period of three years starting in the 2014-15 fiscal year from the California Health Data and Planning Fund to the GMEF Appropriates $25 million dollars from the General Fund into the GMEF Defines primary care physician as a family practitioner, pediatrician, obstetriciangynecologist, internist, or a physician who has restricted her practice to general practice Support: California Academy of Family Physicians (co-sponsor) California Medical Association (co-sponsor) Contacts: Sonja Palladino, Office of Assemblywoman Susan A. Bonilla, 916-319-2014, sonja.palladino@asm.ca.gov
American Congress of Obstetricians and Gynecologists, District IX American Federation of State, County and Municipal Employees, AFL-CIO (AFSCME) American Osteopathic Association Association of California Healthcare Districts California American College of Emergency Physicians (ACEP) California Children s Hospital Association California Hospital Association California Primary Care Association Osteopathic Physicians & Surgeons of California
AMENDED IN ASSEMBLY APRIL 10, 2014 california legislature 2013 14 regular session ASSEMBLY BILL No. 2458 Introduced by Assembly Member Bonilla February 21, 2014 An act to add Article 4 (commencing with Section 128310) to Chapter 4 of Part 3 of Division 107 of the Health and Safety Code, relating to medical care, and making an appropriation therefor. legislative counsel s digest AB 2458, as amended, Bonilla. Medical residency training program grants. Existing law, the Song-Brown Health Care Workforce Training Act, provides for specified training programs for certain health care workers, including family physicians, registered nurses, nurse practitioners, and physician s assistants. This bill would establish the Graduate Medical Education Fund, to be used to administer and fund grants to graduate medical education residency programs located in California hospitals or teaching health centers, as specified. The bill would appropriate an unspecified amount of money twenty-five million dollars ($25,000,000) from the General Fund in the 2014 15 fiscal year for this purpose and $2,840,000 per year for 3 years, commencing with the 2014 15 fiscal year, from the California Health Data and Planning Fund for this purpose. Vote: 2 3. Appropriation: yes. Fiscal committee: yes. State-mandated local program: no. 98
AB 2458 2 The people of the State of California do enact as follows: line 1 SECTION 1. Article 4 (commencing with Section 128310) is line 2 added to Chapter 4 of Part 3 of Division 107 of the Health and line 3 Safety Code, to read: line 4 line 5 Article 4. Medical Residency Training Program Grants line 6 line 7 128310. (a) The Graduate Medical Education Fund is hereby line 8 established in the State Treasury. line 9 (b) Moneys in the fund shall, upon appropriation by the line 10 Legislature, be used solely for the purpose of administering and line 11 funding grants to graduate medical education residency programs line 12 located in California hospitals or teaching health centers. line 13 (c) (1) Notwithstanding Section 16305.7 of the Government line 14 Code, all interest earned on the moneys that have been deposited line 15 into the fund shall be retained in the fund and used for purposes line 16 consistent with the fund. line 17 (2) One-time, ongoing, or administrative costs incurred or line 18 generated by the implementation of this article, including those line 19 that might be incurred by the Office of Statewide Health Planning line 20 and Development (OSHPD), shall come directly from the Graduate line 21 Medical Education Fund. line 22 (d) The fund shall consist of both of the following: line 23 (1) All assessments, transfers, and appropriations received line 24 pursuant to Section 128311. line 25 (2) Interest that accrues on amounts in the fund. line 26 (e) OSHPD, in consultation with the California Healthcare line 27 Workforce Policy Commission, shall develop criteria for line 28 distribution of available moneys in the fund. line 29 (f) Moneys appropriated from the fund shall be used to fund line 30 new graduate medical education residency positions. line 31 (g) Whenever applicable, OSHPD shall utilize moneys line 32 appropriated from the fund to provide a match for available federal line 33 funds for graduate medical education. line 34 (h) For purposes of this article, the following definitions shall line 35 apply: line 36 (1) Commission means the California Healthcare Workforce line 37 Policy Commission, established pursuant to Section 128215. 98
3 AB 2458 line 1 (2) OSHPD means the Office of Statewide Health Planning line 2 and Development. line 3 (3) Primary care physician means an allopathic or osteopathic line 4 physician who has the responsibility for providing initial and line 5 primary care to patients, maintaining the continuity of patient care, line 6 and initiating referral for specialist care. A primary care physician line 7 shall be either a physician who has limited his or her practice of line 8 medicine to general practice or who is a board-certified or line 9 board-eligible internist, pediatrician, obstetrician-gynecologist, or line 10 family practitioner. line 11 128311. (a) In the 2014 15 fiscal year, the sum of line 12 twenty-five million dollars ($ ) ($25,000,000) is hereby line 13 appropriated from the General Fund to the Graduate Medical line 14 Education Fund established in Section 128310. line 15 (b) Commencing with the 2014 15 fiscal year, the sum of two line 16 million eight hundred forty thousand dollars ($2,840,000) per year line 17 for three years is hereby appropriated from the California Health line 18 Data and Planning Fund into to the Graduate Medical Education line 19 Fund established in Section 128310. line 20 128312. Funding of this article shall not affect the existing line 21 funding for the Song-Brown Health Care Workforce Training Act line 22 (Article 1 (commencing with Section 128200)) for family medicine line 23 residency or physician assistant, family nurse practitioner, and line 24 registered nurse training programs. O 98
AB 2458 Question and Answer Medical Residency Funding What does the bill do? Assembly Bill 2458 establishes the Graduate Medical Education Fund to finance additional positions at residency programs in California hospitals and health centers. The bill also calls for additional funds to be invested in primary care residency programs and allocates an additional $2.84 million dollars annually for three years to residency programs, plus $25 million from the State s general fund. Specifically, this bill: Establishes the Graduate Medical Education Fund (GMEF) Directs the Office of Statewide Health Planning and Development to develop criteria for the distribution of monies in the fund Specifies that monies from the fund will be used for new graduate medical education residency positions Appropriates $2.84 million dollars annually for a period of three years starting in the 2014-15 fiscal year from the California Health Data and Planning Fund to the GMEF Appropriates money from the General Fund into the GMEF Defines primary care physician as a family practitioner, pediatrician, obstetrician-gynecologist, internist, or a physician who has restricted her practice to general practice What are the benefits of primary care physicians? Communities with more family physicians have been shown to have better health outcomes, including fewer deaths from cancer, heart disease, and stroke. Is there a shortage of primary care practitioners? Yes. The majority of California counties have less than the recommended number of primary care practitioners and only 34% of physicians statewide practice primary care. One third of our primary care practitioners are age 60 or older. The Council on Graduate Medical Education recommends a ratio of 60-80 primary care physicians per 100,000 population to adequately meet population needs, yet only 16 of California s 58 counties (27%) meet that range. To meet our physician
need, we will need to educate an estimated 515 new family practitioners every year. What does a residency slot cost? The average cost of a residency program slot is estimated at $100,000. How many residency slots do we currently have in California? In 2013, 1,416 students graduated from medical schools in California and another 1,427 originally from the state left California to attend medical schools in other states. There are currently 49 family practice residency programs in California with about 370 residency slots for medical school graduates to train in family medicine and go on to exclusively provide primary care. Another 1,150 slots are available for physicians to train in internal medicine, pediatrics, and obstetrics and gynecology, but only 20 to 30 percent of those physicians will practice as primary care physicians. Last year, 100% of California residency slots in Family Medicine were filled. We need 50 percent of medical students to choose primary care as their specialty to satisfy our primary care need. At present, because of the mismatch between the number of training slots and the demand, California can produce only half that number. Why create more residency slots in California? Nearly 70% of residents who train in California remain here to practice after graduation. Unfortunately, we are training doctors at California universities, however due to lack of residency slots, they are forced to leave California to complete their medical residency - and that is where they stay. According to the Association of American Medical Colleges 2013 State Physician Workforce Data Book, California is the best in the nation in physician retention: Overall, 37.8% of medical students end up practicing in the same state where they received their medical degree. California retains 62.4% of those who receive their medical degree in the state. This is top in the nation.
California retains 69.5% of those who complete their residency in the stateagain, the top in the nation. If we are able to provide medical degree education and residency education to a physician in California, 80.1% stay in California to practice. What does the Governor s budget proposal include? The Governor s 2014-15 proposed budget includes an allocation of $2.84 million dollars for a term of three years to expand the Song-Brown Primary Care Residency Program. This is a repayment from funds borrowed from the California Health Data and Planning Fund. Song Brown Program There are 110 primary care residencies in the state, including the 44 family practice residency programs that are currently statutorily eligible to apply for and receive Song-Brown funds. The remaining 66 residencies include 31 internal medicine, 18 OB/GYN and 17 pediatric residency programs. Residents and trainees of Song-Brown funded health professions training programs are required to complete training in medically underserved communities (Health Professional Shortage Areas, Medically Underserved Areas, Medically Underserved Populations, Primary Care Shortage Areas and Registered Nurse Shortage Areas), as well as rural communities.