California’s industries and companies want the best and brightest to move here. But when it comes to health care, the state is facing a shortage of medical professionals, especially in primary care, in large part because burdensome laws make it difficult for high-quality practitioners from other states and countries to practice medicine here.
The California Future Health Workforce Commission recently reported that seven million Californians already live in health professional shortage areas, with some of the most severe shortages being in the Inland Empire and Los Angeles. Within a decade, the state is expected to have 4,100 fewer primary health care providers than it needs.
The commission, chaired by University of California President Janet Napolitano and Dignity Health CEO Lloyd Dean, proposed a series of measures to reduce the shortage. The recommendations, conservatively priced at $3 billion over 10 years, include a variety of ways to expand medical schools and add residency positions at California hospitals. But California could provide an adequate supply of primary care at a much lower cost to taxpayers. Doing so, however, requires breaking away from the state’s outdated notion of primary care: that it must be provided in-person by doctors who were mostly trained in California. By making more use of doctors trained elsewhere, nurse practitioners and telemedicine, policymakers could increase the supply of primary health care through three specific reforms.
First, California should automatically grant medical licenses to physicians who hold medical licenses in other states and developed nations. The laws of physiology and pathology do not recognize state borders and neither should the California Medical Board. Currently, it can take a Connecticut doctor hoping to move to California several months to gain his California license due to the huge amount of paperwork involved. It’s even more time-consuming if London’s best surgeon wants to move here. This administrative sclerosis decreases the number of physicians and raises patient costs. Granting recognition of other state’s medical licenses, as we already do with drivers licenses, would help meet California’s medical demands.
Second, the state should allow greater use of ancillary medical personnel—nurse practitioners, physician assistants, etc.,—who are now licensed to practice under the supervision of physicians. These providers need not be supervised by specialist physicians at every turn in their daily practice. Nurse practitioners, dental hygienists, and midwives know when to refer patients to doctors, dentists, and obstetricians. The current state law requires that these professionals be overseen by a physician, whose involvement just adds to patients’ medical bills and scheduling delays. Patients who want to see a doctor can schedule and pay for one, but many people would prefer to save time and money when they have minor health concerns and questions.
Finally, California could eliminate restrictions to telemedicine and take advantage of free or low-cost medical apps. Computer technology now allows everything from medical records to electrocardiogram (EKG) tracings to magnetic resonance images (MRIs) to be sent anywhere in the world. Today, the physician interpreting an MRI done in Santa Ana could do that from San Diego, Seattle or Sweden. But current state law requires a New York physician to also have a California license in order to give a California patient medical advice from his New York office. It’s legal for you to fly to New York to seek a medical opinion, yet the outdated state law requires that same New York doctor to have an extra medical license to give you the same advice via the Internet rather than face-to-face.
Advances in computer technology are improving health care on both the patient and physician ends. For example, with the increasing number of medical apps people can download on their phones, many parts of the medical process can now be handled with smartphones capable of running tests and sending results to doctors, which could lead to large cost savings—as long as regulators allow them to move forward.
California needs more doctors but doesn’t need $3 billion to subsidize their training. The state simply needs to remove the regulatory barriers that are preventing trained health care professionals from serving California’s patients.