State leaders meet in Fresno to talk about healthcare workforce shortage

By Angela Hart 

07/15/2019 07:38 PM EDT

Sen. Holly Mitchell said Monday she supports allowing nurse practitioners to practice independently of physicians, an idea that has faced intense opposition in the past from the California Medical Association.

"It makes perfect sense," said Mitchell (D-Los Angeles).

The Senate Select Committee on the Social Determinants of Children's Well-Being, chaired by Mitchell, met Monday in Fresno to consider ways to address mental health and primary care provider shortages.

Giving nurse practitioners independent practice authority was among the ideas under consideration. One such proposal, CA AB890 (19R)by Assemblyman Jim Wood (D-Santa Rosa), died in the Assembly Appropriations Committee this spring but could resurface next year.

Mitchell acknowledged intense opposition surrounding such scope-of-practice bills. She said she still has "missing teeth" from her 2012 bill that would have authorized registered nurses to dispense contraceptives ordered by a physician, nurse practitioner or physician's assistant. Yet, she said, given deep provider shortages, especially in California's Central Valley, the state must act more forcefully.

Central Valley residents told the committee that they have problems accessing affordable health care and voiced broader concerns around clean drinking water and housing costs.

"We can do better," said state Health and Human Services Secretary Mark Ghaly.

He said California must focus on recruiting and training health care workers — particularly those who specialize in primary care and mental health in underserved communities. The state has already begun cracking down on county mental health plans for not offering enough providers to meet needs in the San Joaquin Valley and Inland Empire.

Other recommendations, put forward by the Healthforce Center at the University of California, San Francisco, include increasing funding for psychiatry residency slots and psychiatric nurse practitioner education.

Experts also encouraged the state to increase enrollment at UC medical schools and expand incentives for providers to accept Medi-Cal patients. Currently, 64 percent of California's doctors accept Medi-Cal patients, according to the center.

The Healthforce Center also suggested earlier training and mentoring programs, especially for people in underrepresented and low-income communities, and greater state investment in the broader health care workforce, such as outreach workers.

"We're going to have insufficient numbers of new primary care and behavioral health professionals to replace those who retire unless the state acts proactively to expand their numbers," said Janet Coffman, a professor at the Healthforce Center and the Institute for Health Policy Studies at UCSF. "The budget for this year made a good down payment on that investment, but there's still more to do."

Mitchell, who also chairs the Senate Budget Committee, said the state must "figure out how we address medical school debt" that can prevent people from entering the medical field. The state could expand its loan repayment programs, she suggested.

She said the recommendations and public testimony could be used to develop next year's budget and legislation.

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