Survey Shows PCP Shortage and Lopsided Distribution

Cheryl Clark, for HealthLeaders Media , June 10, 2009

The survey was launched because of concerns that physician supply estimates relied too heavily on projections from the American Medical Association's Physician Masterfile data.

Over the last five years, many health and hospital officials and physicians groups complained that they witnessed firsthand an increasing exodus of the physician workforce. Many left the state to practice in an environment with fewer cost or reimbursement constraints from managed care organizations or reduced their hours. Many took early retirement or left for other pursuits, such as academic research, or other medical fields, such as full or part-time work with institutional review committees, court testimony or publications.

To get a better handle on the problem, the Medical Board of California, which licenses and disciplines physicians, sent out a survey as part of relicensure and now has enough responses for the report.

Indeed, although the survey shows that there are 118,883 physicians who had an active medical license in 2008, less than half were out of training and practicing within the state at least 20 hours per week. Of these 34% were in primary care while 66% were non-primary care specialists.

Conversely, the AMA has estimated that 80,000 active physicians practice in California, a discrepancy this report attributed to the fact that the AMA overestimated the number of hours physicians practiced and listed many physicians as practicing in the state, who in fact are not listed as having a California medical license.

By county, the survey found the greatest number of physicians per 100,000 population are in heavily urban and affluent counties, such as San Francisco, which has 370; Marin, 271; Santa Clara, 239; Napa, 231; San Mateo, 213; and Alamada, 211. The lowest number per 100,000 population practice were in rural counties, such as Alpine, which has none; Sierra, 27; Modoc, 28; Glenn, 43; Trinity, 47; Colusa, 53; Mariposa, 53; and San Benito, 58.

Specialist physician supply is adequate, the report said, but they are poorly distributed. For example, the highest ratio of specialists is located in San Francisco, 265 per 100,000; Marin, 191; Santa Clara, 160; and Napa, 157. But 11 counties have fewer than half the 85 specialists per 100,000 population.

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