Training and Retaining Doctors in the Inland Region

Training and Retaining Doctors in the Inland Region

S. E. Williams

In June, the UCR School of Medicine will celebrate the graduation of 40 physicians. The great news for California is that 33 of the graduates will stay in the state to complete their residencies, ten of which will participate in residency programs in the Inland Empire. This was welcomed news for a state and community impacted by a shortage of doctors. 

California, like other places in the nation, is working to mitigate its physician shortage even as the shortage continues to grow. The Association of American Medical Colleges reported last year that by 2025 the country will experience a shortage of well over 94,000 primary care physicians. California has a projected shortfall of 8,230 by the year 2030. 

In the Inland region, the physician shortage is even more pronounced. There are only 120 doctors per 100,000 people in the Inland area compared to 194 physicians per 100,000 people statewide. Regarding primary care physicians, there are 64 per 100,000 people statewide; but only 43 primary care physicians per 100,000 people in the Inland Empire. The minimum ratio recommended by the Council on Graduate Medical Education is 60 primary care physicians per 100,000 people. Only two regions in the state have successfully attained this benchmark: the Greater Bay Area and Sacramento.

“The state has increased enrollment at existing schools, that’s only the first step…Next they must be put into residency training. The growth here has not kept pace with the number in medical schools.” – Dr. Paul Lyons, Senior Associate Dean for Medical Education, UCR

An even broader gap exists regarding medical specialists. Statewide, there are 130 specialists per 100,000 people compared to only 77 per 100,000 individuals in the Inland region. 

There is no question the physician shortfall increased in recent years as enrollment in the Affordable Care Act/Covered California grew. The shortfall is certain to be further exacerbated by the number of physicians in California rapidly approaching retirement age: more than 60 percent of the state’s doctors are over 50 years old and they are retiring at a pace much faster than new physicians can replace them. 

Fortunately for the residents of Riverside and San Bernardino Counties, healthcare professionals, like those at the UCR School of Medicine, are working to meet this challenge head-on. 

When the UCR School of Medicine welcomed its inaugural class in 2013, it became the first public medical school established in the state in more than forty years. Observers, believe the state can and must do more to provide funding for graduate-level medical training. Such funding could yield great results for the state overall, and communities like those in the inland region specifically. 

Results indicate that California has the highest resident retention rate in the nation. In other words, medical residents that train here, for the most part stay here. It would better serve the medical needs and interests of the state to provide more graduate-level education funding so that students will not travel to other states for opportunities, especially since results show that most graduate-level medical students who train in other states do not return to California to practice. 

Last year, the California legislature committed $100 million to be dispersed over a three-year period to fund the state’s Song-Brown Program. The 1973 Song-Brown Program was designed to increase the number of family doctors to provide medical services to the state’s residents, particularly those in underserved areas like the Inland Empire. This year, however, the Governor’s 2016-17 budget proposal has called for the elimination of the second Song-Brown Program installment—the equivalent of $33.4 million, which could go to schools in the state university system like UCR. 

That is not the only bad budget news. The Governor also proposed redirecting $50 million in Proposition 56 (tobacco tax) funding, also intended to go to the University of California (UC) to expand Graduate Medical Education programs, and instead it will be added to the general fund to offset a cut from the UC’s base budget. 

Working to solve the region’s shortage of doctors and other healthcare professionals is not only being addressed by the UCR School of Medicine; stakeholders from Riverside and San Bernardino Counties have coalesced in pursuit of opportunities to provide the best healthcare services to the area’s residents. Also, a new medical school, the California University of Science and Medicine in Colton, will accept its first class this fall. 

The California Medical Association (CMA) reported that inadequate funding for residency programs has resulted in hundreds of graduating medical students each year unable to find a residency opening in California. This continues to drive young doctors to other states for residency opportunities, which often results in those professionals remaining out of state. 

Concerns over the governor’s proposed budget cuts is not only a concern of the UC system, according to the CMA, leading healthcare groups have also expressed concerns. In addition to the CMA, the California Academy of Family Physicians as well as CaliforniaHealth+ Advocates have urged the governor and legislature to keep their promise to bring much needed primary care physicians to underserved areas of the state. 

According to the CMA, the budget investment promised last year came at the urging of a broad coalition of statewide healthcare organizations. Their goal was to create a reliable and continuous funding stream that primary care residency programs in the state so desperately need.

Inaugural Class of Graduating Medical Students

In a recent statement, Carmela Castellano-Garcia, President and CEO of CaliforniaHealth+ Advocates said, “We are committed to working with the legislature and the governor to forge solutions that protect our state’s most vulnerable communities, but must not turn our back on those we have already committed to helping.” 

This week, in an exclusive interview with The Voice, Dr. Paul Lyons, the Senior Associate Dean for Medical Education at UCR, shared his thoughts on the governor’s budget decision: “In the immediate short-term, it will have no impact on the school itself. Funding for the medical school is separate from funding for residencies.” He further explained how funding residencies is very complex and includes a variety of strategies to provide medical training opportunities for medical school graduates. “It would be terrific to receive the funding but there are a lot of pathways to success,” he noted. 

Lyons further advised that not receiving the funding will create some stresses, but assured adaptions will be made. “We will weather this or any other budget impact. It doesn’t mean we like them, but, we weather them—medical education is resourceful and resilient.” 

Lyons further shared that most funding sources for residencies come from federal dollars via the Medicare program. “Many states, like California, augment that funding for their own strategic reasons–but it is not the major source.” 

Regarding the growing need for physicians, Lyons confirmed it is a national concern that was recognized six to eight years ago. “An organized call was put out to increase the number of medical schools by 30 percent by the year by 2020.” He expounded on how this goal was already met nationwide, but not yet achieved in California. However, with the opening of the UCR School of Medicine, the number of medical students in the state increased by 50. 

“The state has increased enrollment at existing schools, that’s only the first step,” he noted. “Next they must be put into residency training. The growth here has not kept pace with the number in medical schools. The governor’s funding was one way to get at this, as is increased hospital residencies through federal funding.” 

According to Lyons, those are not the only ways. UCR has already partnered with local hospitals to create more than 100 residency positions in the region. The residencies include a spectrum of specialties such as surgery, family medicine, internal medicine, and pediatrics, to name a few. 

As mentioned above, ten of this year’s graduates from the UCR School of Medicine will remain in the inland area to complete residency programs. Lyons said that UCR has about 75 first-year positions and each year some of the residency positions will be matched to candidates from other places. That is part of the school’s strategy, which includes retaining local students and recruiting those from elsewhere. “Now, we have a chance to woo them with the charms of our region and convince them to stay,” he shared. 

Lyons further explained that there are two big predictors that determine where doctors will ultimately choose to practice medicine: where they grew up and where they finished their residency. ”We have good reason to believe this strategy will be successful in the long run.” 

Lyons also expressed his belief that the inland community should be exceptionally proud of all 40 students who are graduating from the UCR School of Medicine in June, and exceptionally proud of all the students asked to residency in this region. “At the end of the day,” he said, “this is a medical school they [the community] helped support and assured it came into being – and it is now starting to pay off.” 

He concluded, “This is a very proud moment for this region that worked so hard and for so long to assure that this medical school would be successful. I think this is an opportunity for all of us to celebrate a very significant milestone.”

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