No Primary Care Doc? Covered California Will Get You One
Budget Cuts Threaten UC Berkeley's Medical Program
California Needs More Primary Care Docs, But Residency Slots Threatened
UC Davis Experiments with Fast-Tracking Medical School
Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk
The Primary Care Crunch: Not Enough Doctors and More Patients Coming
How Nurses and Other 'Mid-Level Providers' Fill Growing Gap in Primary Care
Immigrant Doctors Help Ease California's Primary Care Doctor Shortage
The Doctor Will See You Now -- Virtually
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Bartolone\u003cbr />\u003ca href=\"http://californiahealthline.org/\">California Healthline\u003c/a>","isLoading":false},"lisaaliferis":{"type":"authors","id":"240","meta":{"index":"authors_1591205172","id":"240","found":true},"name":"Lisa Aliferis","firstName":"Lisa","lastName":"Aliferis","slug":"lisaaliferis","email":"laliferis@kqed.org","display_author_email":false,"staff_mastheads":[],"title":null,"bio":"Lisa Aliferis is the founding editor of KQED's \u003cem>State of Health\u003c/em> blog. Since 2011, she's been writing and editing stories for the site. Before taking up blogging, she toiled for many years (more than we can count) producing health stories for television, including\u003cem> Dateline NBC\u003c/em> and San Francisco's CBS affiliate, KPIX-TV. She also wrote up a \u003ca title=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\">handy guide to the Affordable Care Act\u003c/a>, especially for Californians. Her work has been honored for many awards. Most recently she was a finalist for \"Best Topical Reporting\" from the Online News Association. You can follow her on Twitter: \u003ca title=\"https://twitter.com/laliferis\" href=\"https://twitter.com/laliferis\">@laliferis\u003c/a>","avatar":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twitter":"laliferis","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"futureofyou","roles":["subscriber"]},{"site":"stateofhealth","roles":["subscriber"]},{"site":"science","roles":["subscriber"]},{"site":"food","roles":["contributor"]}],"headData":{"title":"Lisa Aliferis | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lisaaliferis"},"state-of-health":{"type":"authors","id":"8344","meta":{"index":"authors_1591205172","id":"8344","found":true},"name":"State of Health","firstName":"State of Health","lastName":null,"slug":"state-of-health","email":"stateofhealth@kqed.org","display_author_email":false,"staff_mastheads":[],"title":null,"bio":null,"avatar":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twitter":null,"facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"stateofhealth","roles":["editor"]}],"headData":{"title":"State of Health | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/state-of-health"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_216703":{"type":"posts","id":"stateofhealth_216703","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"216703","score":null,"sort":[1469465366000]},"guestAuthors":[],"slug":"no-primary-care-doc-covered-california-will-get-you-one","title":"No Primary Care Doc? Covered California Will Get You One","publishDate":1469465366,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Health insurers are gearing up to comply with a new Covered California rule that will require them next year to ensure that all enrollees have a primary care provider.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You need a captain of the ship.'\u003ccite> Lance Lang, chief medical officer of Covered California \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>The policy change for 2017 is part of a broader push by the exchange to improve the quality of care, even as it faces double-digit premium increases.\u003c/p>\n\u003cp>Health insurers selling through Covered California will designate a family doctor — or in some cases a nurse practitioner or physician’s assistant — for every plan holder who doesn’t already have one within 60 days of the coverage start date. The role of the assigned provider will be to help enrollees “navigate the system,” the exchange said last week.\u003c/p>\n\u003cp>The new policy applies to all enrollees, including those in Preferred Provider Organizations (PPOs), in which patients choose the physicians they want, and in HMOs, where the doctor networks are narrower and patients need a referral from their primary care doctor to see other providers.\u003c/p>\n\u003cp>“You need a captain of the ship,” Lance Lang, chief medical officer of Covered California, said of the role primary care providers play in coordinating patient health. These clinicians “[know] the patient, not just their statistics and lab values.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lang said the new policy is meant to improve both the quality and cost efficiency of care.\u003c/p>\n\u003cp>As the agency \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/18/why-obamacare-covered-california-premiums-going-up/\" target=\"_blank\">unveiled its 2017 health plans and premium rates\u003c/a> last week, Executive Director Peter Lee said officials wanted to make sure that “having coverage means [policyholders] also have access to care.”\u003c/p>\n\u003cp>PPO enrollees will still have the freedom to choose their own providers and will not require referrals from their primary care doctors to see other providers.\u003c/p>\n\u003cp>For them, “this isn’t a ‘mother may I’ doctor,” said Lee.\u003c/p>\n\u003cp>Consumers Union, a nonprofit advocacy group with a seat on a Covered California advisory committee, supported the change but wants the exchange to make sure it’s easy for consumers to change doctors if they need to and to find providers in their network who are accepting new patients.\u003c/p>\n\u003cp>The move to more coordinated care did not surprise health policy experts.\u003c/p>\n\u003cp>“California has definitely, relative to the nation as a whole, been far more aggressive in moving into managed care,” said Dr. Geoffrey Joyce, director of health policy at the University of Southern California’s Schaeffer Center.\u003c/p>\n\u003cp>However, Joyce said the Covered California policy change is not a full shift to managed care because the primary care assignments would not be as binding or restrictive as in traditional HMOs, in which patients have to pay more if they see doctors to whom they are not referred.\u003c/p>\n\u003cp>But the new policy could have clinical and financial benefits, he said.\u003c/p>\n\u003cp>“Everyone’s moving towards better integrated care, better coordinated care. And so having one primary care provider be your sort of gatekeeper and your focal point makes sense,” Joyce said.\u003c/p>\n\u003cp>Lang said that Covered California is moving away from a “fragmented, disorganized, wild west” kind of care but is not trying to steer consumers away from PPOs and into HMOs.\u003c/p>\n\u003cp>Primary care relationships can simply help avoid unnecessary medical costs, Lang said, because a family doctor can prevent duplication of tests and other services and make it less likely a patient will be readmitted to a hospital.\u003c/p>\n\u003cp>The new primary care requirement is part of a series of new measures meant to improve the quality of care in Covered California health plans. The exchange’s board of directors recently approved rules that include penalizing hospitals financially for underperforming and even removing them — or doctors — from health insurance networks if they perform too poorly or charge too much.\u003c/p>\n\u003cp>Health plans will also be required to share data about chronic diseases among their patients and work to reduce health disparities.\u003c/p>\n\u003cp>Covered California’s health plan premiums will increase by an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/18/why-obamacare-covered-california-premiums-going-up/\" target=\"_blank\">average of 13.2 percent statewide\u003c/a> next year, but Lang said rising costs are not the impetus for the policy change on primary care. A body of research shows the benefits of coordinated care, he said.\u003c/p>\n\u003cp>How many of the 1.4 million Covered California enrollees who currently have primary care doctors is unknown, but about half of the patients in the marketplace are in HMOs, where primary care physicians are the first point of contact.\u003c/p>\n\u003cp>The California Academy of Family Physicians applauded the Covered California decision, saying primary care can help reduce costs in the current health care system, where “patients sometimes think the emergency room is their only option for urgent care.”\u003c/p>\n\u003cp>The success of Covered California’s effort depends on how it’s carried out, and the implementation should be monitored to make sure there is an adequate number of providers for patients, the family doctors group said.\u003c/p>\n\u003cp>California laws and insurance exchange rules require health plans to ensure that patients can see providers within a certain timeframe. But in some areas where there is a shortage of primary care providers, patients already have to wait to see a clinician, Joyce said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It’s possible patients will still have to wait to see a provider under the new Covered California policy, but being assigned to a primary care provider might help expedite a patient’s search for an in-network doctor, Joyce said.\u003c/p>\n\n","blocks":[],"excerpt":"Next year, Covered California will require health plans to assign a primary care doctor to all enrollees who don’t have one. (The assignment is not binding.)","status":"publish","parent":0,"modified":1469465611,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":926},"headData":{"title":"No Primary Care Doc? Covered California Will Get You One | KQED","description":"Next year, Covered California will require health plans to assign a primary care doctor to all enrollees who don’t have one. (The assignment is not binding.)","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"No Primary Care Doc? Covered California Will Get You One","datePublished":"2016-07-25T16:49:26.000Z","dateModified":"2016-07-25T16:53:31.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"216703 http://ww2.kqed.org/stateofhealth/?p=216703","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/25/no-primary-care-doc-covered-california-will-get-you-one/","disqusTitle":"No Primary Care Doc? Covered California Will Get You One","nprByline":"Pauline Bartolone\u003cbr />\u003ca href=\"http://californiahealthline.org/\">California Healthline\u003c/a>","path":"/stateofhealth/216703/no-primary-care-doc-covered-california-will-get-you-one","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Health insurers are gearing up to comply with a new Covered California rule that will require them next year to ensure that all enrollees have a primary care provider.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You need a captain of the ship.'\u003ccite> Lance Lang, chief medical officer of Covered California \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>The policy change for 2017 is part of a broader push by the exchange to improve the quality of care, even as it faces double-digit premium increases.\u003c/p>\n\u003cp>Health insurers selling through Covered California will designate a family doctor — or in some cases a nurse practitioner or physician’s assistant — for every plan holder who doesn’t already have one within 60 days of the coverage start date. The role of the assigned provider will be to help enrollees “navigate the system,” the exchange said last week.\u003c/p>\n\u003cp>The new policy applies to all enrollees, including those in Preferred Provider Organizations (PPOs), in which patients choose the physicians they want, and in HMOs, where the doctor networks are narrower and patients need a referral from their primary care doctor to see other providers.\u003c/p>\n\u003cp>“You need a captain of the ship,” Lance Lang, chief medical officer of Covered California, said of the role primary care providers play in coordinating patient health. These clinicians “[know] the patient, not just their statistics and lab values.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lang said the new policy is meant to improve both the quality and cost efficiency of care.\u003c/p>\n\u003cp>As the agency \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/18/why-obamacare-covered-california-premiums-going-up/\" target=\"_blank\">unveiled its 2017 health plans and premium rates\u003c/a> last week, Executive Director Peter Lee said officials wanted to make sure that “having coverage means [policyholders] also have access to care.”\u003c/p>\n\u003cp>PPO enrollees will still have the freedom to choose their own providers and will not require referrals from their primary care doctors to see other providers.\u003c/p>\n\u003cp>For them, “this isn’t a ‘mother may I’ doctor,” said Lee.\u003c/p>\n\u003cp>Consumers Union, a nonprofit advocacy group with a seat on a Covered California advisory committee, supported the change but wants the exchange to make sure it’s easy for consumers to change doctors if they need to and to find providers in their network who are accepting new patients.\u003c/p>\n\u003cp>The move to more coordinated care did not surprise health policy experts.\u003c/p>\n\u003cp>“California has definitely, relative to the nation as a whole, been far more aggressive in moving into managed care,” said Dr. Geoffrey Joyce, director of health policy at the University of Southern California’s Schaeffer Center.\u003c/p>\n\u003cp>However, Joyce said the Covered California policy change is not a full shift to managed care because the primary care assignments would not be as binding or restrictive as in traditional HMOs, in which patients have to pay more if they see doctors to whom they are not referred.\u003c/p>\n\u003cp>But the new policy could have clinical and financial benefits, he said.\u003c/p>\n\u003cp>“Everyone’s moving towards better integrated care, better coordinated care. And so having one primary care provider be your sort of gatekeeper and your focal point makes sense,” Joyce said.\u003c/p>\n\u003cp>Lang said that Covered California is moving away from a “fragmented, disorganized, wild west” kind of care but is not trying to steer consumers away from PPOs and into HMOs.\u003c/p>\n\u003cp>Primary care relationships can simply help avoid unnecessary medical costs, Lang said, because a family doctor can prevent duplication of tests and other services and make it less likely a patient will be readmitted to a hospital.\u003c/p>\n\u003cp>The new primary care requirement is part of a series of new measures meant to improve the quality of care in Covered California health plans. The exchange’s board of directors recently approved rules that include penalizing hospitals financially for underperforming and even removing them — or doctors — from health insurance networks if they perform too poorly or charge too much.\u003c/p>\n\u003cp>Health plans will also be required to share data about chronic diseases among their patients and work to reduce health disparities.\u003c/p>\n\u003cp>Covered California’s health plan premiums will increase by an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/18/why-obamacare-covered-california-premiums-going-up/\" target=\"_blank\">average of 13.2 percent statewide\u003c/a> next year, but Lang said rising costs are not the impetus for the policy change on primary care. A body of research shows the benefits of coordinated care, he said.\u003c/p>\n\u003cp>How many of the 1.4 million Covered California enrollees who currently have primary care doctors is unknown, but about half of the patients in the marketplace are in HMOs, where primary care physicians are the first point of contact.\u003c/p>\n\u003cp>The California Academy of Family Physicians applauded the Covered California decision, saying primary care can help reduce costs in the current health care system, where “patients sometimes think the emergency room is their only option for urgent care.”\u003c/p>\n\u003cp>The success of Covered California’s effort depends on how it’s carried out, and the implementation should be monitored to make sure there is an adequate number of providers for patients, the family doctors group said.\u003c/p>\n\u003cp>California laws and insurance exchange rules require health plans to ensure that patients can see providers within a certain timeframe. But in some areas where there is a shortage of primary care providers, patients already have to wait to see a clinician, Joyce said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It’s possible patients will still have to wait to see a provider under the new Covered California policy, but being assigned to a primary care provider might help expedite a patient’s search for an in-network doctor, Joyce said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/216703/no-primary-care-doc-covered-california-will-get-you-one","authors":["byline_stateofhealth_216703"],"categories":["stateofhealth_2442","stateofhealth_15"],"tags":["stateofhealth_368","stateofhealth_2808","stateofhealth_2519","stateofhealth_37"],"featImg":"stateofhealth_216705","label":"stateofhealth"},"stateofhealth_175454":{"type":"posts","id":"stateofhealth_175454","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"175454","score":null,"sort":[1461308663000]},"guestAuthors":[],"slug":"budget-cuts-threaten-uc-berkeleys-medical-program","title":"Budget Cuts Threaten UC Berkeley's Medical Program","publishDate":1461308663,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Budget woes at UC Berkeley could force the shut down of a program many people are unaware of -- its medical program.\u003c/p>\n\u003cp>The Joint Medical Program (JMP), part of Berkeley's School of Public Health, is small. Just 16 students a year are admitted. Under a \u003ca href=\"http://budget.berkeley.edu/budgetprocess\" target=\"_blank\">budget restructuring\u003c/a> process\u003ca href=\"http://ww2.kqed.org/news/2016/02/10/uc-berkeley-chancellor-says-big-deficit-will-lead-to-painful-changes\" target=\"_blank\"> initiated in February\u003c/a> by Berkeley's Chancellor Nicholas Dirks, the School of Public Health must cut expenses by roughly three percent -- or about $900,000.\u003c/p>\n\u003cp>One of the items on the list to meet that target is closure of the JMP. Losing 16 new doctors a year may not sound dramatic, but this particular population is unusual in medicine. While most medical students head into lucrative specialties, the majority of JMP graduates go into primary care.\u003c/p>\n\u003cp>John Balmes, acting director of the program, says California needs these doctors. \"(California) is 43rd in the nation in terms of primary care physicians,\" he said, \"and with the Affordable Care Act increasing the number of insured Californians, we need more primary care physicians, not less.\"\u003c/p>\n\u003cp>In 2014, just \u003ca href=\"http://www.theatlantic.com/health/archive/2014/09/why-im-becoming-a-primary-care-doctor/379231/\" target=\"_blank\">12 percent of medical students\u003c/a> nationally went into primary care residencies. The JMP was above\u003ca href=\"http://sph.berkeley.edu/jmp/residency-matches\" target=\"_blank\"> 50 percent\u003c/a> 1997-2014. It's unclear exactly why so many students go into primary care. One clue lies in the program's unusual approach to curriculum.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The program, established in 1971, prides itself on avoiding lecture halls and instead focusing on what it calls \"problem-based learning,\" where students review cases as a group. In addition, the medical program is one of few nationally, says second-year student Josh Pepper, that is housed within a school of public health, and that gives a broader focus to patients' lives.\u003c/p>\n\u003cp>\"We're constantly having to question how things like socio-economic status, insurance, housing and culture and addiction play a role in patients' health outcomes,\" Pepper said.\u003c/p>\n\u003cp>It gives a more holistic perspective, he said. \"We develop a whole skill set you don't normally get at a traditional medical school.\" Pepper has helped launch an \u003ca href=\"http://www.ipetitions.com/petition/savethejmp\" target=\"_blank\">online petition\u003c/a> in support of the program.\u003c/p>\n\u003cp>It's called a joint medical program because students do three years at Berkeley's School of Public Health, during which they complete an original research project and the first two years of medical school curriculum. They then head to UC San Francisco for two years of clinical rotation. They graduate with a master's in science from Cal and an M.D. from UCSF.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Health%20Care%20Reform/2016-02-01-Horizon2030-PR.pdf\" target=\"_blank\">report earlier this year\u003c/a> commissioned by the California Primary Care Association detailed the shortfall in primary care providers in California. The state's ratio of primary care physicians in its Medicaid program, called Medi-Cal, is roughly half the federal recommendation, it said. By 2030, the analysis predicted a shortage of more than 8,000 primary care doctors.\u003c/p>\n\u003cp>Carmela Castellano-Garcia is the association's president and bemoaned the possible closure of Cal's medical program.\u003c/p>\n\u003cp>[contextly_sidebar id=\"KH05iLE8gCziGB39qVZNvU5QcFzHysTq\"]\"Certainly with the shortage we are facing, we should not eliminate any existing programs that we know have successful track records into funneling people into primary care,\" she said. \"We cannot afford that at this time.\"\u003c/p>\n\u003cp>All of Cal's professional schools, including the School of Public Health, must trim expenses by the same rate, said Dan Mogulof, a spokesman for the university, and it's up to the schools themselves to determine how to meet the target.\u003c/p>\n\u003cp>Linda Anderberg, director of communications for the School of Public Health, said it is considering several options to achieve the budget cuts. \"The school does not want to lose the (medical) program,\" she said.\u003c/p>\n\u003cp>She stressed that no decisions have been made and that the process would be completed during the summer. Most of the cuts would not go into effect until 2018, she said.\u003c/p>\n\u003cp>Meanwhile, staff and students are speaking out to try to save the program.\u003c/p>\n\u003cp>\"If I had to go to medical school all over again, I'd want to do it in the Joint Medical Program,\" said acting director Balmes. He said there's an advantage to being in a small, supportive environment.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think that translates into very fine doctors, because they're good human beings as well as good doctors,\" he said.\u003c/p>\n\n","blocks":[],"excerpt":"Unlike most medical schools, the majority of Cal's students go into primary care, much needed in California.","status":"publish","parent":0,"modified":1461705069,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":20,"wordCount":709},"headData":{"title":"Budget Cuts Threaten UC Berkeley's Medical Program | KQED","description":"Unlike most medical schools, the majority of Cal's students go into primary care, much needed in California.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Budget Cuts Threaten UC Berkeley's Medical Program","datePublished":"2016-04-22T07:04:23.000Z","dateModified":"2016-04-26T21:11:09.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"175454 http://ww2.kqed.org/stateofhealth/?p=175454","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/04/22/budget-cuts-threaten-uc-berkeleys-medical-program/","disqusTitle":"Budget Cuts Threaten UC Berkeley's Medical Program","path":"/stateofhealth/175454/budget-cuts-threaten-uc-berkeleys-medical-program","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Budget woes at UC Berkeley could force the shut down of a program many people are unaware of -- its medical program.\u003c/p>\n\u003cp>The Joint Medical Program (JMP), part of Berkeley's School of Public Health, is small. Just 16 students a year are admitted. Under a \u003ca href=\"http://budget.berkeley.edu/budgetprocess\" target=\"_blank\">budget restructuring\u003c/a> process\u003ca href=\"http://ww2.kqed.org/news/2016/02/10/uc-berkeley-chancellor-says-big-deficit-will-lead-to-painful-changes\" target=\"_blank\"> initiated in February\u003c/a> by Berkeley's Chancellor Nicholas Dirks, the School of Public Health must cut expenses by roughly three percent -- or about $900,000.\u003c/p>\n\u003cp>One of the items on the list to meet that target is closure of the JMP. Losing 16 new doctors a year may not sound dramatic, but this particular population is unusual in medicine. While most medical students head into lucrative specialties, the majority of JMP graduates go into primary care.\u003c/p>\n\u003cp>John Balmes, acting director of the program, says California needs these doctors. \"(California) is 43rd in the nation in terms of primary care physicians,\" he said, \"and with the Affordable Care Act increasing the number of insured Californians, we need more primary care physicians, not less.\"\u003c/p>\n\u003cp>In 2014, just \u003ca href=\"http://www.theatlantic.com/health/archive/2014/09/why-im-becoming-a-primary-care-doctor/379231/\" target=\"_blank\">12 percent of medical students\u003c/a> nationally went into primary care residencies. The JMP was above\u003ca href=\"http://sph.berkeley.edu/jmp/residency-matches\" target=\"_blank\"> 50 percent\u003c/a> 1997-2014. It's unclear exactly why so many students go into primary care. One clue lies in the program's unusual approach to curriculum.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The program, established in 1971, prides itself on avoiding lecture halls and instead focusing on what it calls \"problem-based learning,\" where students review cases as a group. In addition, the medical program is one of few nationally, says second-year student Josh Pepper, that is housed within a school of public health, and that gives a broader focus to patients' lives.\u003c/p>\n\u003cp>\"We're constantly having to question how things like socio-economic status, insurance, housing and culture and addiction play a role in patients' health outcomes,\" Pepper said.\u003c/p>\n\u003cp>It gives a more holistic perspective, he said. \"We develop a whole skill set you don't normally get at a traditional medical school.\" Pepper has helped launch an \u003ca href=\"http://www.ipetitions.com/petition/savethejmp\" target=\"_blank\">online petition\u003c/a> in support of the program.\u003c/p>\n\u003cp>It's called a joint medical program because students do three years at Berkeley's School of Public Health, during which they complete an original research project and the first two years of medical school curriculum. They then head to UC San Francisco for two years of clinical rotation. They graduate with a master's in science from Cal and an M.D. from UCSF.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Health%20Care%20Reform/2016-02-01-Horizon2030-PR.pdf\" target=\"_blank\">report earlier this year\u003c/a> commissioned by the California Primary Care Association detailed the shortfall in primary care providers in California. The state's ratio of primary care physicians in its Medicaid program, called Medi-Cal, is roughly half the federal recommendation, it said. By 2030, the analysis predicted a shortage of more than 8,000 primary care doctors.\u003c/p>\n\u003cp>Carmela Castellano-Garcia is the association's president and bemoaned the possible closure of Cal's medical program.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"Certainly with the shortage we are facing, we should not eliminate any existing programs that we know have successful track records into funneling people into primary care,\" she said. \"We cannot afford that at this time.\"\u003c/p>\n\u003cp>All of Cal's professional schools, including the School of Public Health, must trim expenses by the same rate, said Dan Mogulof, a spokesman for the university, and it's up to the schools themselves to determine how to meet the target.\u003c/p>\n\u003cp>Linda Anderberg, director of communications for the School of Public Health, said it is considering several options to achieve the budget cuts. \"The school does not want to lose the (medical) program,\" she said.\u003c/p>\n\u003cp>She stressed that no decisions have been made and that the process would be completed during the summer. Most of the cuts would not go into effect until 2018, she said.\u003c/p>\n\u003cp>Meanwhile, staff and students are speaking out to try to save the program.\u003c/p>\n\u003cp>\"If I had to go to medical school all over again, I'd want to do it in the Joint Medical Program,\" said acting director Balmes. He said there's an advantage to being in a small, supportive environment.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think that translates into very fine doctors, because they're good human beings as well as good doctors,\" he said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/175454/budget-cuts-threaten-uc-berkeleys-medical-program","authors":["240"],"categories":["stateofhealth_11"],"tags":["stateofhealth_2519","stateofhealth_37"],"featImg":"stateofhealth_175558","label":"stateofhealth"},"stateofhealth_24651":{"type":"posts","id":"stateofhealth_24651","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"24651","score":null,"sort":[1426871900000]},"guestAuthors":[],"slug":"california-needs-more-primary-care-docs-but-residency-slots-threatened","title":"California Needs More Primary Care Docs, But Residency Slots Threatened","publishDate":1426871900,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_10770\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/PlevinPhoto-e1426871743106.jpg\">\u003cimg class=\"wp-image-10770 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/PlevinPhoto-e1426871743106.jpg\" alt=\"Dr. Peter Broderick of Doctors Medical Center in Modesto examines a patient's x-ray while family practice medical residents look on. (Rebecca Plevin/KVPR)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/02/PlevinPhoto-e1426871743106.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/02/PlevinPhoto-e1426871743106-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/02/PlevinPhoto-e1426871743106-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Peter Broderick of Doctors Medical Center in Modesto examines a patient's x-ray while family practice medical residents look on. (Rebecca Plevin/KVPR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By David Gorn,\u003c/strong> \u003ca title=\"http://www.californiahealthline.org/capitol-desk/2015/3/residency-training-slots-may-evaporate\" href=\"http://www.californiahealthline.org/capitol-desk/2015/3/residency-training-slots-may-evaporate\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cp>Today is a huge day for graduating medical students. It's Match Day -- the day they find out where they're going for residency programs -- the training years between medical school and practice.\u003c/p>\n\u003cp>In California, there are 140 residency slots every year in the family practice specialty. That number may diminish, given the pending loss of four funding sources designed to encourage California medical students to join family-practice residencies, particularly in underserved areas of the state.\u003c/p>\n\u003cp>According to Del Morris, president of the California Academy of Family Physicians, California faces a loss of $50 million from the end of these four programs:\u003c!--more-->\u003c/p>\n\u003cul>\n\u003cli>The federal government's \u003ca title=\"http://bhpr.hrsa.gov/grants/teachinghealthcenters/\" href=\"http://bhpr.hrsa.gov/grants/teachinghealthcenters/\" target=\"_blank\">Teaching Health Center Graduate Medical Education\u003c/a> grant program is set to expire this year\u003c/li>\n\u003cli>Another federal program -- the \u003ca title=\"http://bhpr.hrsa.gov/grants/medicine/pcre.html\" href=\"http://bhpr.hrsa.gov/grants/medicine/pcre.html\" target=\"_blank\">Primary Care Residency Expansion\u003c/a> is also ending. It awarded about $18 million in grants in California last year to create new resident positions in primary care residency programs\u003c/li>\n\u003cli>A \u003ca title=\"http://tcenews.calendow.org/releases/the-california-endowment-commits-78-2-million-in-grants-to-increase-california-s-health-care-workforce\" href=\"http://tcenews.calendow.org/releases/the-california-endowment-commits-78-2-million-in-grants-to-increase-california-s-health-care-workforce\" target=\"_blank\">California Endowment grant\u003c/a> supporting the California workforce training program known as \u003ca title=\"http://www.ccahn.org/post/song-brown-residency-program\" href=\"http://www.ccahn.org/post/song-brown-residency-program\" target=\"_blank\">Song-Brown\u003c/a> -- providing $21 million over the past three years -- ends in 2016\u003c/li>\n\u003cli>$4 million appropriated last year by the Legislature to add into the Song-Brown fund was a one-time infusion of funds.\u003c/li>\n\u003c/ul>\n\u003cp>Those programs helped fund residency slots and encouraged California medical school graduates to remain in the state for residency. Many people set up practices near their residency program, Morris said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>No one knows how many residency slots in California might be lost because of dried-up funding, but the \u003ca title=\"http://ww2.kqed.org/stateofhealth/2013/02/25/new-approach-to-medical-residency-may-ease-doctor-shortage-in-central-valley/\" href=\"http://ww2.kqed.org/stateofhealth/2013/02/25/new-approach-to-medical-residency-may-ease-doctor-shortage-in-central-valley/\" target=\"_blank\">Sierra Vista Family Medicine Residency Program\u003c/a> in Fresno won't be enrolling a class of residents this year because they can't afford it, given that federal funding is expected to end.\u003c/p>\n\u003cp>According to Norma Forbes, executive director of Fresno Healthy Communities Access Partners, \"it is estimated 66 percent (of California's Teaching Health Center programs) are unlikely to be able to support current residency positions in the future without continued federal funding.\" That statistic came from a survey of 60 THC residency programs.\u003c/p>\n\u003cp>Even the status quo of 140 residency slots won't nearly approach the need for primary care physicians in California, Morris said, especially in rural and urban underserved areas.\u003c/p>\n\u003cp>\"That's just not enough,\" Morris said. \"One-third of physicians in the state will retire by 2030, our population is growing and millions more Californians have gained coverage under health care reform.\"\u003c/p>\n\u003cp>California can't afford to lose more medical students to other states, he said.\u003c/p>\n\u003cp>On the state level, Morris said his association is working with the Legislature on budget language that could appropriate an additional $8 million to put into the Song-Brown Fund.\u003c/p>\n\u003cp>On the national front, California Rep. Doug LaMalfa (R-Redding) is leading a bipartisan effort to fund the Teaching Health Center program.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Californians' health depends in part on a sufficient number of primary care physicians to treat them,\" Morris said. \"Our state must increase its family medicine training capacity.\"\u003c/p>\n\n","blocks":[],"excerpt":"Even the status quo of 140 residency slots won't fill the need for primary care doctors in California.","status":"publish","parent":0,"modified":1427305294,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":15,"wordCount":524},"headData":{"title":"California Needs More Primary Care Docs, But Residency Slots Threatened | KQED","description":"Even the status quo of 140 residency slots won't fill the need for primary care doctors in California.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"California Needs More Primary Care Docs, But Residency Slots Threatened","datePublished":"2015-03-20T17:18:20.000Z","dateModified":"2015-03-25T17:41:34.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"24651 http://blogs.kqed.org/stateofhealth/?p=24651","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/03/20/california-needs-more-primary-care-docs-but-residency-slots-threatened/","disqusTitle":"California Needs More Primary Care Docs, But Residency Slots Threatened","path":"/stateofhealth/24651/california-needs-more-primary-care-docs-but-residency-slots-threatened","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_10770\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/PlevinPhoto-e1426871743106.jpg\">\u003cimg class=\"wp-image-10770 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/PlevinPhoto-e1426871743106.jpg\" alt=\"Dr. Peter Broderick of Doctors Medical Center in Modesto examines a patient's x-ray while family practice medical residents look on. (Rebecca Plevin/KVPR)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/02/PlevinPhoto-e1426871743106.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/02/PlevinPhoto-e1426871743106-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/02/PlevinPhoto-e1426871743106-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Peter Broderick of Doctors Medical Center in Modesto examines a patient's x-ray while family practice medical residents look on. (Rebecca Plevin/KVPR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By David Gorn,\u003c/strong> \u003ca title=\"http://www.californiahealthline.org/capitol-desk/2015/3/residency-training-slots-may-evaporate\" href=\"http://www.californiahealthline.org/capitol-desk/2015/3/residency-training-slots-may-evaporate\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cp>Today is a huge day for graduating medical students. It's Match Day -- the day they find out where they're going for residency programs -- the training years between medical school and practice.\u003c/p>\n\u003cp>In California, there are 140 residency slots every year in the family practice specialty. That number may diminish, given the pending loss of four funding sources designed to encourage California medical students to join family-practice residencies, particularly in underserved areas of the state.\u003c/p>\n\u003cp>According to Del Morris, president of the California Academy of Family Physicians, California faces a loss of $50 million from the end of these four programs:\u003c!--more-->\u003c/p>\n\u003cul>\n\u003cli>The federal government's \u003ca title=\"http://bhpr.hrsa.gov/grants/teachinghealthcenters/\" href=\"http://bhpr.hrsa.gov/grants/teachinghealthcenters/\" target=\"_blank\">Teaching Health Center Graduate Medical Education\u003c/a> grant program is set to expire this year\u003c/li>\n\u003cli>Another federal program -- the \u003ca title=\"http://bhpr.hrsa.gov/grants/medicine/pcre.html\" href=\"http://bhpr.hrsa.gov/grants/medicine/pcre.html\" target=\"_blank\">Primary Care Residency Expansion\u003c/a> is also ending. It awarded about $18 million in grants in California last year to create new resident positions in primary care residency programs\u003c/li>\n\u003cli>A \u003ca title=\"http://tcenews.calendow.org/releases/the-california-endowment-commits-78-2-million-in-grants-to-increase-california-s-health-care-workforce\" href=\"http://tcenews.calendow.org/releases/the-california-endowment-commits-78-2-million-in-grants-to-increase-california-s-health-care-workforce\" target=\"_blank\">California Endowment grant\u003c/a> supporting the California workforce training program known as \u003ca title=\"http://www.ccahn.org/post/song-brown-residency-program\" href=\"http://www.ccahn.org/post/song-brown-residency-program\" target=\"_blank\">Song-Brown\u003c/a> -- providing $21 million over the past three years -- ends in 2016\u003c/li>\n\u003cli>$4 million appropriated last year by the Legislature to add into the Song-Brown fund was a one-time infusion of funds.\u003c/li>\n\u003c/ul>\n\u003cp>Those programs helped fund residency slots and encouraged California medical school graduates to remain in the state for residency. Many people set up practices near their residency program, Morris said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>No one knows how many residency slots in California might be lost because of dried-up funding, but the \u003ca title=\"http://ww2.kqed.org/stateofhealth/2013/02/25/new-approach-to-medical-residency-may-ease-doctor-shortage-in-central-valley/\" href=\"http://ww2.kqed.org/stateofhealth/2013/02/25/new-approach-to-medical-residency-may-ease-doctor-shortage-in-central-valley/\" target=\"_blank\">Sierra Vista Family Medicine Residency Program\u003c/a> in Fresno won't be enrolling a class of residents this year because they can't afford it, given that federal funding is expected to end.\u003c/p>\n\u003cp>According to Norma Forbes, executive director of Fresno Healthy Communities Access Partners, \"it is estimated 66 percent (of California's Teaching Health Center programs) are unlikely to be able to support current residency positions in the future without continued federal funding.\" That statistic came from a survey of 60 THC residency programs.\u003c/p>\n\u003cp>Even the status quo of 140 residency slots won't nearly approach the need for primary care physicians in California, Morris said, especially in rural and urban underserved areas.\u003c/p>\n\u003cp>\"That's just not enough,\" Morris said. \"One-third of physicians in the state will retire by 2030, our population is growing and millions more Californians have gained coverage under health care reform.\"\u003c/p>\n\u003cp>California can't afford to lose more medical students to other states, he said.\u003c/p>\n\u003cp>On the state level, Morris said his association is working with the Legislature on budget language that could appropriate an additional $8 million to put into the Song-Brown Fund.\u003c/p>\n\u003cp>On the national front, California Rep. Doug LaMalfa (R-Redding) is leading a bipartisan effort to fund the Teaching Health Center program.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Californians' health depends in part on a sufficient number of primary care physicians to treat them,\" Morris said. \"Our state must increase its family medicine training capacity.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/24651/california-needs-more-primary-care-docs-but-residency-slots-threatened","authors":["8344"],"categories":["stateofhealth_14"],"tags":["stateofhealth_791","stateofhealth_37"],"featImg":"stateofhealth_24477","label":"stateofhealth"},"stateofhealth_20602":{"type":"posts","id":"stateofhealth_20602","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"20602","score":null,"sort":[1407427582000]},"guestAuthors":[],"slug":"uc-davis-experiments-with-fast-tracking-medical-school-primary-care","title":"UC Davis Experiments with Fast-Tracking Medical School","publishDate":1407427582,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_20605\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/goodlifegarden/9027218041/in/photolist-eKGRqn-eKGR8B-5pvJQs-eKGRfM-eK5iAw-eK5qyN-eK5hxN-eK5auG-eK5h2C-eK5tvY-eK5nuw-eK5i9o-4MJjfo-2G7HEk-9mPRbe-d3nCey-d3nARw-d3nAXh-d3nBch-d3nCb5-d3nCQ3-fDnsXY-eK91J3-eJWB1g-eJWAxk-eK92hb-eJWzeZ-eK91j7-eK92JW-eJWBj4-eJWA6F-eK916h-eJWApa-eK91vb-eJWyNv-eK8ZCo-eK92zq-eK8Zk3-eK8Zp1-eK91DG-eJWzj2-eJWz6Z-eJWAR8-eK91NL-eK91by-eJWAUT-eK8ZWC-eJWzLt-eJWBaB-eJWzo6\">\u003cimg class=\"size-full wp-image-20605\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/9027218041_04d775bac3_z.jpg\" alt=\"(UC Davis Gateways Project/Flickr)\" width=\"640\" height=\"425\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/9027218041_04d775bac3_z.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/9027218041_04d775bac3_z-400x266.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/9027218041_04d775bac3_z-320x213.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(UC Davis Gateways Project/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Pauline Bartolone,\u003c/strong> \u003ca href=\"http://capsules.kaiserhealthnews.org/index.php/2014/08/fast-track-for-primary-care-docs-at-one-calif-university/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Some doctors in California will soon be able to practice after three years of medical school instead of the traditional four. The American Medical Association is providing seed money for the effort in the form of a $1 million, five-year grant to UC Davis.\u003c/p>\n\u003cp>Student Ngabo Nzigira is in his sixth week of medical school and he’s already interacting with patients, as he trains under the guidance of a doctor at Kaiser Permanente in Sacramento.\u003c/p>\n\u003cp>In a traditional medical school, Nzigira wouldn’t be in a clinic until his third year. In this accelerated course, students can shave up to $60,000 off their education debt. Still, Nzigira initially had hesitations.\u003c!--more-->\u003c/p>\n\u003cp>“I thought ‘Oh man, you want me to put the intensity and stress that is medical school in four years, you want me to condense it down to three years? I’m not sure about that,’” Nzigira says. But, after learning more, he became convinced it was a good path for him.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The curriculum cuts out summer vacations, electives and the residency search. It’s designed to get primary care physicians into the field faster, says Dr. Tonya Fancher, director of the program, called Accelerated Competency-based Education in Primary Care, or ACE-PC .\u003c/p>\n\u003cp>“There’s a huge problem, a huge shortage of primary care physicians,” Fancher says.\u003c/p>\n\u003cp>UC Davis says more people gaining health insurance coverage under the Affordable Care Act is expected to compound the need for primary care, and one of the goals of the new curriculum is to make family medicine a more appealing and lasting choice for young doctors.\u003c/p>\n\u003cp>“Students come into medical school, they’re passionate about patients, passionate about primary care, and then that wanes over time,” Fancher says. “Part of it is probably the debt that they accrue in school, and part of it are the models of primary care that they’re traditionally exposed to.”\u003c/p>\n\u003cp>Texas, Georgia and New York also have three-year medical schools. And both the AMA and the Association of American Medical Colleges support these initiatives as part of the redesign of medical education. The physician groups want students to advance based on their competency, not a set time frame.\u003c/p>\n\u003cp>UC Davis’s ACE-PC medical students are guaranteed a residency, another training step before facing patient expectations on their own.\u003c/p>\n\u003cp>Outside the Sacramento health center where Nzigira and other students are getting their first experiences in clinical practice, people were not troubled by the idea of a faster track through medical school. Angela Woodard says even doctors with four years of training may have trouble treating patients.\u003c/p>\n\u003cp>“So them going to school a shorter time is not going to make it any worse,” Woodard said.\u003c/p>\n\u003cp>Patient Joe King isn’t too concerned either, “as long as they maintain the same critieria of standards that primary care doctors have to meet,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"The goal is to get primary care physicians into the field faster.","status":"publish","parent":0,"modified":1407438931,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":546},"headData":{"title":"UC Davis Experiments with Fast-Tracking Medical School | KQED","description":"The goal is to get primary care physicians into the field faster.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"UC Davis Experiments with Fast-Tracking Medical School","datePublished":"2014-08-07T16:06:22.000Z","dateModified":"2014-08-07T19:15:31.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"20602 http://blogs.kqed.org/stateofhealth/?p=20602","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/08/07/uc-davis-experiments-with-fast-tracking-medical-school-primary-care/","disqusTitle":"UC Davis Experiments with Fast-Tracking Medical School","path":"/stateofhealth/20602/uc-davis-experiments-with-fast-tracking-medical-school-primary-care","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20605\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/goodlifegarden/9027218041/in/photolist-eKGRqn-eKGR8B-5pvJQs-eKGRfM-eK5iAw-eK5qyN-eK5hxN-eK5auG-eK5h2C-eK5tvY-eK5nuw-eK5i9o-4MJjfo-2G7HEk-9mPRbe-d3nCey-d3nARw-d3nAXh-d3nBch-d3nCb5-d3nCQ3-fDnsXY-eK91J3-eJWB1g-eJWAxk-eK92hb-eJWzeZ-eK91j7-eK92JW-eJWBj4-eJWA6F-eK916h-eJWApa-eK91vb-eJWyNv-eK8ZCo-eK92zq-eK8Zk3-eK8Zp1-eK91DG-eJWzj2-eJWz6Z-eJWAR8-eK91NL-eK91by-eJWAUT-eK8ZWC-eJWzLt-eJWBaB-eJWzo6\">\u003cimg class=\"size-full wp-image-20605\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/9027218041_04d775bac3_z.jpg\" alt=\"(UC Davis Gateways Project/Flickr)\" width=\"640\" height=\"425\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/9027218041_04d775bac3_z.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/9027218041_04d775bac3_z-400x266.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/9027218041_04d775bac3_z-320x213.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(UC Davis Gateways Project/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Pauline Bartolone,\u003c/strong> \u003ca href=\"http://capsules.kaiserhealthnews.org/index.php/2014/08/fast-track-for-primary-care-docs-at-one-calif-university/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Some doctors in California will soon be able to practice after three years of medical school instead of the traditional four. The American Medical Association is providing seed money for the effort in the form of a $1 million, five-year grant to UC Davis.\u003c/p>\n\u003cp>Student Ngabo Nzigira is in his sixth week of medical school and he’s already interacting with patients, as he trains under the guidance of a doctor at Kaiser Permanente in Sacramento.\u003c/p>\n\u003cp>In a traditional medical school, Nzigira wouldn’t be in a clinic until his third year. In this accelerated course, students can shave up to $60,000 off their education debt. Still, Nzigira initially had hesitations.\u003c!--more-->\u003c/p>\n\u003cp>“I thought ‘Oh man, you want me to put the intensity and stress that is medical school in four years, you want me to condense it down to three years? I’m not sure about that,’” Nzigira says. But, after learning more, he became convinced it was a good path for him.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The curriculum cuts out summer vacations, electives and the residency search. It’s designed to get primary care physicians into the field faster, says Dr. Tonya Fancher, director of the program, called Accelerated Competency-based Education in Primary Care, or ACE-PC .\u003c/p>\n\u003cp>“There’s a huge problem, a huge shortage of primary care physicians,” Fancher says.\u003c/p>\n\u003cp>UC Davis says more people gaining health insurance coverage under the Affordable Care Act is expected to compound the need for primary care, and one of the goals of the new curriculum is to make family medicine a more appealing and lasting choice for young doctors.\u003c/p>\n\u003cp>“Students come into medical school, they’re passionate about patients, passionate about primary care, and then that wanes over time,” Fancher says. “Part of it is probably the debt that they accrue in school, and part of it are the models of primary care that they’re traditionally exposed to.”\u003c/p>\n\u003cp>Texas, Georgia and New York also have three-year medical schools. And both the AMA and the Association of American Medical Colleges support these initiatives as part of the redesign of medical education. The physician groups want students to advance based on their competency, not a set time frame.\u003c/p>\n\u003cp>UC Davis’s ACE-PC medical students are guaranteed a residency, another training step before facing patient expectations on their own.\u003c/p>\n\u003cp>Outside the Sacramento health center where Nzigira and other students are getting their first experiences in clinical practice, people were not troubled by the idea of a faster track through medical school. Angela Woodard says even doctors with four years of training may have trouble treating patients.\u003c/p>\n\u003cp>“So them going to school a shorter time is not going to make it any worse,” Woodard said.\u003c/p>\n\u003cp>Patient Joe King isn’t too concerned either, “as long as they maintain the same critieria of standards that primary care doctors have to meet,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/20602/uc-davis-experiments-with-fast-tracking-medical-school-primary-care","authors":["8344"],"categories":["stateofhealth_14"],"tags":["stateofhealth_37"],"featImg":"stateofhealth_20605","label":"stateofhealth"},"stateofhealth_15004":{"type":"posts","id":"stateofhealth_15004","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"15004","score":null,"sort":[1379094752000]},"guestAuthors":[],"slug":"midwifery-physical-therapy-pharmacists-bills-move-to-governors-desk-scope-of-practice","title":"Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk","publishDate":1379094752,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_15016\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/115011610-e1379100622408.jpg\">\u003cimg class=\"size-large wp-image-15016\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/115011610-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>California's legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/12/the-primary-care-crunch-not-enough-doctors-and-more-patients-coming-engaged-patient/\" target=\"_blank\">expand access to primary care\u003c/a>. These \"scope-of-practice\" bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown's desk.\u003c/p>\n\u003cp>Here's a recap of some of the bills and where they stand now:\u003c/p>\n\u003cp>\u003cstrong>Midwifery Bill (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billVotesClient.xhtml\" target=\"_blank\">AB 1308\u003c/a>) -- headed to governor's desk\u003c/strong>\u003c/p>\n\u003cp>The \u003ca href=\"http://centerforhealthreporting.org/blog/update-midwifery-bill-moves-governor%E2%80%99s-desk1175\" target=\"_blank\">Center for Health Reporting writes\u003c/a> that the bill passed unanimously Thursday night and is now on the governor's desk. From the Center:\u003c/p>\n\u003cblockquote>\n\u003cp dir=\"ltr\">(L)icensed midwives were legally obligated to be supervised by physicians. If a doctor supervised a licensed midwife, however, the doctor ran the risk of losing liability insurance. So, collaboration was unattainable and advocates said this put women and babies at risk.\u003c/p>\n\u003cp dir=\"ltr\">The bill removes the requirement for licensed midwives to be supervised by a physician.\u003c/p>\n\u003cp dir=\"ltr\">“Because physician supervision was required but not available, the midwives often had to operate in the shadows,” said Shannon Smith-Crowley, a lobbyist for the American Congress of Obstetricians and Gynecologists (ACOG), a group representing OB/GYNs and the bill’s sponsor. “Midwives can be out in the open, helping them develop better relationships, warmer reception and protocols for transfer, ideally leading to earlier transfers in less dire circumstances.”\u003c/p>\n\u003c/blockquote>\n\u003cp>\u003cstrong>Physical Therapy (\u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/asm/ab_0951-1000/ab_1000_bill_20130906_amended_sen_v91.pdf\" target=\"_blank\">AB 1000\u003c/a>) -- headed to governor's desk\u003c!--more-->\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This bill would eliminate the need for patients to have a physician's diagnosis to receive physical therapy. Under the bill, patients could access physical therapy directly. But as \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/9/physical-therapist-bill-headed-to-governor\" target=\"_blank\">California Healthline \u003c/a>reports, the bill is both supported and opposed by physical therapists, some of whom want the governor to veto the bill:\u003c/p>\n\u003cblockquote>\u003cp>Paul Gaspar, president of the Independent Physical Therapists of California, said the bill wasn't really about direct patient access to therapy as much as it was about changing the financial relationship between physicians and physical therapists.\u003c/p>\n\u003cp>\"People who own [physical therapy] businesses are very concerned about this,\" Gaspar said. \"We feel threatened that people are going to take advantage of us.\"\u003c/p>\n\u003cp>Physician groups now will be able to directly hire physical therapists, and Gaspar said that means they'll be able to make money on the work of other providers. That bucks a national trend, he said, that goes against referral-for-profit plans.\u003c/p>\n\u003cp>Gaspar said his group will talk to the governor's office about the possibility of a veto, based in part on national legislation (\u003ca href=\"http://thomas.loc.gov/cgi-bin/bdquery/z?d113:hr.2914:\" target=\"_blank\">HR 2914\u003c/a>) by Rep. Jackie Speier (D-San Mateo) that may conflict with the state law.\u003c/p>\n\u003cp>Wieckowski said direct access to physical therapists can only be good for consumers.\u003c/p>\n\u003cp>\"This bill helps streamline health care delivery in California and will help patients get the access they need,\" he said, \"rather than losing valuable time with unnecessary and costly delays.\"\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong> Pharmacists (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml\" target=\"_blank\">SB 493\u003c/a>) -- headed to governor's desk\u003c/strong>\u003c/p>\n\u003cp>This bill allows pharmacists to order some lab tests and prescribe smoking cessation drugs. From \u003ca href=\"http://www.sacbee.com/2013/09/11/5728426/bill-would-expand-role-of-pharmacists.html#storylink=cpy\" target=\"_blank\">The Sacramento Bee\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The legislation is part of what had been a package from Democratic Sen. Ed Hernandez of \u003ca href=\"http://topics.sacbee.com/West+Covina/\" rel=\"nofollow\">West Covina\u003c/a> intended to help address the state's expected shortage of primary care physicians. ...\u003c/p>\n\u003cp>Supporters, which include pharmacy schools and \u003ca href=\"http://topics.sacbee.com/Blue+Shield/\" rel=\"nofollow\">Blue Shield\u003c/a> of California, say the legislation would allow pharmacists to better use their training and could help control \u003ca href=\"http://topics.sacbee.com/health+care+costs/\" rel=\"nofollow\">health care costs.\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cdiv>\u003cstrong>Nurse Practitioners (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB491\" target=\"_blank\">SB 491\u003c/a>) -- stuck in committee\u003c/strong>\u003c/div>\n\u003cdiv>This bill was \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/09/debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities/\" target=\"_blank\">one of the most hotly contested\u003c/a> of all the scope-of-practice bills. On August 30, it failed to move out of committee. The Los Angeles Times\u003ca href=\"http://www.latimes.com/local/la-me-healthcare-20130902,0,3526045.story\" target=\"_blank\"> captured the mood\u003c/a>:\u003c/div>\n\u003cdiv>\n\u003cblockquote>\u003cp>The proposal failed in a committee Friday, under fire from the California Medical Assn., the powerful lobbying arm for the state's physicians. The organization teamed with some specialists and labor unions to mobilize lobbyists, engage doctors across the state and even dedicate Twitter accounts as it waged its campaign against the bill. ...\u003c/p>\n\u003cp>Jockeying over the scope of medical professionals' practice has intensified this year as California prepares for full implementation of the new national healthcare law, which will bring an influx of newly insured patients.\u003c/p>\n\u003cp>But \"the sticking point for the nurse practitioner bill [was] the word 'independent,'\" said Hernandez, who chairs the Senate health committee. \"For organized medicine, that's the … line in the sand.\"\u003c/p>\u003c/blockquote>\n\u003c/div>\n\u003cp>\u003cstrong> Optometrists (\u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0451-0500/sb_492_bill_20130508_amended_sen_v95.html\" target=\"_blank\">SB 492\u003c/a>) -- pulled from consideration by bill's author\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill would have allowed optometrists to prescribe more drugs and treat certain diseases. But Sen. Ed Hernandez (D-West Covina) opted to hold the bill to the next session, as the\u003ca href=\"http://blogs.sacbee.com/capitolalertlatest/2013/08/bill-expanding-optometrists-authority-on-hold-til-next-year.html\" target=\"_blank\"> Sacramento Bee\u003c/a> reported:\u003c/p>\n\u003cblockquote>\u003cp>\"We turned that into a two-year bill just to make sure we can continue working on it in committee, continue to work with the opposition,\" Hernandez told The Bee.\u003c/p>\n\u003cp>\"What we wanted to achieve we felt needed a little more conversation, and we felt it would just be better to work over the break on it.\" ...\u003c/p>\n\u003cp>Molly Weedn, a spokeswoman for the California Medical Association, said doctors hoped to reach compromise with Hernandez on the optometry bill the way they had on the bill regarding pharmacists.\u003c/p>\n\u003cp>\"We're glad there is extra time to work out what some of those difference are,\" she said. \"Our biggest concern has been and remains that patients are being treated by qualified health care professionals.\"\u003c/p>\n\u003cp>Hernandez said it's too soon to say what kind of compromise is in order:\u003c/p>\n\u003cp>\"We're not willing to give up on anything because we haven't had that conversation yet with the opposition.\"\u003c/p>\u003c/blockquote>\n\u003cdiv>And, as has been\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/06/bill-to-increase-abortion-providers-on-governors-desk/\" target=\"_blank\"> widely reported\u003c/a>,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB154\" target=\"_blank\"> AB 154\u003c/a>, which would permit specially trained clinicians to conduct aspiration abortions, went to the governor's desk earlier this month.\u003c/div>\n\n","blocks":[],"excerpt":"California's legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to expand access to primary care. These \"scope-of-practice\" bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown's desk.","status":"publish","parent":0,"modified":1379365592,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":966},"headData":{"title":"Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk | KQED","description":"California's legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to expand access to primary care. These "scope-of-practice" bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown's desk.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk","datePublished":"2013-09-13T17:52:32.000Z","dateModified":"2013-09-16T21:06:32.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"15004 http://blogs.kqed.org/stateofhealth/?p=15004","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/09/13/midwifery-physical-therapy-pharmacists-bills-move-to-governors-desk-scope-of-practice/","disqusTitle":"Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk","WpOldSlug":"midwifery-physical-therapy-pharmacists-bills-move-to-governors-desk","path":"/stateofhealth/15004/midwifery-physical-therapy-pharmacists-bills-move-to-governors-desk-scope-of-practice","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15016\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/115011610-e1379100622408.jpg\">\u003cimg class=\"size-large wp-image-15016\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/115011610-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>California's legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/12/the-primary-care-crunch-not-enough-doctors-and-more-patients-coming-engaged-patient/\" target=\"_blank\">expand access to primary care\u003c/a>. These \"scope-of-practice\" bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown's desk.\u003c/p>\n\u003cp>Here's a recap of some of the bills and where they stand now:\u003c/p>\n\u003cp>\u003cstrong>Midwifery Bill (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billVotesClient.xhtml\" target=\"_blank\">AB 1308\u003c/a>) -- headed to governor's desk\u003c/strong>\u003c/p>\n\u003cp>The \u003ca href=\"http://centerforhealthreporting.org/blog/update-midwifery-bill-moves-governor%E2%80%99s-desk1175\" target=\"_blank\">Center for Health Reporting writes\u003c/a> that the bill passed unanimously Thursday night and is now on the governor's desk. From the Center:\u003c/p>\n\u003cblockquote>\n\u003cp dir=\"ltr\">(L)icensed midwives were legally obligated to be supervised by physicians. If a doctor supervised a licensed midwife, however, the doctor ran the risk of losing liability insurance. So, collaboration was unattainable and advocates said this put women and babies at risk.\u003c/p>\n\u003cp dir=\"ltr\">The bill removes the requirement for licensed midwives to be supervised by a physician.\u003c/p>\n\u003cp dir=\"ltr\">“Because physician supervision was required but not available, the midwives often had to operate in the shadows,” said Shannon Smith-Crowley, a lobbyist for the American Congress of Obstetricians and Gynecologists (ACOG), a group representing OB/GYNs and the bill’s sponsor. “Midwives can be out in the open, helping them develop better relationships, warmer reception and protocols for transfer, ideally leading to earlier transfers in less dire circumstances.”\u003c/p>\n\u003c/blockquote>\n\u003cp>\u003cstrong>Physical Therapy (\u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/asm/ab_0951-1000/ab_1000_bill_20130906_amended_sen_v91.pdf\" target=\"_blank\">AB 1000\u003c/a>) -- headed to governor's desk\u003c!--more-->\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This bill would eliminate the need for patients to have a physician's diagnosis to receive physical therapy. Under the bill, patients could access physical therapy directly. But as \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/9/physical-therapist-bill-headed-to-governor\" target=\"_blank\">California Healthline \u003c/a>reports, the bill is both supported and opposed by physical therapists, some of whom want the governor to veto the bill:\u003c/p>\n\u003cblockquote>\u003cp>Paul Gaspar, president of the Independent Physical Therapists of California, said the bill wasn't really about direct patient access to therapy as much as it was about changing the financial relationship between physicians and physical therapists.\u003c/p>\n\u003cp>\"People who own [physical therapy] businesses are very concerned about this,\" Gaspar said. \"We feel threatened that people are going to take advantage of us.\"\u003c/p>\n\u003cp>Physician groups now will be able to directly hire physical therapists, and Gaspar said that means they'll be able to make money on the work of other providers. That bucks a national trend, he said, that goes against referral-for-profit plans.\u003c/p>\n\u003cp>Gaspar said his group will talk to the governor's office about the possibility of a veto, based in part on national legislation (\u003ca href=\"http://thomas.loc.gov/cgi-bin/bdquery/z?d113:hr.2914:\" target=\"_blank\">HR 2914\u003c/a>) by Rep. Jackie Speier (D-San Mateo) that may conflict with the state law.\u003c/p>\n\u003cp>Wieckowski said direct access to physical therapists can only be good for consumers.\u003c/p>\n\u003cp>\"This bill helps streamline health care delivery in California and will help patients get the access they need,\" he said, \"rather than losing valuable time with unnecessary and costly delays.\"\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong> Pharmacists (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml\" target=\"_blank\">SB 493\u003c/a>) -- headed to governor's desk\u003c/strong>\u003c/p>\n\u003cp>This bill allows pharmacists to order some lab tests and prescribe smoking cessation drugs. From \u003ca href=\"http://www.sacbee.com/2013/09/11/5728426/bill-would-expand-role-of-pharmacists.html#storylink=cpy\" target=\"_blank\">The Sacramento Bee\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The legislation is part of what had been a package from Democratic Sen. Ed Hernandez of \u003ca href=\"http://topics.sacbee.com/West+Covina/\" rel=\"nofollow\">West Covina\u003c/a> intended to help address the state's expected shortage of primary care physicians. ...\u003c/p>\n\u003cp>Supporters, which include pharmacy schools and \u003ca href=\"http://topics.sacbee.com/Blue+Shield/\" rel=\"nofollow\">Blue Shield\u003c/a> of California, say the legislation would allow pharmacists to better use their training and could help control \u003ca href=\"http://topics.sacbee.com/health+care+costs/\" rel=\"nofollow\">health care costs.\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cdiv>\u003cstrong>Nurse Practitioners (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB491\" target=\"_blank\">SB 491\u003c/a>) -- stuck in committee\u003c/strong>\u003c/div>\n\u003cdiv>This bill was \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/09/debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities/\" target=\"_blank\">one of the most hotly contested\u003c/a> of all the scope-of-practice bills. On August 30, it failed to move out of committee. The Los Angeles Times\u003ca href=\"http://www.latimes.com/local/la-me-healthcare-20130902,0,3526045.story\" target=\"_blank\"> captured the mood\u003c/a>:\u003c/div>\n\u003cdiv>\n\u003cblockquote>\u003cp>The proposal failed in a committee Friday, under fire from the California Medical Assn., the powerful lobbying arm for the state's physicians. The organization teamed with some specialists and labor unions to mobilize lobbyists, engage doctors across the state and even dedicate Twitter accounts as it waged its campaign against the bill. ...\u003c/p>\n\u003cp>Jockeying over the scope of medical professionals' practice has intensified this year as California prepares for full implementation of the new national healthcare law, which will bring an influx of newly insured patients.\u003c/p>\n\u003cp>But \"the sticking point for the nurse practitioner bill [was] the word 'independent,'\" said Hernandez, who chairs the Senate health committee. \"For organized medicine, that's the … line in the sand.\"\u003c/p>\u003c/blockquote>\n\u003c/div>\n\u003cp>\u003cstrong> Optometrists (\u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0451-0500/sb_492_bill_20130508_amended_sen_v95.html\" target=\"_blank\">SB 492\u003c/a>) -- pulled from consideration by bill's author\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill would have allowed optometrists to prescribe more drugs and treat certain diseases. But Sen. Ed Hernandez (D-West Covina) opted to hold the bill to the next session, as the\u003ca href=\"http://blogs.sacbee.com/capitolalertlatest/2013/08/bill-expanding-optometrists-authority-on-hold-til-next-year.html\" target=\"_blank\"> Sacramento Bee\u003c/a> reported:\u003c/p>\n\u003cblockquote>\u003cp>\"We turned that into a two-year bill just to make sure we can continue working on it in committee, continue to work with the opposition,\" Hernandez told The Bee.\u003c/p>\n\u003cp>\"What we wanted to achieve we felt needed a little more conversation, and we felt it would just be better to work over the break on it.\" ...\u003c/p>\n\u003cp>Molly Weedn, a spokeswoman for the California Medical Association, said doctors hoped to reach compromise with Hernandez on the optometry bill the way they had on the bill regarding pharmacists.\u003c/p>\n\u003cp>\"We're glad there is extra time to work out what some of those difference are,\" she said. \"Our biggest concern has been and remains that patients are being treated by qualified health care professionals.\"\u003c/p>\n\u003cp>Hernandez said it's too soon to say what kind of compromise is in order:\u003c/p>\n\u003cp>\"We're not willing to give up on anything because we haven't had that conversation yet with the opposition.\"\u003c/p>\u003c/blockquote>\n\u003cdiv>And, as has been\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/06/bill-to-increase-abortion-providers-on-governors-desk/\" target=\"_blank\"> widely reported\u003c/a>,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB154\" target=\"_blank\"> AB 154\u003c/a>, which would permit specially trained clinicians to conduct aspiration abortions, went to the governor's desk earlier this month.\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/15004/midwifery-physical-therapy-pharmacists-bills-move-to-governors-desk-scope-of-practice","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_37","stateofhealth_589"],"featImg":"stateofhealth_15016","label":"stateofhealth"},"stateofhealth_14982":{"type":"posts","id":"stateofhealth_14982","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"14982","score":null,"sort":[1379026102000]},"guestAuthors":[],"slug":"the-primary-care-crunch-not-enough-doctors-and-more-patients-coming-engaged-patient","title":"The Primary Care Crunch: Not Enough Doctors and More Patients Coming","publishDate":1379026102,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_14991\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126488183-e1379026016774.jpg\">\u003cimg class=\"size-full wp-image-14991\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126488183-e1379026016774.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"564\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/09/126488183-e1379026016774.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/09/126488183-e1379026016774-400x353.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/09/126488183-e1379026016774-320x282.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The full implementation of Obamacare and (potentially) millions more insured is now just over 100 days away, on Jan. 1. Questions abound: W\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/24/young-adults-key-to-obamacare-in-california/\" target=\"_blank\">ill young, healthy people really sign up?\u003c/a> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/23/californias-health-insurance-exchange-sets-plans-premiums-no-apparent-rate-shock/\" target=\"_blank\">How much will my premium be? \u003c/a>\u003ca href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" target=\"_blank\">How does the Affordable Care Act work anyway? \u003c/a>\u003c/p>\n\u003cp>Floating around in all those Obamacare discussions is another question: Who is going to treat all the newly insured? After all, we already have\u003ca href=\"http://www.chcf.org/publications/2009/06/fewer-and-more-specialized--a-new-assessment-of-physician-supply-in-california\" target=\"_blank\"> a shortage \u003c/a>of primary care doctors. Out of 7 million uninsured in the state, Covered California estimates 1.4 million people could sign up for insurance next year. Plus another 1.4 million people will be newly eligible for Medi-Cal.\u003c/p>\n\u003cp>To address this question, San Francisco's Commonwealth Club invited me to \u003ca href=\"http://www.commonwealthclub.org/events/archive/podcast/primary-care-crunch-anticipating-doctor-shortage-after-obamacare-82813\" target=\"_blank\">moderate a discussion\u003c/a> about the shortage of primary care providers. Kevin Grumbach, a family physician and co-director at UC San Francisco's Center for Excellence in Primary Care, started off by defining the subject at hand.\u003c!--more-->\u003c/p>\n\u003cp>Primary care \"is about having someone who cares for you as a whole person,\" he said. \"What a shocking concept, right.\"\u003c/p>\n\u003cp>Judging from the laughter in the room, audience members hadn't had a lot of experience with being dealt with as a whole person in their medical encounters. Much has been written about \u003ca href=\"https://www.google.com/#q=lack+of+coordinated+health+care+\" target=\"_blank\">the lack of coordination in health care\u003c/a>. One example: when the surgeon confirms the incision is healing nicely, but is seemingly unaware that the patient has moved to ICU due to pulmonary failure. (Examples are not hard to come by; this one happened to the father of a dear friend of mine.)\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Bob Wiebe, chief medical officer of Dignity Health, pointed to two chief drivers of the primary care shortage: money and work environment. Taking money first, Wiebe noted that medical students often graduate with $200,000 to $300,000 of debt. While primary care doctors might earn $200,000 to $220,000 a year, he said, specialists can make double or triple that amount. In addition, primary care physicians work in a \"hectic, even chaotic environment\" defined by 15-minute appointments with patients.\u003c/p>\n\u003cp>\u003cstrong>Transformation needed\u003c/strong>\u003c/p>\n\u003cp>While \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/14/in-midst-of-physician-shortage-inland-empire-gets-new-medical-school/\" target=\"_blank\">educating more primary care doctors\u003c/a> would help, a bigger change is needed, all three panelists argued. Panelist Patricia Knight had a special perspective. She's a former nurse who became an attorney and now works as a \u003ca href=\"http://pacificcoasthealthadvocacy.com/about.html\" target=\"_blank\">patient advocate\u003c/a>. She talked about nurse practitioners, nurses with advanced training who, along with physician assistants, \"can handle many of the problems that come in and take care of them without ever having to involve the physicians.\" But she also urged caution before rushing ahead. She worries that if we try to \"churn out more nurse practitioners\" they might be lacking in the clinical experience necessary to do an effective job. Amending laws to allow these midlevel health providers to practice more independently has been a\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/09/debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities/\" target=\"_blank\"> hot topic in Sacramento\u003c/a>.\u003c/p>\n\u003cp>Grumbach argued for a new approach to primary care, a team-based approach. \"We need to deploy nurses, physicians, pharmacists, mental health personnel in the team. There's so much work to be done.\" He said that people in the U.S. who have diabetes are twice as likely to have an amputation as someone in Europe. That's because we haven't invested in \"nursing care, the head coaching, the health coaching, the support in how to control your diet, the fundamental primary care to keep that foot healthy so you don't wind up in the hospital.\"\u003c/p>\n\u003cp>Knight called for an innovation in the way people are seen. Instead of having an appointment, going home and then heading off to a specialist appointment at another location, the patient stays in the room and various health professionals come to the patient, all in one visit. She described how this could work for someone with diabetes or heart disease. \"Instead of seeing one (health care provider) in a silo, you have a group, and with the specialties together, (providers) are able to offer a broader scope of care in a concentrated time.\"\u003c/p>\n\u003cp>\u003cstrong>People don't want health care, they want health\u003c/strong>\u003c/p>\n\u003cp>Wiebe pointed to changes already coming, some related to new incentives under the Affordable Care Act. Already there are changes coming in payment systems. Instead of a fee-for-service model where doctors get paid for specific things they do to patients -- tests, treatments -- new approaches, such as a bundled payments, are coming into play. Physicians might receive a lump sum of money, an incentive to keep patients healthy.\u003c/p>\n\u003cp>Knight said that patients have a responsibility to oversee their own health and be more engaged. Patients should \"be prepared to the extent you can be for your appointment ... getting an overview of a condition. That enables you to go in and ask more questions, be prepared, be ready to interact with your team.\"\u003c/p>\n\u003cp>Grumbach believes the Affordable Care Act is a step ahead for the country, making sure that people have health insurance, but beyond that \"we need to fundamentally rethink how we deliver health care,\" he said. \"It does not makes sense to just cover more people with the same shoddy product.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.commonwealthclub.org/events/archive/podcast/primary-care-crunch-anticipating-doctor-shortage-after-obamacare-82813\" target=\"_blank\">Listen to the podcast of the one-hour discussion\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"The full implementation of Obamacare and (potentially) millions more insured is now just over 100 days away, on Jan. 1. Questions abound: Will young, healthy people really sign up? How much will my premium be? How does the Affordable Care Act work anyway?\r\n\r\nFloating around in all that Obamacare discussion is another question: Who is going to treat all the newly insured? After all, we already have a shortage of primary care doctors. Out of 7 million uninsured in the state, Covered California estimates 1.4 million people could sign up for insurance next year. Plus another 1.4 million people will be newly eligible for Medi-Cal.","status":"publish","parent":0,"modified":1379098130,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":864},"headData":{"title":"The Primary Care Crunch: Not Enough Doctors and More Patients Coming | KQED","description":"The full implementation of Obamacare and (potentially) millions more insured is now just over 100 days away, on Jan. 1. Questions abound: Will young, healthy people really sign up? How much will my premium be? How does the Affordable Care Act work anyway?\r\n\r\nFloating around in all that Obamacare discussion is another question: Who is going to treat all the newly insured? After all, we already have a shortage of primary care doctors. Out of 7 million uninsured in the state, Covered California estimates 1.4 million people could sign up for insurance next year. Plus another 1.4 million people will be newly eligible for Medi-Cal.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"The Primary Care Crunch: Not Enough Doctors and More Patients Coming","datePublished":"2013-09-12T22:48:22.000Z","dateModified":"2013-09-13T18:48:50.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"14982 http://blogs.kqed.org/stateofhealth/?p=14982","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/09/12/the-primary-care-crunch-not-enough-doctors-and-more-patients-coming-engaged-patient/","disqusTitle":"The Primary Care Crunch: Not Enough Doctors and More Patients Coming","path":"/stateofhealth/14982/the-primary-care-crunch-not-enough-doctors-and-more-patients-coming-engaged-patient","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14991\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126488183-e1379026016774.jpg\">\u003cimg class=\"size-full wp-image-14991\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126488183-e1379026016774.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"564\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/09/126488183-e1379026016774.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/09/126488183-e1379026016774-400x353.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/09/126488183-e1379026016774-320x282.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The full implementation of Obamacare and (potentially) millions more insured is now just over 100 days away, on Jan. 1. Questions abound: W\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/24/young-adults-key-to-obamacare-in-california/\" target=\"_blank\">ill young, healthy people really sign up?\u003c/a> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/23/californias-health-insurance-exchange-sets-plans-premiums-no-apparent-rate-shock/\" target=\"_blank\">How much will my premium be? \u003c/a>\u003ca href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" target=\"_blank\">How does the Affordable Care Act work anyway? \u003c/a>\u003c/p>\n\u003cp>Floating around in all those Obamacare discussions is another question: Who is going to treat all the newly insured? After all, we already have\u003ca href=\"http://www.chcf.org/publications/2009/06/fewer-and-more-specialized--a-new-assessment-of-physician-supply-in-california\" target=\"_blank\"> a shortage \u003c/a>of primary care doctors. Out of 7 million uninsured in the state, Covered California estimates 1.4 million people could sign up for insurance next year. Plus another 1.4 million people will be newly eligible for Medi-Cal.\u003c/p>\n\u003cp>To address this question, San Francisco's Commonwealth Club invited me to \u003ca href=\"http://www.commonwealthclub.org/events/archive/podcast/primary-care-crunch-anticipating-doctor-shortage-after-obamacare-82813\" target=\"_blank\">moderate a discussion\u003c/a> about the shortage of primary care providers. Kevin Grumbach, a family physician and co-director at UC San Francisco's Center for Excellence in Primary Care, started off by defining the subject at hand.\u003c!--more-->\u003c/p>\n\u003cp>Primary care \"is about having someone who cares for you as a whole person,\" he said. \"What a shocking concept, right.\"\u003c/p>\n\u003cp>Judging from the laughter in the room, audience members hadn't had a lot of experience with being dealt with as a whole person in their medical encounters. Much has been written about \u003ca href=\"https://www.google.com/#q=lack+of+coordinated+health+care+\" target=\"_blank\">the lack of coordination in health care\u003c/a>. One example: when the surgeon confirms the incision is healing nicely, but is seemingly unaware that the patient has moved to ICU due to pulmonary failure. (Examples are not hard to come by; this one happened to the father of a dear friend of mine.)\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Bob Wiebe, chief medical officer of Dignity Health, pointed to two chief drivers of the primary care shortage: money and work environment. Taking money first, Wiebe noted that medical students often graduate with $200,000 to $300,000 of debt. While primary care doctors might earn $200,000 to $220,000 a year, he said, specialists can make double or triple that amount. In addition, primary care physicians work in a \"hectic, even chaotic environment\" defined by 15-minute appointments with patients.\u003c/p>\n\u003cp>\u003cstrong>Transformation needed\u003c/strong>\u003c/p>\n\u003cp>While \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/14/in-midst-of-physician-shortage-inland-empire-gets-new-medical-school/\" target=\"_blank\">educating more primary care doctors\u003c/a> would help, a bigger change is needed, all three panelists argued. Panelist Patricia Knight had a special perspective. She's a former nurse who became an attorney and now works as a \u003ca href=\"http://pacificcoasthealthadvocacy.com/about.html\" target=\"_blank\">patient advocate\u003c/a>. She talked about nurse practitioners, nurses with advanced training who, along with physician assistants, \"can handle many of the problems that come in and take care of them without ever having to involve the physicians.\" But she also urged caution before rushing ahead. She worries that if we try to \"churn out more nurse practitioners\" they might be lacking in the clinical experience necessary to do an effective job. Amending laws to allow these midlevel health providers to practice more independently has been a\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/09/debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities/\" target=\"_blank\"> hot topic in Sacramento\u003c/a>.\u003c/p>\n\u003cp>Grumbach argued for a new approach to primary care, a team-based approach. \"We need to deploy nurses, physicians, pharmacists, mental health personnel in the team. There's so much work to be done.\" He said that people in the U.S. who have diabetes are twice as likely to have an amputation as someone in Europe. That's because we haven't invested in \"nursing care, the head coaching, the health coaching, the support in how to control your diet, the fundamental primary care to keep that foot healthy so you don't wind up in the hospital.\"\u003c/p>\n\u003cp>Knight called for an innovation in the way people are seen. Instead of having an appointment, going home and then heading off to a specialist appointment at another location, the patient stays in the room and various health professionals come to the patient, all in one visit. She described how this could work for someone with diabetes or heart disease. \"Instead of seeing one (health care provider) in a silo, you have a group, and with the specialties together, (providers) are able to offer a broader scope of care in a concentrated time.\"\u003c/p>\n\u003cp>\u003cstrong>People don't want health care, they want health\u003c/strong>\u003c/p>\n\u003cp>Wiebe pointed to changes already coming, some related to new incentives under the Affordable Care Act. Already there are changes coming in payment systems. Instead of a fee-for-service model where doctors get paid for specific things they do to patients -- tests, treatments -- new approaches, such as a bundled payments, are coming into play. Physicians might receive a lump sum of money, an incentive to keep patients healthy.\u003c/p>\n\u003cp>Knight said that patients have a responsibility to oversee their own health and be more engaged. Patients should \"be prepared to the extent you can be for your appointment ... getting an overview of a condition. That enables you to go in and ask more questions, be prepared, be ready to interact with your team.\"\u003c/p>\n\u003cp>Grumbach believes the Affordable Care Act is a step ahead for the country, making sure that people have health insurance, but beyond that \"we need to fundamentally rethink how we deliver health care,\" he said. \"It does not makes sense to just cover more people with the same shoddy product.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.commonwealthclub.org/events/archive/podcast/primary-care-crunch-anticipating-doctor-shortage-after-obamacare-82813\" target=\"_blank\">Listen to the podcast of the one-hour discussion\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/14982/the-primary-care-crunch-not-enough-doctors-and-more-patients-coming-engaged-patient","authors":["240"],"categories":["stateofhealth_12","stateofhealth_14"],"tags":["stateofhealth_365","stateofhealth_37"],"label":"stateofhealth"},"stateofhealth_12516":{"type":"posts","id":"stateofhealth_12516","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"12516","score":null,"sort":[1367601526000]},"guestAuthors":[],"slug":"how-nurses-and-other-mid-level-providers-fill-growing-gap-in-primary-care","title":"How Nurses and Other 'Mid-Level Providers' Fill Growing Gap in Primary Care","publishDate":1367601526,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>By Jose Martinez, KPCC\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_12531\" class=\"wp-caption alignleft\" style=\"max-width: 217px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/03/how-nurses-and-other-mid-level-providers-fill-growing-gap-in-primary-care/md000661/\" rel=\"attachment wp-att-12531\">\u003cimg class=\"size-medium wp-image-12531\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/Nurse_stethoscope-300x413.jpg\" alt=\"(Keith Brofsky/Getty Images)\" width=\"217\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Keith Brofsky/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Simmi Gandhi -- a family nurse practitioner at South LA's UMMA Community Clinic -- is at work early. When she calls a patient, she apologizes for waking the woman up. But she knew the woman was waiting for test results.\u003c/p>\n\u003cp>In Urdu, she tells the patient her mammogram shows the mass in the woman's breast isn't cancer. After Gandhi hangs up, she doesn't miss a beat: She starts debriefing for her next patient, who's been missing appointment for months.\u003c/p>\n\u003cp>\"Looks like he has diabetes,\" she says. \"I had asked for him to be able to get an appointment six weeks thereafter, so that was back in September. That was cancelled, and then he didn't come for two appointments that were rescheduled. And now he's finally back.\"\u003c/p>\n\u003cp>Simmi Gandhi is what's called a midlevel provider -- which includes registered nurses, physician assistants and nurse practitioners. These are medical professionals who are in-between physicians and lower skilled medical technicians and nurses. At the UMMA clinic, she provides a wide range of primary care people in need.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"A community like this has less resources,\" she says. \"A lot of the folks that live here have less education as I'm sure everybody's aware, our educational system is stressed so the basic education people get around their bodies ... is low.\"\u003c!--more-->\u003c/p>\n\u003cp>UMMA clinic sees many patients who have diabetes and hypertension but don't know how to deal manage their illnesses. Doctors often come at a premium in community clinics -- where salaries are lower -- so midlevel providers often shoulder the workload.\u003c/p>\n\u003cp>In an exam room, Gandhi examines her long-missing patient, Hamdi Badar, a 52-year-old taxi driver originally from Indonesia. He's had diabetes years, but because he's been AWOL from the clinic, it's now out of control.\u003c/p>\n\u003cp>Gandhi reminds him what poorly controlled diabetes can do. \"Sometimes that can mean that you get problems with your heart, right, you remember that?\" she asks him. \"With your eyes? With your kidneys?\"\u003c/p>\n\u003cp>Gandhi seems to have captured Badar's attention. \"I didn't realize it was so bad like that,\" he says.\u003c/p>\n\u003cp>About 2,000 patients walk into UMMA every year. Simmi Gandhi sees up to four patients an hour. Without her and her fellow mid-level providers, UMMA couldn't care for as many people as it does.\u003c/p>\n\u003cp>Five minutes away, at St. John's Well Child and Family Center, family nurse practitioner Alexis Gomez is checking up on 74-year-old Rafael Baez. He has high blood pressure, diabetes and a history of heart failure. So Gomez questions him in Spanish about his diet. Are you eating a lot of tortillas? No, says Baez. How about fruits and vegetables. Yes, Baez says. Gomez tells him that's good, because fruits and vegetables are important to his diet.\u003c/p>\n\u003cp>Gomez has an unusual vantage point. He was a doctor in Cuba and a midlevel provider in the U.S. He sees the importance of professionals like him to fill a yawning gap in primary care.\u003c/p>\n\u003cp>Gomez puts it in simple terms: If St. Johns' midlevel providers played hooky one day, it would be \"a disaster,\" he says.\u003c/p>\n\u003cp>Dr. Padra Nourparvar is the lone doctor at the same St. John's clinic where Gomez works. He agrees with Gomez and says there's a \"always a shortage\" of primary care providers in their clinic.\u003c/p>\n\u003cp>But Dr. Nourpavar says that doesn't mean mid-levels can replace doctors. He says that'll be true even as the patient load swells next year with people who'll gain health insurance under the Affordable Care Act's Medi-Cal expansion.\u003c/p>\n\u003cp>\"You cannot completely substitute physicians,\" he says. \"Because then the quality of the care can go down. You need ... [some] people with more experience and higher education to also be involved, to make sure that the quality is not compromised.\"\u003c/p>\n\u003cp>Back at UMMA clinic Dr. Felix Aguilar its president and CEO, disagrees. \"The future is not with physicians; the future of primary care will be with what we call mid-level providers.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201305030850b.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201305030850b.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n","blocks":[],"excerpt":"Simmi Gandhi -- a family nurse practitioner at South LA's UMMA Community Clinic -- is at work early. When she calls a patient, she apologizes for waking the woman up. But she knew the woman was waiting for test results.\r\n\r\nIn Urdu, she tells the patient her mammogram shows the mass in the woman's breast isn't cancer. After Gandhi hangs up, she doesn't miss a beat: She starts debriefing for her next patient, who's been missing appointment for months.","status":"publish","parent":0,"modified":1376070066,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":21,"wordCount":699},"headData":{"title":"How Nurses and Other 'Mid-Level Providers' Fill Growing Gap in Primary Care | KQED","description":"Simmi Gandhi -- a family nurse practitioner at South LA's UMMA Community Clinic -- is at work early. When she calls a patient, she apologizes for waking the woman up. But she knew the woman was waiting for test results.\r\n\r\nIn Urdu, she tells the patient her mammogram shows the mass in the woman's breast isn't cancer. After Gandhi hangs up, she doesn't miss a beat: She starts debriefing for her next patient, who's been missing appointment for months.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"How Nurses and Other 'Mid-Level Providers' Fill Growing Gap in Primary Care","datePublished":"2013-05-03T17:18:46.000Z","dateModified":"2013-08-09T17:41:06.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"12516 http://blogs.kqed.org/stateofhealth/?p=12516","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/05/03/how-nurses-and-other-mid-level-providers-fill-growing-gap-in-primary-care/","disqusTitle":"How Nurses and Other 'Mid-Level Providers' Fill Growing Gap in Primary Care","path":"/stateofhealth/12516/how-nurses-and-other-mid-level-providers-fill-growing-gap-in-primary-care","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Jose Martinez, KPCC\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_12531\" class=\"wp-caption alignleft\" style=\"max-width: 217px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/03/how-nurses-and-other-mid-level-providers-fill-growing-gap-in-primary-care/md000661/\" rel=\"attachment wp-att-12531\">\u003cimg class=\"size-medium wp-image-12531\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/Nurse_stethoscope-300x413.jpg\" alt=\"(Keith Brofsky/Getty Images)\" width=\"217\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Keith Brofsky/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Simmi Gandhi -- a family nurse practitioner at South LA's UMMA Community Clinic -- is at work early. When she calls a patient, she apologizes for waking the woman up. But she knew the woman was waiting for test results.\u003c/p>\n\u003cp>In Urdu, she tells the patient her mammogram shows the mass in the woman's breast isn't cancer. After Gandhi hangs up, she doesn't miss a beat: She starts debriefing for her next patient, who's been missing appointment for months.\u003c/p>\n\u003cp>\"Looks like he has diabetes,\" she says. \"I had asked for him to be able to get an appointment six weeks thereafter, so that was back in September. That was cancelled, and then he didn't come for two appointments that were rescheduled. And now he's finally back.\"\u003c/p>\n\u003cp>Simmi Gandhi is what's called a midlevel provider -- which includes registered nurses, physician assistants and nurse practitioners. These are medical professionals who are in-between physicians and lower skilled medical technicians and nurses. At the UMMA clinic, she provides a wide range of primary care people in need.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"A community like this has less resources,\" she says. \"A lot of the folks that live here have less education as I'm sure everybody's aware, our educational system is stressed so the basic education people get around their bodies ... is low.\"\u003c!--more-->\u003c/p>\n\u003cp>UMMA clinic sees many patients who have diabetes and hypertension but don't know how to deal manage their illnesses. Doctors often come at a premium in community clinics -- where salaries are lower -- so midlevel providers often shoulder the workload.\u003c/p>\n\u003cp>In an exam room, Gandhi examines her long-missing patient, Hamdi Badar, a 52-year-old taxi driver originally from Indonesia. He's had diabetes years, but because he's been AWOL from the clinic, it's now out of control.\u003c/p>\n\u003cp>Gandhi reminds him what poorly controlled diabetes can do. \"Sometimes that can mean that you get problems with your heart, right, you remember that?\" she asks him. \"With your eyes? With your kidneys?\"\u003c/p>\n\u003cp>Gandhi seems to have captured Badar's attention. \"I didn't realize it was so bad like that,\" he says.\u003c/p>\n\u003cp>About 2,000 patients walk into UMMA every year. Simmi Gandhi sees up to four patients an hour. Without her and her fellow mid-level providers, UMMA couldn't care for as many people as it does.\u003c/p>\n\u003cp>Five minutes away, at St. John's Well Child and Family Center, family nurse practitioner Alexis Gomez is checking up on 74-year-old Rafael Baez. He has high blood pressure, diabetes and a history of heart failure. So Gomez questions him in Spanish about his diet. Are you eating a lot of tortillas? No, says Baez. How about fruits and vegetables. Yes, Baez says. Gomez tells him that's good, because fruits and vegetables are important to his diet.\u003c/p>\n\u003cp>Gomez has an unusual vantage point. He was a doctor in Cuba and a midlevel provider in the U.S. He sees the importance of professionals like him to fill a yawning gap in primary care.\u003c/p>\n\u003cp>Gomez puts it in simple terms: If St. Johns' midlevel providers played hooky one day, it would be \"a disaster,\" he says.\u003c/p>\n\u003cp>Dr. Padra Nourparvar is the lone doctor at the same St. John's clinic where Gomez works. He agrees with Gomez and says there's a \"always a shortage\" of primary care providers in their clinic.\u003c/p>\n\u003cp>But Dr. Nourpavar says that doesn't mean mid-levels can replace doctors. He says that'll be true even as the patient load swells next year with people who'll gain health insurance under the Affordable Care Act's Medi-Cal expansion.\u003c/p>\n\u003cp>\"You cannot completely substitute physicians,\" he says. \"Because then the quality of the care can go down. You need ... [some] people with more experience and higher education to also be involved, to make sure that the quality is not compromised.\"\u003c/p>\n\u003cp>Back at UMMA clinic Dr. Felix Aguilar its president and CEO, disagrees. \"The future is not with physicians; the future of primary care will be with what we call mid-level providers.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201305030850b.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201305030850b.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/12516/how-nurses-and-other-mid-level-providers-fill-growing-gap-in-primary-care","authors":["8344"],"categories":["stateofhealth_11"],"tags":["stateofhealth_37"],"featImg":"stateofhealth_12531","label":"stateofhealth"},"stateofhealth_12005":{"type":"posts","id":"stateofhealth_12005","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"12005","score":null,"sort":[1365458112000]},"guestAuthors":[],"slug":"immigrant-doctors-help-ease-californias-primary-care-doctor-shortage","title":"Immigrant Doctors Help Ease California's Primary Care Doctor Shortage","publishDate":1365458112,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>By \u003ca href=\"http://www.kaiserhealthnews.org/Reporters/GoldJ.aspx\">Jenny Gold\u003c/a>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/April/04/california-doctors-primary-care-latin-america.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cdiv>\n\u003cfigure id=\"attachment_12010\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/08/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage/immigrant-doc-300_jennygold_khn/\" rel=\"attachment wp-att-12010\">\u003cimg class=\"size-full wp-image-12010\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/immigrant-doc-300_JennyGold_KHN.jpg\" alt=\"Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>It's a familiar story in California.\u003c/p>\n\u003cp>When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get -- stocking warehouses, construction, cleaning houses and working in a meat processing plant.\u003c/p>\n\u003cp>But unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs. At night he studied for the boards.\u003c/p>\n\u003caside class=\"pullquote alignright\">Hundreds, maybe thousands, of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. That’s a wasted resource.\u003c/aside>\n\u003cp>“I had to do it. And I wouldn’t complain,” says Chavez. “It was OK to me. I mean, of course medicine is my passion, but since I didn’t have a license here, I couldn’t practice it.”\u003c/p>\n\u003cp>A quarter of U.S. doctors are foreign-born, mostly from countries like India that focus on training medical students to work in the U.S. Many other immigrant physicians never become American doctors, particularly those who come from Latin American countries like Chavez.\u003c/p>\n\u003cp>But a program at the University of California is seeking to change that, while at the same time helping to address \u003ca href=\"http://www.npr.org/2012/08/07/158370069/the-prognosis-for-the-shortage-in-primary-care\" target=\"_blank\">the shortage of primary care doctors\u003c/a> in the state. The UCLA \u003ca href=\"http://fm.mednet.ucla.edu/IMG/img_program.asp\" target=\"_blank\">International Medical Graduate Program\u003c/a> offers Latino doctors a stipend along with board preparation classes, mentorship and references to help them find a good residency slot in primary care. In return, the doctors pledge to work in an underserved area of California for two or three years.\u003c!--more-->\u003c/p>\n\u003cp>The program at UCLA was founded by Dr. Patrick Dowling and Dr. Michelle Bholat to help address the shortage of primary care doctors in the state, and a particular shortage of doctors of Latin American heritage. Though more than one-third of California’s population is Hispanic, only 5 percent of its doctors are.\u003c/p>\n\u003cp>In addition, nearly half of the estimated \u003ca href=\"http://www.healthexchange.ca.gov/BoardMeetings/Documents/November%2014_2012/IX_HBEX_CoveredCaBoardLevel2-Blueprint11-14-2012_Final.pdf\">5 million Californians\u003c/a> expected to be newly eligible for health insurance under the Affordable Care Act are Latino, and Dowling says it’s key that patients see a doctor who understands their language and culture.\u003c/p>\n\u003cp>“You can either do total body cat scans on everybody or you can sit down and try to understand what the patient is saying and why and what’s going on in their life,” says Dowling.\u003c/p>\n\u003cp>The program is small. But slowly, it’s making a dent. Chavez was able to pass his medical exams in two years. Today, he’s hard at work as a first-year resident at the Riverside County Regional Medical Center. Most of his patients are Hispanic, and many are immigrants like him.\u003c/p>\n\u003cp>Graciela Jauregui came to the clinic with severe pain in her knee. She was born in Mexico but has lived in the U.S. for 17 years, working as a housekeeper. She’s 62 and doesn’t speak English. She says she always prefers to see a doctor who can actually understand her.\u003c/p>\n\u003cp>Speaking through an interpreter, Jauregui says, “All doctors are good people, but when they speak Spanish it’s better.”\u003c/p>\n\u003cp>Chavez’s fluency in Spanish is prized by his boss, Riverside’s chief of family medicine Dr. Geoffrey Leung. Leung says the clinic employs translators, but they are often in short supply. And even \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2009/April/21/Medical-Interpreters.aspx\" target=\"_blank\">with a translator\u003c/a>, important details can be lost.\u003c/p>\n\u003cp>“No matter how good of a translator you have, your concern is that you may lose some part of the integrity of the message,” Leung says.\u003c/p>\n\u003cp>So far, the UCLA program has placed 54 Hispanic doctors into family medicine training programs –- Dowling says that’s almost as many as came from all 10 California medical schools put together.\u003c/p>\n\u003cp>Dowling says hundreds and maybe thousands of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. And that’s a wasted resource.\u003c/p>\n\u003cp>“I was just reviewing an applicant this morning who’s currently working in McDonalds,” Dowling says. “And I thought of the irony: She’s serving people Big Macs right now and what she could be doing is explaining to people that isn’t what you want you want to be eating.”\u003c/p>\n\u003cp>Chavez, for his part, is happy to be treating patients again: “[It] gave me the opportunity to stop working and focus full-time on studying. Without the program, I would still be working on construction.”\u003c/p>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":"When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get -- stocking warehouses, construction, cleaning houses and working in a meat processing plant.\r\n\r\nBut unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs and at night he studied for the boards.\r\n","status":"publish","parent":0,"modified":1365627038,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":21,"wordCount":866},"headData":{"title":"Immigrant Doctors Help Ease California's Primary Care Doctor Shortage | KQED","description":"When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get -- stocking warehouses, construction, cleaning houses and working in a meat processing plant.\r\n\r\nBut unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs and at night he studied for the boards.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Immigrant Doctors Help Ease California's Primary Care Doctor Shortage","datePublished":"2013-04-08T21:55:12.000Z","dateModified":"2013-04-10T20:50:38.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"12005 http://blogs.kqed.org/stateofhealth/?p=12005","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/04/08/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage/","disqusTitle":"Immigrant Doctors Help Ease California's Primary Care Doctor Shortage","path":"/stateofhealth/12005/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>By \u003ca href=\"http://www.kaiserhealthnews.org/Reporters/GoldJ.aspx\">Jenny Gold\u003c/a>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/April/04/california-doctors-primary-care-latin-america.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cdiv>\n\u003cfigure id=\"attachment_12010\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/08/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage/immigrant-doc-300_jennygold_khn/\" rel=\"attachment wp-att-12010\">\u003cimg class=\"size-full wp-image-12010\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/immigrant-doc-300_JennyGold_KHN.jpg\" alt=\"Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>It's a familiar story in California.\u003c/p>\n\u003cp>When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get -- stocking warehouses, construction, cleaning houses and working in a meat processing plant.\u003c/p>\n\u003cp>But unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs. At night he studied for the boards.\u003c/p>\n\u003caside class=\"pullquote alignright\">Hundreds, maybe thousands, of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. That’s a wasted resource.\u003c/aside>\n\u003cp>“I had to do it. And I wouldn’t complain,” says Chavez. “It was OK to me. I mean, of course medicine is my passion, but since I didn’t have a license here, I couldn’t practice it.”\u003c/p>\n\u003cp>A quarter of U.S. doctors are foreign-born, mostly from countries like India that focus on training medical students to work in the U.S. Many other immigrant physicians never become American doctors, particularly those who come from Latin American countries like Chavez.\u003c/p>\n\u003cp>But a program at the University of California is seeking to change that, while at the same time helping to address \u003ca href=\"http://www.npr.org/2012/08/07/158370069/the-prognosis-for-the-shortage-in-primary-care\" target=\"_blank\">the shortage of primary care doctors\u003c/a> in the state. The UCLA \u003ca href=\"http://fm.mednet.ucla.edu/IMG/img_program.asp\" target=\"_blank\">International Medical Graduate Program\u003c/a> offers Latino doctors a stipend along with board preparation classes, mentorship and references to help them find a good residency slot in primary care. In return, the doctors pledge to work in an underserved area of California for two or three years.\u003c!--more-->\u003c/p>\n\u003cp>The program at UCLA was founded by Dr. Patrick Dowling and Dr. Michelle Bholat to help address the shortage of primary care doctors in the state, and a particular shortage of doctors of Latin American heritage. Though more than one-third of California’s population is Hispanic, only 5 percent of its doctors are.\u003c/p>\n\u003cp>In addition, nearly half of the estimated \u003ca href=\"http://www.healthexchange.ca.gov/BoardMeetings/Documents/November%2014_2012/IX_HBEX_CoveredCaBoardLevel2-Blueprint11-14-2012_Final.pdf\">5 million Californians\u003c/a> expected to be newly eligible for health insurance under the Affordable Care Act are Latino, and Dowling says it’s key that patients see a doctor who understands their language and culture.\u003c/p>\n\u003cp>“You can either do total body cat scans on everybody or you can sit down and try to understand what the patient is saying and why and what’s going on in their life,” says Dowling.\u003c/p>\n\u003cp>The program is small. But slowly, it’s making a dent. Chavez was able to pass his medical exams in two years. Today, he’s hard at work as a first-year resident at the Riverside County Regional Medical Center. Most of his patients are Hispanic, and many are immigrants like him.\u003c/p>\n\u003cp>Graciela Jauregui came to the clinic with severe pain in her knee. She was born in Mexico but has lived in the U.S. for 17 years, working as a housekeeper. She’s 62 and doesn’t speak English. She says she always prefers to see a doctor who can actually understand her.\u003c/p>\n\u003cp>Speaking through an interpreter, Jauregui says, “All doctors are good people, but when they speak Spanish it’s better.”\u003c/p>\n\u003cp>Chavez’s fluency in Spanish is prized by his boss, Riverside’s chief of family medicine Dr. Geoffrey Leung. Leung says the clinic employs translators, but they are often in short supply. And even \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2009/April/21/Medical-Interpreters.aspx\" target=\"_blank\">with a translator\u003c/a>, important details can be lost.\u003c/p>\n\u003cp>“No matter how good of a translator you have, your concern is that you may lose some part of the integrity of the message,” Leung says.\u003c/p>\n\u003cp>So far, the UCLA program has placed 54 Hispanic doctors into family medicine training programs –- Dowling says that’s almost as many as came from all 10 California medical schools put together.\u003c/p>\n\u003cp>Dowling says hundreds and maybe thousands of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. And that’s a wasted resource.\u003c/p>\n\u003cp>“I was just reviewing an applicant this morning who’s currently working in McDonalds,” Dowling says. “And I thought of the irony: She’s serving people Big Macs right now and what she could be doing is explaining to people that isn’t what you want you want to be eating.”\u003c/p>\n\u003cp>Chavez, for his part, is happy to be treating patients again: “[It] gave me the opportunity to stop working and focus full-time on studying. Without the program, I would still be working on construction.”\u003c/p>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/12005/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage","authors":["240"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_415","stateofhealth_407","stateofhealth_37"],"featImg":"stateofhealth_12010","label":"stateofhealth"},"stateofhealth_11260":{"type":"posts","id":"stateofhealth_11260","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"11260","score":null,"sort":[1363016092000]},"guestAuthors":[],"slug":"the-doctor-will-see-you-now-virtually","title":"The Doctor Will See You Now -- Virtually","publishDate":1363016092,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_11271\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/11/the-doctor-will-see-you-now-virtually/screen-shot-2013-02-01-at-2-51-53-pm/\" rel=\"attachment wp-att-11271\">\u003cimg class=\"size-medium wp-image-11271\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-02-01-at-2.51.53-PM-300x177.png\" alt=\"A demonstration of CareSimple's virtual house call.\" width=\"300\" height=\"177\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A demonstration of CareSimple's virtual house call.\u003c/figcaption>\u003c/figure>\n\u003cp>Remember the really old days of house calls? A kindly doctor with a black bag would come to your house and treat your (often minor) complaint?\u003c/p>\n\u003cp>Frankly, I don't remember those days either. But I have heard of the house call, and now Carena, a Seattle-based company, is expanding into California with a 21st century house call -- a virtual house call.\u003c/p>\n\u003cp>It works like this: like everything these days, you first create an account. When you need care, you log on and request a visit. Within 30 minutes, Carena says, a doctor or nurse practitioner will contact you by phone or email (your choice). If it's email, you will get a link to a secure \"virtual exam room.\" (The man in the photo above is Dr. Ben Green, in a virtual exam room.)\u003c/p>\n\u003cp>From there you are diagnosed. If you need a prescription, CareSimple says its doctors are licensed in California and can phone in a prescription to your pharmacy. The service is $25/month with a $5 per visit fee. Or you can pay for a single visit, without the membership. That's $85.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Carena's CEO Ralph Derrickson says this kind of service is driven by several factors, not the least of which is technological advancement which permits secure video conferencing. But Derrickson also points out that the prevalence of high-deductible health plans, sometimes $5,000, makes a service like CareSimple appealing financially.\u003c/p>\n\u003cp>\"The way health care is getting paid for is changing,\" Derrickson says. \"The reality is that what used to be a $25 co-pay, in 2013 is becoming a $250 encounter. … We’re less expensive and done on your terms.”\u003c/p>\n\u003cp>And a visit to the ER can easily run over $1,000, which Derrickson says CareSimple can help clients avoid. If not, and a CareSimple doctor or nurse needs to refer you to the ER, then there's no charge for the CareSimple visit.\u003c/p>\n\u003cp>Dr. Sophia Chang is skeptical. She's with the California HealthCare Foundation and a practicing internist at San Francisco General Hospital. She wondered if this was a higher cost version of the nurse advice line and fretted about continuity of care, something which is already a challenge in American medicine.\u003c/p>\n\u003cp>\"It’s great to be able to answer primary style medical questions quickly at the convenience of the consumer,\" Chang says. \"The problem is that when it may be something that requires more than simple triage. There’s no mechnamism to link this to any testing. It’s all phone interaction or video interaction.\"\u003c/p>\n\u003cp>Derrickson and Green say the company's statistics show that more than 80 percent of the time, they are able to resolve a visit with advice or prescription.\u003c/p>\n\u003cp>Green says the company has been in business for several years in Washington state, and they've learned well what they can and cannot manage. \"We’ve developed skills, we’ve developed clinical protocols,\" he says. \"Our providers are a local group that we train independently here, and we focus on all the conditions that we are safely and effectively going to manage.\"\u003c/p>\n\u003cp>He specifies sinus infections, urinary tract infections, stomach viruses, flu and rashes, as common conditions CareSimple doctors can safely manage.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>They say all the doctors with the service are board certified, and their patient satisfaction rates in Washington have been greater than 95 percent.\u003c/p>\n\n","blocks":[],"excerpt":"Remember the really old days of house calls? A kindly doctor with a black bag would come to your house and treat your (usually minor) complaint?\r\n\r\nFrankly, I don't remember those days either. But I have heard of the house call, and now Carena, a Seattle-based company, is expanding into California with its virtual house call.","status":"publish","parent":0,"modified":1363030419,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":581},"headData":{"title":"The Doctor Will See You Now -- Virtually | KQED","description":"Remember the really old days of house calls? A kindly doctor with a black bag would come to your house and treat your (usually minor) complaint?\r\n\r\nFrankly, I don't remember those days either. But I have heard of the house call, and now Carena, a Seattle-based company, is expanding into California with its virtual house call.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"The Doctor Will See You Now -- Virtually","datePublished":"2013-03-11T15:34:52.000Z","dateModified":"2013-03-11T19:33:39.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"11260 http://blogs.kqed.org/stateofhealth/?p=11260","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/03/11/the-doctor-will-see-you-now-virtually/","disqusTitle":"The Doctor Will See You Now -- Virtually","path":"/stateofhealth/11260/the-doctor-will-see-you-now-virtually","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_11271\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/11/the-doctor-will-see-you-now-virtually/screen-shot-2013-02-01-at-2-51-53-pm/\" rel=\"attachment wp-att-11271\">\u003cimg class=\"size-medium wp-image-11271\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-02-01-at-2.51.53-PM-300x177.png\" alt=\"A demonstration of CareSimple's virtual house call.\" width=\"300\" height=\"177\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A demonstration of CareSimple's virtual house call.\u003c/figcaption>\u003c/figure>\n\u003cp>Remember the really old days of house calls? A kindly doctor with a black bag would come to your house and treat your (often minor) complaint?\u003c/p>\n\u003cp>Frankly, I don't remember those days either. But I have heard of the house call, and now Carena, a Seattle-based company, is expanding into California with a 21st century house call -- a virtual house call.\u003c/p>\n\u003cp>It works like this: like everything these days, you first create an account. When you need care, you log on and request a visit. Within 30 minutes, Carena says, a doctor or nurse practitioner will contact you by phone or email (your choice). If it's email, you will get a link to a secure \"virtual exam room.\" (The man in the photo above is Dr. Ben Green, in a virtual exam room.)\u003c/p>\n\u003cp>From there you are diagnosed. If you need a prescription, CareSimple says its doctors are licensed in California and can phone in a prescription to your pharmacy. The service is $25/month with a $5 per visit fee. Or you can pay for a single visit, without the membership. That's $85.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Carena's CEO Ralph Derrickson says this kind of service is driven by several factors, not the least of which is technological advancement which permits secure video conferencing. But Derrickson also points out that the prevalence of high-deductible health plans, sometimes $5,000, makes a service like CareSimple appealing financially.\u003c/p>\n\u003cp>\"The way health care is getting paid for is changing,\" Derrickson says. \"The reality is that what used to be a $25 co-pay, in 2013 is becoming a $250 encounter. … We’re less expensive and done on your terms.”\u003c/p>\n\u003cp>And a visit to the ER can easily run over $1,000, which Derrickson says CareSimple can help clients avoid. If not, and a CareSimple doctor or nurse needs to refer you to the ER, then there's no charge for the CareSimple visit.\u003c/p>\n\u003cp>Dr. Sophia Chang is skeptical. She's with the California HealthCare Foundation and a practicing internist at San Francisco General Hospital. She wondered if this was a higher cost version of the nurse advice line and fretted about continuity of care, something which is already a challenge in American medicine.\u003c/p>\n\u003cp>\"It’s great to be able to answer primary style medical questions quickly at the convenience of the consumer,\" Chang says. \"The problem is that when it may be something that requires more than simple triage. There’s no mechnamism to link this to any testing. It’s all phone interaction or video interaction.\"\u003c/p>\n\u003cp>Derrickson and Green say the company's statistics show that more than 80 percent of the time, they are able to resolve a visit with advice or prescription.\u003c/p>\n\u003cp>Green says the company has been in business for several years in Washington state, and they've learned well what they can and cannot manage. \"We’ve developed skills, we’ve developed clinical protocols,\" he says. \"Our providers are a local group that we train independently here, and we focus on all the conditions that we are safely and effectively going to manage.\"\u003c/p>\n\u003cp>He specifies sinus infections, urinary tract infections, stomach viruses, flu and rashes, as common conditions CareSimple doctors can safely manage.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>They say all the doctors with the service are board certified, and their patient satisfaction rates in Washington have been greater than 95 percent.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/11260/the-doctor-will-see-you-now-virtually","authors":["240"],"categories":["stateofhealth_12"],"tags":["stateofhealth_37"],"featImg":"stateofhealth_11271","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. 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Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. 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