California’s “Physician Hiring Ban” Keeps Doctors From Serving Low Income Communities


Posted on 29 December 2009

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By Dr. Larry A. Bedard

While there are differences in opinion as to whether the various proposed reforms at the federal level will fix our heath care crisis, there should be no question that at the heart of the problem in California is the glaring shortage of doctors now practicing or in the pipeline to treat its rural and low income residents.

A snapshot of California Senate districts illustrates the severity of the problem: In Senator Florez’s District more than 20% of citizens live in areas designated by the U.S. Department of Health and Human Services as “Designated Physician Shortage Areas”; in Senator Negrete-McCloud’s district - nearly 15%; Senator Oropeza’s district – more than 15%; Senator Wyland’s district- nearly 10%.

In Senate President pro Tem Darrell Steinberg’s district more than 188,000 citizens live in physician shortage areas. Access to doctors in these and other areas throughout the state is inadequate and unacceptable.

Training more doctors is just part of the solution – and alone it isn’t enough. Building more rural medical schools like that proposed at U.C. Merced is positive, but what good is it to simply train more doctors when they can’t afford to stay and work in poor and rural communities? When they graduate – in order to make a living - they will need to practice in higher income, urban communities where most patients are privately insured.

Doctors simply cannot make a living treating patients in communities where the majority are covered by Medi-Cal or uninsured and where they are routinely reimbursed less than $25 per office visit when the actual cost of care is more than $50. Rurally-trained doctors don’t solve the access problem for poor communities. 

Here’s the part of the solution that is largely overlooked in California: Allow healthcare facilities serving poor and rural communities to directly employ the physicians they need. Pay doctors a competitive salary, offer them benefits, and remove the economic barrier that currently prevents them from treating the poor.

All but 5 states in the nation allow for direct physician hiring and in those states doctor shortages in poor communities are far lower than in California (or Texas – another state that still imposes a physician hiring ban).

Current legislation, SB 726 (Ashburn), would expand an exemption to California’s archaic “physician hiring ban”  and allow hospitals and clinics in medically underserved areas to effectively recruit and hire a limited number of doctors.

Support for this bill is broad and diverse and includes the California Medical Board, AARP, California Labor Federation, Association of California Healthcare Districts, Dolores Huerta Foundation, California State Association of Counties, JERICHO and California Hospital Association.

And, unlike the myriad of health care reforms being presented, it costs California taxpayers nothing.

I urge members of the California Senate who represent medically underserved citizens to look closely at this sound, no-cost, practical solution and vote for its passage. The time is now to lift this archaic statute that is part of the reason 3.6 million Californians don’t have adequate access to doctors.

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Dr. Larry A. Bedard is a physician in Marin County, former president of American College of Emergency Physicians and former chair of CMA’s Corporate Practice of Medicine Advisory Committee.

A truth that ought to be distressing to progressives as they look forward to health care reform and their utopia of the single-payer system....

Doctors simply cannot make a living treating patients in communities where the majority are covered by Medi-Cal or uninsured and where they are routinely reimbursed less than $25 per office visit when the actual cost of care is more than $50.

The fact is that Medicare and MediCal don't generally cover the cost of providing the services. These programs have - for years - been responsible for the above-COLA rate of the rise in health insurance premiums. They pay - at most - the marginal cost of providing care (and often far less than that) forcing medical facilities and providers to overcharge those with insurance or who pay cash to cover the actual costs of providing health care to everyone.

I have no gripe about repealing the physician hiring ban - but to 'Pay doctors a competitive salary, offer them benefits, and remove the economic barrier that currently prevents them from treating the poor' requires more than the rem,oval of this law, because that in and of itself does nothing to remove the economic barrier.

Yes, the federal government can MANDATE that hospital facilities (and even, I suppose, providers) treat these people for a reimbursement that is less than the actual cost of providing it, but they can't keep them doing it for long without providing more funds, because the barrier is economic - not this law.

Until and unless Congress actually starts to fund its unfunded social mandates - that is to pay what it ACTUALLY costs to provide them - be they 'no child left behind' or Medicare and MediCal, the promised utopia can never be realized.

As if to make my point, the Mayo Clinic has now decided to institute a "pilot" program to stop accepting MediCare patients.

http://www.bloomberg.com/apps/news?pid=20601070&sid=aHoYSI84VdL0

The Mayo Clinic, touted as the vanguard of future health care by the Obama administration, LOST $840 million last year treating Medicare patients - losses that the non-profit passed on to the rest of us.

Congress is scamming us on health care - they've been doing it for a long time.