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Health Professional Shortages i


									 Health Professional Shortages in the
  San Joaquin Valley: The Impact on
   Federally Qualified Health Clinics
 Deborah Riordan, PT, MPH

Central Valley Regional Network
June 1, 2007
  The Central Valley Health Policy
Institute is funded through a grant
  from The California Endowment.
    CVHPI History and Overview
   Established in 2002 and funded in 2003 by
    The California Endowment to solve the
    region’s health issues and educate
    decision makers and community leaders
   Focuses on health policy issues in 8 San
    Joaquin Valley Counties
   Regional Advisory Council of community
    and health leaders provides input and
    feedback to the Institute
           Institute Objectives
   Based on community feedback on needed
    research and education
       Conduct Valley- focused research and policy
       Train emerging leaders

       Provide master’s level training in health policy

       Connect evidence-based research with policy
       Promote collaboration to solve health system
    Research Focus (current and
 Uninsured adults in the San
  Joaquin Valley
 Environmental influences on
 Chronic diseases, mental health
  and substance abuse
 Health Professional Shortages
   Dr. John Capitman, Executive Director

   Cheryl Paul, Administrative Analyst

   Laurie Primavera, Associate Director

   Dr. Marlene Benjiamin, Research Associate

   Dr. Mathilda Ruwe, Research Associate
   Developed and conducted a survey in an effort to
    respond to regional concerns regarding health
    professional shortages (HPS) and their effect on
    the health of Valley residents

   Three primary objectives:

          Describe impact of HPS on access to primary care in
           the SJV

          Describe current patterns of health resources coming
           into the valley

          Identify new approaches to addressing the
           consequences of HPS
   All 8 counties have medically underserved
    areas/populations designations with
    Madera listed as a county-wide MUA/P

   All counties have shortage designations
    for primary care, dental and mental health
    Six of the eight counties have county-wide
    mental health shortage area designations
                                           Filled RN
    Location            County
  Merced MSA            Merced              257

 Bakersfield MSA         Kern               345
                         Tulare             429
 Porterville MSA
Stockton-Lodi MSA     San Joaquin           533

   Fresno MSA        Fresno, Madera         632

  Modesto MSA          Stanislaus           660

    California            All               622
  National Mean           N/A               787
                        All MDs/   Primary Care   Specialists/
                        100,000    MDs/100,000     100,000

San Joaquin Valley        173          87             43

Northern/Sierra Co.       226          107            55

Central Coast             274          116            79

Southern California       294          120            86

Sacramento Area           310          132            89

Greater Bay Area          415          170           122

California                302          126            87
   Surveyed 8 Federally Qualified Health Clinics
    (FQHC) with 60 clinic sites in the San Joaquin

   Clinics serve almost 300,000 patients, providing
    over one million visits/year

   Conducted by telephone (5), in person (2), by
    email (1)
         Clinic Position            Number of Participants

     Chief Executive Officer                  5

Chief Operating/Financial Officer             3

      Chief Medical Officer                   2

 Deputy Chief Executive Officer               1

     Director of Operations                   1

 Director of Integrated Services              1

Grants Management Coordinator                 1

       Site Administrator                     1
   Quantitative: The survey asked
    participants to rate how important or
    how often various
    clinic, patient, access dynamics were
    a factor in providing health care (17

   Qualitative: 15 open ended questions
    allowed clinics to express their
    unique experiences and strategies in
    addressing those factors
Quantitative Analysis Results
   All sites rated access to specialists and site
    limitations as very or extremely important
    in limiting their clinic’s ability to provide
    health care

   The majority of clinics rated other medical
    services, substance abuse, mental health
    and case management referrals as difficult
    most of the time or almost always
    Quantitative Analysis Results
   When comparing referral difficulty by insurance
    status, the majority of clinics noted that
    uninsured had difficulty accessing specialists half
    or more than half of the time (exception was

   For Medi-Cal patients access was difficult half or
    more than half of the time for 7 out of 20

   Paradoxically, for some specialties clinics
    reported difficult access more often for their
    Medi-Cal patients than their uninsured patients
    Quantitative Analysis Results

   Factors rated extremely important in limiting
    access to specialists by all sites were Medi-Cal
    and county indigent program reimbursement

   All clinics ranked low numbers of providers
    accepting Medi-Cal or uninsured patients and
    excess demand for specialty care as extremely or
    very important

   The low number of regional specialists was
    ranked as extremely important by ½ of the clinics
    and important or very important by the other ½.
Results of Qualitative Analysis
      Four recurring themes

   Inadequacy of Funding
   Recruiting Issues
   Capacity
   Specialty Access
    Strategies to Reduce the Impact of
          Professional Shortages
   Taking advantage of multiple federal, state and
    foundation funding opportunities

   Participation in Health Disparities Collaboration

   Develop informal and formal relationships for
    providing non-physician services

   Increased use of technology to increase clinic
   Modify and increase reimbursement rates

   Health Policy Changes

   Workforce Development

   “Demand that community providers accept
    Medi-Cal and uninsured patients”
   Educate the public as to the breadth and benefits
    of services FQHCs provide to the community

   Policy changes to remove 5 yr practice
    restrictions for Dentists coming to CA

   Continue the vision of developing “an integrated
    and collaborative model of patient care for FQHCs
    as advocated but not funded by federal, state and
    private funders”
                   Next Steps
   Survey expansion to document experiences from
    other community clinics in the SJV and state

   Explore the feasibility and barriers to
    implementing policy recommendations

   Clarify what statute or regulatory changes are
    needed to allow clinics to hire specialists as staff
    with appropriate reimbursement. Also determine
    their impact on health outcomes and clinic
                Next Steps
Another area for further study is to evaluate
 the effect of advancing the use of
 community health workers or
 “promotoras” in the community clinic
 model for use as practice extenders
      Best practices in training and scope of
      Sustainable funding/reimbursement
These findings can be used to:

   Compare differences between primary
    care settings

    To evaluate regional differences in the
    impact of HPS

   To provide direction to policy makers in
    resource allocation decisions

Efforts such as these are critical to
   developing healthcare reforms
    that effectively address the
    needs of providers and their
Report is available on the web at :

Or you may go to publications at the
 CVHPI website:

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