In 2016, the California legislature passed a budget that included historic support for and expansion of primary care graduate medical education (GME) in medically underserved areas, committing to invest $100 million over three years ($33 million each year) in health care workforce funding. Unfortunately, Governor Jerry Brown is proposing to eliminate the first year of that funding in his 2017-2018 state budget, and has discontinued any additional funding in the future for this purpose. CMA believes these proposed cuts are short-sighted and reckless, and would exacerbate our state's already serious access to care problems.

The $100 million budget appropriation was meant to support and expand primary care residency training and programs in medically underserved areas through the Song-Brown Workforce Training Program and targeted investment in teaching hospitals. The goal is to create a reliable and continuous funding stream that primary care residency programs in California so desperately need.

“A robust, well-trained primary care workforce is essential to meeting the health care demands of all Californians,” said California Medical Association (CMA) President Ruth E. Haskins, M.D. “The legislature’s move to restore and stabilize funding for these programs was an important first step toward reversing our shortage of primary care physicians, particularly in the underserved communities that need it the most.”

Without this appropriation, California primary care training programs cannot replace significant federal and private foundation grants that recently expired, including $18 million in federal Health Resources and Services Administration funding for the Primary Care Residency Expansion program; a $21 million California Endowment grant to the Song-Brown Program; $15 million allotted through the federal Teaching Health Center program; and a one-time $4 million California Health Data and Planning Fund appropriation to Song-Brown.

California faces a drastic shortage of primary care physicians. Even if these cuts were replaced dollar for dollar, California would struggle to provide sufficient access to primary care. The federally recommended number of primary care physicians per 100,000 people is 70. According to the Council on Graduate Medical Education, 23 of California’s 58 counties fall below the minimum required primary care physician-to-population ratio. Our state's primary care physician shortage is expected to get exponentially worse as the population continues to grow and our aging physician workforce moves toward retirement. That’s why this new appropriation is so critical.

Inadequate funding for residency programs also means that hundreds of graduating medical students don't find a residency slot to continue their training – forcing talented young doctors who want to stay and practice in California to other states and communities.

“The governor’s proposed elimination of funding is of serious concern in California as our primary care residency programs have recently lost more than $60 million,” said Michelle Quiogue, M.D., president-elect of the California Academy of Family Physicians. “Last year’s appropriation was intended to save these programs, but this proposed cut would be devastating, causing programs to close and exacerbating serious access problems for some of the state’s most vulnerable patients.”

CMA will be working through the budget negotiation process to restore this critical funding. We are also urging physicians, residents and medical students to ask their legislators to oppose Governor Brown’s budget proposal to eliminate the physician workforce funding.