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A New View of the Complexion of the California Physician Workforce: Preliminary Data From the CA Med

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Title: A New View of the Complexion of the California Physician Workforce: Preliminary Data From the CA Med


1
A New View of the Complexion of the California
Physician Workforce Preliminary Data From the
CA Medical Board Survey
  • Kevin Grumbach, MD
  • UCSF Department of Family and Community Medicine,
  • California Ethnic Physician Leadership Summit,
    2006

2
Overview of Presentation
  • CA Medical Board Relicensure Survey
  • New source of data on CA physicians
  • Policy context for Med Board Survey
  • AB 1586
  • Value of Med Board Survey data for understanding
    physician diversity
  • Results of preliminary analyses on race-ethnicity
  • Case study of South Asian physicians
  • Policy Implications

3
Policy Context 2001
  • Controversy about number of physicians in CA
  • Dueling reports
  • UCSF Profile of the Physician Workforce
  • CMA And Then There Were None
  • Controversy over validity of AMA Physician
    Masterfile Data
  • Number of active physicians
  • Physician race-ethnicity

4
California Physicians and Population by
Race/Ethnicity (2000)
Sources AMA Masterfile, California Dept. of
Finance.
5
A Constructive Solution AB 1586 (McLeod)
  • CMA Sponsored
  • Enacted October 2001
  • Required CA Medical Board to implement a
    physician survey linked to relicensure
  • training and practice characteristics for each
    physician licensed in California

6
Survey Items
  • Required items
  • Weekly hours in patient care, research, etc
  • Practice zip code (if in patient care)
  • Training status
  • Self-designated specialties
  • Board certification

7
Survey Items
  • Not-So-Required items
  • Ethnic background
  • 28 ethnic options
  • Can select gt1
  • Foreign language (fluent)
  • 34 options

8
Initial Survey Data Base
Represents 75,013 CA patient care physicians
9
Respondent Ethnicity
10
Ethnicity Summary
Total adds to gt100 due to physicians with more
than 1 ethnicity checked
11
Selected Asian Ethnicities, as Overall CA
PhysiciansUS Medical Grads International
Medical Grads
12
Selected Latino Ethnicities, as Overall CA
PhysiciansUS Medical Grads International
Medical Grads
13
Case Study of South Asian Physicians in CA
  • Context
  • IMGs are known to be more likely than USMGs to
    work in underserved communities
  • Many IMGs are South Asians
  • US South Asians are growing proportion of US
    medical students
  • Study Question
  • Does the likelihood of practicing in an
    underserved community depend on whether a South
    Asian physician in CA is an IMG or USMG?

14
Study Design
  • Study sample
  • Self reported ethnicity Indian or Pakistani
  • Not currently in training
  • Active in patient care in California
  • 315 South Asian USMGs, 1,223 South Asian IMGs
  • Data on practice communities
  • Based on reported zip code of practice
  • Linked to state data base from OSHPD on HPSAs,
    MUAs, rural status, census characteristics

15
Percentages of South Asian Physicians in CA
Working in Underserved Communities,According to
Whether Physician is a USMG or IMG
16
Study Conclusion
  • Country of medical school education, rather than
    ethnicity per se, is the key predictor of
    practice in an underserved community among South
    Asian physicians

17
The Broader Context of Physician Diversity
18
Underrepresented Minorities U.S. Population and
U.S. Medical School Entrants
Population
Percentage
Medical School Entrants
Phase 1
Phase 2
Phase 3
Phase 4
19
URMs as matriculants US vs CA, TX
20
Number of Medical Students per Capita State
Comparisons
21
UC PRIME Programs
  • New UC initiative
  • Programs in Medical Education (PRIME)
  • First expansion of medical school enrollment at
    UC in 30 years
  • Short term 15 increase at existing schools
  • Long term 1-2 new UC medical schools
  • New student tracks to address unmet health needs
    in California
  • Attract students with life experiences preparing
    them for leadership and service to disadvantaged
    populations

22
Ominous Federal Trends in Support for Workforce
Diversity
HCOP
COE
23
Take Home Points
  • Unprecedented ability to understand the ethnic
    profile of CA physicians using Med Board survey
    data
  • More accurate measurement of overall patterns and
    trends by major ethnic groups
  • Ability to discern variation within major ethnic
    groups (e.g., Asian, Latino)
  • Importance of physicians completing surveys and
    reporting ethnicity, language information!!!!!!
  • Need for funding and infrastructure to track and
    analyze CA physician workforce data

24
Take Home Points Policy Trends
  • The Good
  • UC Prime Programs
  • The Bad and the Ugly
  • Elimination of federal diversity programs
  • Need for federal and state political action
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