SECTION 1.
The Legislature finds and declares all of the following:(a) The facts and sources cited in this subdivision describe the physician shortages that existed up to 2001 in California and the United States, including an emphasis on the lack of Latino medical students and licensed physicians in proportion to their population in California. These critical and dangerous shortages led to the creation of the Licensed Physicians and Dentists from Mexico Pilot Program.
(1) The 2020 United States Census determined the population of California to be over 39 million people
with approximately 16 million being Latino.
(2) From July 1990 to July 1999, California’s population increased by approximately 4 million people. Approximately 61 percent of this growth can be attributed to the growth in the Latino population. The Latino population has increased at an average rate of 275,000 persons per year from 1990 to 1999. The Latino population is estimated to have grown in virtually all counties over this period.
(3) The United States General Accounting Office reports that the United States Community Health Centers patients comprise 65 percent ethnic and racial minorities.
(4) Title VI of the Civil Rights Act of 1964 requires any federally
funded health facility to ensure persons with limited English proficiency may meaningfully access health care services. Persons with limited English proficiency are often excluded from programs, experience delays or denials of services, or receive care and services based on inaccurate or incomplete information.
(5) The federal Health Resources and Services Administration reports the number of physicians in California grew 17 percent between 1989 and 1998.
(6) The federal Health Resources and Services Administration found in 1998 that only 4 percent of active patient care physicians were Latino.
(7) The Association of American Medical Colleges in 1998 found
only 6.8 percent of all graduates from United States medical schools were of an ethnic or racial minority group.
(8) In 1999 only 11 percent of dentists in California were a member of a racial or ethnic minority group with 5 percent being classified as Asian or Pacific Islanders.
(9) In 1996 only 4 percent of dentists in California were Latino.
(10) According to the Institute of Medicine report requested by the United States Congress, research evidence suggests that provider-patient communication is directly linked to patient satisfaction, adherence, and subsequently health outcomes. Thus, when sociocultural differences between the patient and the provider are not
appreciated, explored, understood, or communicated in the medical encounter, the result is patient dissatisfaction, poor adherence, poorer health outcomes, and racial and ethnic disparities in health care.
(11) A Commonwealth Fund of New York study found that: (1) one-third of Latinos said they had problems communicating with their doctors with barriers to this poor communication including language, cultural traditions, and sensitivity; (2) communication is essential to quality health care; and (3) inadequate communication can lead to the perception of inhumane health care service delivery.
(12) The Summit on Immigration Needs & Contributions of the Bridging Borders in the Silicon Valley Project found that approximately 50
percent of participants reported that having a provider that speaks their language will improve the quality of health care services they receive.
(13) Only two states in the country have reported cultural competency standards for care.
(14) No states in the country have reported foreign language competencies for physicians or dentists.
(15) According to the Dallas Morning News, many immigrants travel to Mexico to receive health care due to the cultural and language barriers they encounter in the United States health care system. According to the San Jose Mercury News, 65 percent of the membership of the largest medical association in California reported
that if they were required to pay for medical interpreters, they would stop seeing patients that required interpretation services.
(16) According to the Journal of the American Medical Association, in 1999, one medical school had a separate course covering cultural diversity, 109 medical schools included cultural diversity content as part of a required course or clerkship, and 84 medical schools included information on cultural beliefs or
practices related to death or dying in a required course or clerkship.
(b) The facts and data set forth in this subdivision reflect physician shortages from 2015 onward, as projected through 2034 nationwide, but do not include the shortage of culturally and linguistically competent medical providers in the nation or California, which seriously exacerbates the problems of accessing medical care in non-English dominant communities.
(1) Despite the Latino population comprising approximately 38 percent of the people in California in 2015, the percentage of Latino physicians in California was only 7 percent in 2015.
(2) In 2015, the percentage of Doctor of Osteopathic Medicine graduates in California
was 3 percent, physician assistants was 20 percent, nurse practitioners was 9 percent, and registered nurses was 20 percent.
(3) According to data reported in the Physicians Almanac, 7 percent of physicians working in the San Joaquin Valley in 2021 were Latina or Latino, whereas the Latino population in that region was 53 percent.
(4) In 2021, Latina and Latino physicians working in the County of Los Angeles accounted for 6 percent of the population, whereas the Latino population in that region was 49 percent.
(5) In 2021, Latina and Latino physicians working in the Inland Empire accounted for 7 percent of the population, whereas the Latino population in that region was 52 percent.
(6) In 2021, Latina and Latino physicians in the Sacramento area accounted for 4 percent, whereas Latinos comprised 22 percent of the population in that region.
(7) The Physicians Almanac reported in 2021 that all of the most populated regions of California where Latinos reside had less than the recommended number of primary care physicians, with only 60 per 100,000 patients.
(8) The region with the highest percentage of doctors who spoke Spanish in 2021 was the Central Coast, with 28 percent, followed by the County of Los Angeles, with 27 percent. There was no detailed information on this data based on Spanish language fluency or knowledge of cultural beliefs and practices related to health care.
(9) Based on a study published in the Journal of Health Affairs, “Latino and Hispanic groups are underrepresented in medical professions that require advanced degrees and overrepresented in similar professions that don’t require a bachelor’s or higher degree.”
(10) In 2020, the American Community Survey found that, “Mexican Americans made up 10.7 percent of the U.S. workforce but just 1.77 percent of U.S. physicians.”
(11) According to a recent article in the Washington Post from 2023, “Underrepresentation among Latino healthcare workers is a concern because data suggests racially, and ethnically diverse and culturally competent medical providers can help reduce healthcare disparities among minority populations. Minority patients
with providers who share their race, ethnicity, or language report receiving better care than when they see providers from different racial or language groups. Studies have shown that providers from minority groups are more likely to work in areas with healthcare shortages, accept Medicaid, and spend more time with patients.”
(12) As of November 1, 2023, California has the nation’s most federally designated Primary Care Health Professional Shortage Areas (HPSAs) with 694, followed by Texas with 436. An HPSA is an area that must have 3,500 in population for one primary care physician.
(13) The Association of American Medical Colleges (AAMC) is a leading voice in medical academia and research. The AAMC issued a significant study in June 2021 on physician shortages in the
United States titled “The Complexities of Physician Supply and Demand: Projections from 2019 to 2034.”
(14) In this study, the AAMC projects that the United States could see an estimated shortage of between 37,800 and 124,000 physicians by 2034, including shortfalls in both primary and specialty care.
(15) The study cites the COVID-19 pandemic as exposing “many of the deepest disparities in health and access to health care services and exposed vulnerabilities in the health care system,” according to AAMC President and CEO David J. Skorton, MD.
(16) The AAMC projected the following physician shortages by 2034:
(A) Primary Care (e.g., family medicine,
general pediatrics, geriatric medicine): between 17,800 and 48,000.
(B) Surgical Specialties (e.g., general surgery, obstetrics and gynecology, orthopedic surgery): between 15,800 and 30,200.
(C) Medical Specialties (e.g., cardiology, oncology, infectious diseases, pulmonology): between 3,800 and 13,400.
(D) Other Specialties (e.g., anesthesiology, neurology, emergency medicine, addiction medicine): between 10,300 and 35,600.
(17) The President and CEO of the AAMC, David J. Skorton, MD, testified before Congress, stating that “the issue of increasing clinician burnout, which the pandemic has intensified, could cause doctors and other health workers to cut back
their hours or accelerate their plans for retirement.”
(18) Despite Congressional efforts in 2021 to introduce bipartisan legislation to increase medical residencies by 2,000 annually for seven years, the shortages identified by the AAMC will come about.
(19) On the matter of workforce diversity, equity, and inclusion (DEI), the AAMC stated in this study as follows:
(20) “The physician workforce lacks sufficient diversity and inclusion (i.e., it lacks diversity overall and in positions of leadership and influence). The AAMC has identified addressing this lack as a core strategic priority. Extensive long-term data-collection work is needed, as is extensive and nuanced research about physician workforce diversity and
the anti-racist policies that can combat the endemic structural and systemic racism that harms the current physician workforce, damages the nation’s ability to create a more diverse and inclusive physician workforce, and impedes a diverse population from receiving equitable health care.”
(21) In 1980, the United States Census found an unprecedented growth in the Latino community that would continue beyond the decade. The United States census predicted that Latino demographic trends would have Latinos being the largest minority population in the United States during the first decade of the 2000s.
(22) Latinos were already 19 percent of the state's population in California in 1980. From 1980 to 1990, the state's total population grew by 26 percent, but the Latino population
increased by 69 percent.
(23) In other words, the need to be more inclusive of Latinos in the health care workforce and the health care needs of Latinos was well known to California policymakers in the 1980s, 1990s, 2000s, and since 2010. However, the academic medical community and health care policymakers made no substantive move to prevent the situation from getting to the point that the AAMC and many other studies on the health care workforce have warned us to take immediate action to resolve this matter.
(24) The AAMC and the majority of all studies on health care workforce shortages have underestimated the impact of physician shortages in the Latino community over the last four decades. They have also underestimated its impact on other communities that are not predominantly
English-speaking and are at least first- and, at times, second-generation foreign-born. The lack of culturally and linguistically competent physicians exacerbates and worsens the physician shortages in these communities for generations. Hence, the poor health profile of Latinos and other ethnic and racial populations in California.
(c) Underscoring the lack of preparation, creativity, and commitment to deal with the needs of a culturally and linguistically diverse society, such as California since the 1980s, and the growing physician shortages in the state, the University of California Schools of Medicine and the three private university medical schools at Stanford University, the University of Southern California, and Loma Linda University do not offer any mandatory cultural or foreign language courses to prepare medical students to
serve the diverse populations that reside in California. The actions and policies taken by these medical institutions confirm the need for programs such as the Licensed Physicians from Mexico Program.