San Francisco Marin Medical Society Blog

Growing the Physician Pipeline

By Katherine Boroski

A robust, diverse and well-trained workforce is essential to meeting the health care demands of all Californians. While California has made great strides since the passage of the Affordable Care Act in extending health insurance to millions of residents who were previously uninsured, our state is currently facing a critical physician shortage.

California’s underserved communities are already facing a severe shortage of physicians, which will exponentially worsen as the population continues to grow, diversify and age. This will be further compounded as physicians move toward retirement faster than the replacement rate.

This year, the California Medical Association’s (CMA) foundation, Physicians for a Healthy California (PHC), launched two new projects that will make real progress in growing and strengthening the physician pipeline to meet the demands of California’s growing patient population, with a focus on medically-underserved areas and populations. 

CalMedForce: GME Grant Program

PHC’s CalMedForce program is committed to growing a diverse physician workforce by supporting, incentivizing and expanding graduate medical education (GME) in California.

The program was made possible by the Proposition 56 tobacco tax, which was sponsored in 2016 by CMA, the California Hospital Association and Service International Employees Union-United Healthcare Workers West. The University of California is the designated recipient of the funding and has contracted with PHC to administer the annual grants.  

“These CalMedForce grants will help California grow and strengthen the physician pipeline to meet the demands of our state’s growing and changing patient population,” said Lupe Alonzo-Diaz, MPAff, PHC president and CEO.

In the inaugural cycle of CalMedForce in January 2019, PHC awarded $38 million to GME programs across the state to fund approximately 150 physician residents. In total, PHC received funding requests for nearly 600 residency positions from 131 residency programs, totaling more than $147 million!

The 73 programs that received awards in the first cycle represent residency positions in both urban and rural areas. Programs that focus on medically-underserved areas and populations were given priority. Of the 156 residency positions funded, 74 are existing residency slots that could have been eliminated if not for this funding. Eighty-two of the positions funded are brand new – 60 of them in new residency programs and 22 at existing programs.

“The demand for these funds is a clear indicator of the statewide need for this funding and an example of how the new tobacco tax will help improve access to care in California,” said Cathryn Nation, M.D, associate vice president for health sciences in the UC Office of the President.

Every dollar invested into expanding residency slots in California is significant, considering one primary care resident can conduct approximately 600 patient visits per year.

Why Is GME Funding So Important?

Sadly, California is a mass exporter of medical students. Every year, hundreds of graduating medical students do not find a residency slot in California to continue their training.

“Inadequate funding for medical residency programs forces talented young doctors who want to stay and practice in California to train in other states,” said CMA President David H. Aizuss, M.D.

The data shows that most physicians set down roots in the areas where they train and remain there after their training to care for their communities. When California-educated medical students leave to another state for a residency program, they often do not return. Overall, 54.2% of individuals who completed residency training from 2008-2017 are practicing in the state of where they trained. California ranks the highest of all states, with a 77.7% rate for in-state retention. We can grow our physician workforce by expanding the number of California residency positions.

CalHealthCares: Loan Repayment Program

Ample research demonstrates that the Medi-Cal system is struggling from persistent underfunding. As a result, California ranks among the lowest in the nation in payments to providers. These chronically low reimbursement rates have a direct effect on Medi-Cal patients’ ability to receive timely treatment from a physician.

Compounding the problems is the fact that physicians often enter practice with hundreds of thousands of dollars in educational debt. This debt burden, coupled with low reimbursement rates, makes it unsustainable for many physician practices to take on a significant number of Medi-Cal patients.

In April 2019, the California Department of Health Care Services (DHCS) launched a new loan repayment program—CalHealthCares, which incentivizes physicians to provide care to Medi-Cal beneficiaries by repaying educational debt up to $300,000 in exchange for a five-year service obligation. DHCS has contracted with PHC to administer the program.

CalHealthCares was also made possible by Proposition 56, which provided a one-time allocation of $220 million for state loan repayment programs.

The first round of applications for the new CalHealthCares statewide loan repayment program attracted more than 1,200 applications from physicians and dentists who agreed to see more of California’s 13 million Medi-Cal patients in exchange for repayment of their student loans.

In all, requests totaled more than $300 million, reflecting tremendous interest in the five-year program. CalHealthCares expects to award approximately 125 physicians and 20 dentists in this first award cycle, to be announced by June 30.

All awardees will be required to maintain a patient caseload of 30% or more Medi-Cal beneficiaries. The program is open to physicians who graduated from a residency program and/or completed a fellowship within the past five years (on or after January 1, 2014). There are no geographic limitations—providers may be located in any California county.

With more than 13 million Californians relying on Medi-Cal programs to provide basic and specialty care for serious diseases, the stakes are high.

“The CalHealthCares program promises to have a real and immediate impact on access to care for Medi-Cal patients,” said Dr. Aizuss. “Especially for new enrollees, who often struggle to access to timely and quality care.”

For more information about CalMedForce and CalHealthCares, visit the PHC website at

Katherine Boroski is Senior Director of Communications at the California Medical Association. She can be reached at


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