Lawmakers in California are considering a pilot program that would financially support would-be physicians from underrepresented groups while addressing the shortage of healthcare workers in underserved communities.
In late March, California assembly member Carlos Villapudua (D-13) announced the introduction of bill AB 2132, also known as "the California Future Physician Fund." The bill would create a pilot program to support 70 high school students from underrepresented groups through community college, undergraduate college, medical school, and residency, said Lupe Alonzo-Diaz, the CEO of Physicians for a Healthy California, the organization behind the legislation. Those students would then be required to practice in a rural or medically underserved area in California after completing residency.
"The vision of this program is really to identify those young, aspiring physicians in those communities that are underserved, support them through their medical education process, and then at the end require them to practice in those communities," Alonzo-Diaz told Medscape Medical News.
The bill is unique in that financial support would start in community college and during undergraduate years. By contrast, most existing medical scholarship or stipend programs begin during medical school, said Matthew Shick, JD, senior director of government relations and regulatory affairs for the Association of American Medical Colleges.
While AB 2132 still has a long legislative journey ahead, the hope is that this legislation could provide a new model that both increases the diversity of the physician workforce and addresses healthcare worker shortages throughout the country, Alonzo-Diaz said.
A Seamless Support System
More than 10 million Californians ― about a quarter of the state's residents ― live in areas where there is a shortage of healthcare professionals, according to Alonzo-Diaz. According to Villapudua, San Joaquin Valley has just 39 primary care providers per 100,000 residents, roughly one sixth the national average of 252 per 100,000.
The average educational debt for graduating physicians in California is more than $280,000, slightly higher than the national average, said Alonzo-Diaz. That number can be even higher for students from underrepresented communities who may not have access to the same commercial or private loans and stipends available to other students, she added.
What's more, the demographics of California physicians does not match the demographics of the California population. For example, 39% of the California population identifies as Latino, but only 5% of all licensed physicians in the state say they belong to that ethnic group, Alonzo-Diaz said.
The pilot program proposed by AB 2132 would set aside $20 million to provide financial support or fill in the gaps with other scholarships and stipends, for the 70 would-be physicians for their entire post–high school education. The students would also work with an education navigator to help them apply to medical school and residency. Ideally, students in the program would stay in California for both medical school and residency, although this may not always be possible, given the limited number of residency spots in the state, Alonzo-Diaz said.
The proposed bill does not specify how the state would pay for the program, but Alonzo-Diaz said the money would most likely come from general funds rather than a special tax or fee.
Serena Ly is the type of medical student who would have benefited from a program such as the one that would be provided by AB 2132. A first-year student at the University of California, Davis, School of Medicine, Ly is the child of Cambodian refugees. Her father worked for 30 years as an information technology specialist for the US Postal Service, and her mother works as a supervisor at a biotech plant that manufacturers parts for heart valves.
"I will have to take out substantial loans next year, so that's always in the back of your mind," Ly said. "At the end of a medical education, I will have accumulated a crazy high amount of loan money. It's daunting." For many of Ly's peers, the ability to more quickly pay off loans adds to the appeal of going into more lucrative specialties instead of choosing a specialty in primary care, she said.
Accumulating hundreds of thousands of dollars in debt can be a major deterrent to going into medicine in the first place, Alonzo-Diaz said. Anyone who graduates from medical school and residency and works as a physician will be able to repay their loans, Shick said. "That doesn't mean, though, that the cost of attendance is not a barrier for some students and certainly for those who come from a lower socioeconomic status or are underrepresented in medicine," he said.
"The beauty behind this vision is that we're really trying to create a seamless support system for those individuals," Alonzo-Diaz said. "We will invest in them, and then they will in turn commit to being employed in one of those underserved areas."
Expanding the Pool
Starting support for would-be physicians while they are undergraduates and particularly in community college makes this program unique, Shick said. "A program like this that reaches back into high school and community college is not just working with students who would have already applied to medical school but is potentially expanding the pool of students who can consider medicine as a career," he said.
Other programs have tied the receipt of scholarship funding or stipends for medical school with primary care service in underserved areas, according to Shick. The Health Resources and Services Administration's National Health Service Corps (NHSCS) Scholarship Program and NHSC Loan Repayment Program are two examples offered at the federal level, he noted.
But support from those programs starts in medical school; indeed, a student has to be accepted in order to qualify. The Build Back Better Act would establish a program for students from underrepresented groups to attend post-baccalaureate programs and medical school, providing support before medical school but not reaching all the way back to support students immediately after high school, Shick noted. The bill is currently stalled in Congress.
At the state level, many state loan programs target students already accepted into medical schools. Several medical schools, including New York University (NYU) Grossman School of Medicine, offer free tuition to encourage students to enter service-oriented specialties such as primary care, but again, that support would begin in medical school, not before.
"We haven't found another comparable program," Alonzo-Diaz said of AB 2132 and the California Future Physician Fund.
Now that the bill has been announced, it will be heard in two assembly committees ― higher education and health ― later this month. Ly said she plans to testify in favor of the proposed program.
The bill could end up on Governor Gavin Newsom's desk this fall. If he signs the measure, the program would go into effect in 2023 and could release the application process for next summer or fall.
"All individuals regardless of income, immigration status, preexisting medical conditions should have access to quality, timely healthcare, and this is opening up the ways of doing that," Alonzo-Diaz said.