No evidence that large numbers of physicians are leaving California, say UCSF researchers

Anecdotes abound about the tumultuous state of physician affairs in California. However, there is no objective evidence that large numbers of doctors are leaving California, according to a report released by the UCSF Center for Health Professions.

In fact, the ratio of physicians to population has increased from 177 doctors for every 100,000 people in 1994 to 190 per 100,000 in 2000. This is above the requirement set forth by the Council on Graduate Medical Education (COGME), according to the report titled The Practice of Medicine in California: A Profile of the Physician Workforce, the third in a series released by the UCSF Center for Health Professions' California Workforce Initiative.

The report's findings refute the following:

� California now has too many primary care physicians and not enough specialists.

� Doctors are leaving major urban centers in California.

� Doctors are shunning managed care and finding plenty of patients without needing to contract with managed care plans.

� Physicians' earnings are plummeting.

The study finds that in 2000, slightly more than one third of California's active, patient-care physicians practiced in the generalist fields of medicine (family practice, general practice, general internal medicine, and general pediatrics). "Although California still has many more specialists than generalists, the growth of specialists was slightly slower in recent years relative to the growth of generalists," said Kevin Grumbach, MD, UCSF associate professor of family and community medicine and co-principal investigator on the study. "The data indicate that public policy and the managed care environment in California may have had a modest effect on slowing the rate of growth of specialists relative to the rate of growth for generalists. However, the magnitude of this effect falls well short of the suggested mass exodus of specialists in California."

The UCSF investigators also noted that despite the highly competitive environment in densely populated areas such as San Francisco and Los Angeles, physicians have not migrated to less competitive, lower supply regions in California in sufficient numbers to change significantly the distribution that already exists in the state. Much of the Central Valley and eastern portions of the state still have ratios of physicians to population below recommended minimum requirements, despite the overall abundance of physicians in California.

Contrary to anecdotal reports, most physicians are not shunning managed care, according to the investigators. In 1998, about half of generalists and one-third of specialists in urban California had the majority of their patients enrolled in HMOs (including private, Medicare, and Medi-Cal HMOs). And in 1998, only sixteen percent of generalists and 20 percent of specialists had no HMO patients in their practice.

However, physicians clearly are experiencing many stresses in the current managed care environment, including perceived pressures to see more patients per day and to limit medical tests and specialist referrals, said Grumbach.

"The tenor of media and trade publication articles suggest a high level of anxiety among California doctors in a managed care environment where some perceive physicians to be working more and making less," said O'Neil. "Although managed care may be dampening the rate of increase of physician incomes, especially for specialists, California physicians have median incomes ranging from $120,000 to $250,000. These are comparable to those reported for physicians nationwide and well above $33,000, the mean income for California."

The report also includes a synopsis of demographic and medical training data:

� Most California physicians are male and white -- with the largest group comprised of physicians between ages 45 and 54.

� The physician workforce is slowly but steadily approaching parity between the numbers of female and male physicians. California is on par with national estimates that women will constitute more than a third of active physicians in the U.S. in 2020.

� Women physicians are more likely than men to choose primary care specialties and obstetrics and gynecology.

� The state's physician workforce is losing ground in terms of its racial and ethnic diversity. African Americans and Hispanic/Latinos each comprised less than 5 percent of the state's physicians, although they made up 7 and 31 percent of the state's population respectively. Medical education pipelines do not show significant advances in recent years in racial and ethnic diversity.

� Only about a quarter of physicians practicing in California in 2000 attended medical school in the state. About 50 percent of the state's physicians attended school in another U.S. state and the remaining 25 percent attended school outside the U.S.

� A slight majority (55 percent) of the physicians practicing in California in 2000 did their residency training in the state. The remaining 45 percent completed their residencies outside California.

The report was made possible through the support of the California HealthCare Foundation which, in partnership with The California Endowment, funds the California Workforce Initiative.

The California HealthCare Foundation is an Oakland-based, independent non-profit philanthropic organization whose mission is to expand access for underserved individuals and communities, and to promote fundamental improvements in health status of the people of California.

The California Endowment is a private foundation with staff throughout the state whose grants are made to organizations and institutions that directly benefit the well being of Californians.

Additional support for research activities contributing to this report came from the Bureau of Health Professions, Health Resource and Services Administration; the Agency for Health Care Research and Quality; and the California Program on Access to Care, California Policy and Research Center.

The California Workforce Initiative will be conducting a survey of physicians in the state during 2001. For more information, visit www.futurehealth.ucsf.edu