Primary Care

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Midwifery, Physical Therapy, Pharmacist Bills Move to Governor’s Desk

(Getty Images)

(Getty Images)

California’s legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to expand access to primary care. These “scope-of-practice” bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown’s desk.

Here’s a recap of some of the bills and where they stand now:

Midwifery Bill (AB 1308) — headed to governor’s desk

The Center for Health Reporting writes that the bill passed unanimously Thursday night and is now on the governor’s desk. From the Center:

(L)icensed midwives were legally obligated to be supervised by physicians. If a doctor supervised a licensed midwife, however, the doctor ran the risk of losing liability insurance. So, collaboration was unattainable and advocates said this put women and babies at risk.

The bill removes the requirement for licensed midwives to be supervised by a physician.

“Because physician supervision was required but not available, the midwives often had to operate in the shadows,” said Shannon Smith-Crowley, a lobbyist for the American Congress of Obstetricians and Gynecologists (ACOG), a group representing OB/GYNs and the bill’s sponsor. “Midwives can be out in the open, helping them develop better relationships, warmer reception and protocols for transfer, ideally leading to earlier transfers in less dire circumstances.”

Physical Therapy (AB 1000) — headed to governor’s desk Continue reading

The Primary Care Crunch: Not Enough Doctors and More Patients Coming

(Getty Images)

(Getty Images)

The full implementation of Obamacare and (potentially) millions more insured is now just over 100 days away, on Jan. 1. Questions abound: Will young, healthy people really sign up? How much will my premium be? How does the Affordable Care Act work anyway?

Floating around in all those Obamacare discussions is another question: Who is going to treat all the newly insured? After all, we already have a shortage of primary care doctors. Out of 7 million uninsured in the state, Covered California estimates 1.4 million people could sign up for insurance next year. Plus another 1.4 million people will be newly eligible for Medi-Cal.

To address this question, San Francisco’s Commonwealth Club invited me to moderate a discussion about the shortage of primary care providers. Kevin Grumbach, a family physician and co-director at UC San Francisco’s Center for Excellence in Primary Care, started off by defining the subject at hand. Continue reading

How Nurses and Other ‘Mid-Level Providers’ Fill Growing Gap in Primary Care

By Jose Martinez, KPCC

(Keith Brofsky/Getty Images)

(Keith Brofsky/Getty Images)

Simmi Gandhi — a family nurse practitioner at South LA’s UMMA Community Clinic — is at work early. When she calls a patient, she apologizes for waking the woman up. But she knew the woman was waiting for test results.

In Urdu, she tells the patient her mammogram shows the mass in the woman’s breast isn’t cancer. After Gandhi hangs up, she doesn’t miss a beat: She starts debriefing for her next patient, who’s been missing appointment for months.

“Looks like he has diabetes,” she says. “I had asked for him to be able to get an appointment six weeks thereafter, so that was back in September. That was cancelled, and then he didn’t come for two appointments that were rescheduled. And now he’s finally back.”

Simmi Gandhi is what’s called a midlevel provider — which includes registered nurses, physician assistants and nurse practitioners. These are medical professionals who are in-between physicians and lower skilled medical technicians and nurses. At the UMMA clinic, she provides a wide range of primary care people in need.

“A community like this has less resources,” she says. “A lot of the folks that live here have less education as I’m sure everybody’s aware, our educational system is stressed so the basic education people get around their bodies … is low.” Continue reading

Immigrant Doctors Help Ease California’s Primary Care Doctor Shortage

By Jenny Gold, Kaiser Health News

Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).

Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).

It’s a familiar story in California.

When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get — stocking warehouses, construction, cleaning houses and working in a meat processing plant.

But unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs. At night he studied for the boards.

Hundreds, maybe thousands, of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. That’s a wasted resource.
“I had to do it. And I wouldn’t complain,” says Chavez. “It was OK to me. I mean, of course medicine is my passion, but since I didn’t have a license here, I couldn’t practice it.”

A quarter of U.S. doctors are foreign-born, mostly from countries like India that focus on training ­­medical students to work in the U.S.  Many other immigrant physicians never become American doctors, particularly those who come from Latin American countries like Chavez.

But a program at the University of California is seeking to change that, while at the same time helping to address the shortage of primary care doctors in the state. The UCLA International Medical Graduate Program offers Latino doctors a stipend along with board preparation classes, mentorship and references to help them find a good residency slot in primary care. In return, the doctors pledge to work in an underserved area of California for two or three years. Continue reading

The Doctor Will See You Now — Virtually

A demonstration of CareSimple's virtual house call.

A demonstration of CareSimple’s virtual house call.

Remember the really old days of house calls? A kindly doctor with a black bag would come to your house and treat your (often minor) complaint?

Frankly, I don’t remember those days either. But I have heard of the house call, and now Carena, a Seattle-based company, is expanding into California with a 21st century house call — a virtual house call.

It works like this: like everything these days, you first create an account. When you need care, you log on and request a visit. Within 30 minutes, Carena says, a doctor or nurse practitioner will contact you by phone or email (your choice). If it’s email, you will get a link to a secure “virtual exam room.” (The man in the photo above is Dr. Ben Green, in a virtual exam room.)

From there you are diagnosed. If you need a prescription, CareSimple says its doctors are licensed in California and can phone in a prescription to your pharmacy. The service is $25/month with a $5 per visit fee. Or you can pay for a single visit, without the membership. That’s $85.

Continue reading

New Approach to Medical Residency May Ease Doctor Shortage in Central Valley

By Rebecca Plevin, Valley Public Radio

Dr. Peter Broderick examines a patient's x-ray while family practice medical residents look on. (Rebecca Plevin/KVPR)

Dr. Peter Broderick examines a patient’s x-ray while family practice medical residents look on. (Rebecca Plevin/KVPR)

The Central Valley suffers from an acute shortage of doctors — especially primary care doctors — but a new type of residency program aims to bring relief. These new “teaching health centers” are funded by the Affordable Care Act.

This new approach contrasts with traditional medical residency programs, which are often based at university medical centers in large cities and encourage specialty training.

With the recognition that medical residents often stay where they are trained, the idea behind this new approach is to place these young doctors not in large hospitals but in community health centers where they will focus on primary care.

“The hope is that more of the graduates from these programs will stay in these underserved settings, will work in these community health clinics, and hopefully address some of the shortages that we have with that population,” said Dr. Peter Broderick, the CEO of Modesto’s Valley Consortium of Medical Education.

In 2010 Broderick’s group opened the state’s first “teaching health center” — the Valley Family Medical Residency Program. It has trained 12 doctors a year since then. Continue reading

Primary Care Efforts to Involve Patients in Decision Making

(Mercy Health: Flickr)

(Mercy Health: Flickr)

All day, every day, people make medical choices that have repercussions for common yet dangerous conditions like asthma, heart disease and diabetes.  Although chronic disease takes a greater toll [PDF] on people with lower socioeconomic status, chronically ill patients are part of every community. In California and across the country, public health officials and physicians keep searching for the best way to get patients involved in improving their health.

Some patients naturally want to be involved with their care. Other times it’s doctors and nurses who must try to encourage more engagement by their patients. “Whether to exercise or change their diet, take medication,” Dr. David Thom told me recently, “those are the bread and butter decisions that go into primary care.”

Thom, director of research in the UC San Francisco department of Family and Community Medicine, is launching a new study, exploring how patients make decisions when they work with a “health coach.” Often health coaches are trained medical assistants who join the primary care team. “Our belief is that health coaches are going to have a fairly different relationship with patients than providers do,” he says. “Their role in helping the patients make decisions will be clearly different than the providers’ role.” Continue reading

Doctors Fall Short in Helping Seniors, Poll Reveals

(Photo: Kaiser Health News)

(Photo: Kaiser Health News)

Medicare provides free screening on more than a dozen primary care tests, but a new poll shows that seniors are not receiving the benefit. The poll comes from the John A. Hartford Foundation and looked at Americans age 65 and older.

The Foundation was interested in whether seniors had received seven services that would support “healthy aging” including:

  • an annual medication review
  • falls risk assessment
  • screening for depression
Kaiser Health News reported details of the poll’s findings: Continue reading

L.A. Health Care Director’s Vision Brings Change, Challenge

By Sarah Varney

Colleagues say Dr. Mitch Katz rides his bike everywhere, including to work and many appointments. (Photo: Michael Wilson)

Colleagues say Dr. Mitch Katz rides his bike everywhere, including to work and many appointments. (Photo: Michael Wilson)

It would be easy to confuse Dr. Mitch Katz with any other doctor at the Roybal clinic in East Los Angeles. His desk in a closet-sized, windowless office is littered with patient records, x-rays and cans of Diet Coke.

His every man demeanor belies his stature. In fact, he even rides his bike to work and many appointments.  But Mitch Katz is Director of Los Angeles County’s Department of Health Services, long one of the most beleaguered in the country. Katz oversees L.A.’s public hospitals and clinics, the place of last resort for millions of low-income Angelenos. He has 22,000 employees and a $3.7-billion dollar budget. When he arrived in Los Angeles last year after running San Francisco’s health department, he insisted on seeing patients one afternoon a week, a demand that struck many here as odd, if not impossible. How would Katz have time to treat patients with a system in ruin? Continue reading

Lack of Primary and Preventive Care Sends Thousands to Hospital

By Bernice Yeung, California Watch

(Bastian: Flickr)

(Bastian: Flickr)

Better access to primary health care and prevention programs could have kept thousands of California adults out of hospitals, according to a new statewide analysis.

According to new data released last week by the Office of Statewide Health Planning and Development, there were more than 335,000 adult hospitalizations in California that could have been avoided if the patient had seen a doctor sooner.

According to the state agency, so-called “preventable hospitalizations” are an indication of systemic shortcomings related to access to quality primary care. Continue reading