Spike in Medi-Cal Enrollment Adds Pressure to 'Doctor Deserts'

A spike in Medi-Cal enrollment after California expanded the program under the Affordable Care Act has exacerbated problems with health care access in rural areas, such as long travel distances and wait times for care, the Sacramento Bee reports.
Medi-Cal is California’s Medicaid program.

Details of Physician Shortages

According to state data, about 2.7 million beneficiaries have enrolled in Medi-Cal since 2014.
While such enrollment helped reduce the state’s uninsured rate, it also added pressure to the state’s “doctor deserts,” areas where there is only one physician per 3,500 residents. In comparison, there is about one physician per 1,000 residents on average statewide.
According to the Bee, there are 214 doctor deserts in California. About three-quarters of them are in rural areas of the state.
In such areas, patients often have to travel long distances to seek care.
Doreen Bradshaw, executive director of the Health Alliance of Northern California, said, “Patients have to travel quite a few hours just for basic services,” adding, “When that travel is difficult, sometimes they just don’t go.”
Such conditions also can make it difficult to recruit physicians in those areas, where doctors typically earn less money than their counterparts in major urban hospitals, the Bee reports.
Dean Germano, CEO of the Shasta Health Center in Redding, said the facility has had to turn away new adult Medi-Cal beneficiaries because of provider shortages.
He said, “There’s a lot more competition than there ever was before,” adding, “You combine that with all these new people with coverage and it’s like the Wild West of medicine out here, in terms of recruitment.”

Potential Workarounds, Solutions

To work around such physicians shortages, some patients have started seeking care:

  • At mobile clinics; and
  • Across state lines.

Meanwhile, providers have started testing new care delivery models, such as telehealth, as they work to recruit more physicians, the Bee reports (Caiola, Sacramento Bee, 11/23).