CAL I FORNIAHEALTHCAREFOUNDATION
californiaHealth Care Almanac
july 2010California Physician Facts and Figures
©2010 California HealtHCare foundation 2
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California’s supply of physicians has been growing faster than the overall population in recent years,
rising 7 percent since 1998. demand for physicians is expected to rise, as the senior population grows,
and as more individuals obtain health insurance as a result of health care reform. With large numbers
of physicians nearing retirement, and not all doctors taking patients with private or public insurance,
those seeking care, especially in some regions, could have difficulty finding a provider. this report
draws from numerous sources to describe the market landscape for physician services in California.
Key findings include:
California barely meets the nationally recognized standard for supply of primary care physicians. •
only the orange, sacramento, and Greater Bay area regions meet the recommended supply.
eighty-four percent of PCPs are accepting new patients, and just over half are accepting new •
Medi-Cal patients.
nearly 30 percent of physicians are over 60 years old — a higher percentage than any other state. •
While latinos represent almost 40 percent of the population, only 5 percent of the state’s •
physicians are latinos, which could have implications for language and cultural aspects of care.
California draws a substantial portion of physicians, especially PCPs, from foreign and out-of-state •
medical schools.
While family and general practitioner compensation has been rising, they earned only 88 percent •
of the national average in 2008.
a list of data sources can be found on page 30.
California Physician Facts and Figures
c o n t e n t s
Physician supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
education and training . . . . . . . . . . . . . . . . . . . . . . 16
Compensation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
satisfaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Medical Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Pay for Performance . . . . . . . . . . . . . . . . . . . . . . . . . 26
author, acknowledgments, and data resources . . . . . . . . . . . . . . . . . . . . . . . . 30
appendices
a: definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
B: region Counties . . . . . . . . . . . . . . . . . . . . . . . 32
C: estimated requirements for . . . . . . . . . . . . 33 Physicians per 100,000 Population, by Patient age, united states, 2000
Introduction
©2010 CALIFORNIA HEALTHCARE FOUNDATION 3
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220
230
240
250
260
270
280
20082007200620052004200320022001200019991998
245
262
California Physician Facts and FiguresPhysician Supply
Note: Data includes only MDs with active licenses and includes residents, fellows, and fee-exempt MDs. Excludes MDs with out-of-state zip code and doctors of osteopathic medicine (DOs).
Sources: RAND California, Number of Physicians and Surgeons, ca.rand.org. State of California, Department of Finance, Race/Ethnic Population with Age and Sex Detail, 1990 – 1999. Sacramento, CA, May 2009. State of California, Department of Finance, E-3 Race/Ethnic Population Estimates with Age and Sex Detail, 2000 – 2008. Sacramento, CA, June 2010.
*See Appendix C for estimated requirements for physicians by patient age.
The ratio of physicians to
population climbed 7 percent
in the decade from 1998 to
2008. The population as a
whole grew by 16 percent
during this period, while those
over age 65 — the highest
users of physician services —
increased 22 percent.*
Physicians per 100,000 Population, California, 1998–2008
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40 or more51%
30 to 3921%
20 to 2912%
10 to 197%
1 to 96%
3%
None
California Physician Facts and Figures
number of hours worKed
Physician supply
notes: data includes only active California-based Mds who answered relevant questions. excludes residents, fellows, and dos.
source: Medical Board of California, survey of licensees, private tabulation, 2009.
the total number of California
physicians does not accurately
reflect the availability of
physicians to provide care.
only half of the state’s
physicians work full-time in
patient care. other activities
include research, teaching,
and administration.
Physicians, by Average Weekly Patient Care Hours Worked, California, 2009
©2010 California HealtHCare foundation 5
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0 2000 4000 6000 8000 10000
Cardiology
Orthopedic Surgery
Radiology
Emergency Medicine
Obstetrics/Gynecology
Anesthesiology
Psychiatry
Pediatrics
Family/General Practice
Internal Medicine 8,880
7,532
4,734
4,092
3,653
3,157
2,851
2,231
1,874
1,730
California Physician Facts and FiguresPhysician supply
notes: data includes only active California-based Mds who answered relevant questions. excludes residents, fellows, and dos.
source: Medical Board of California, survey of licensees, private tabulation, 2009.
active patient care physicians
— those who practice at least
20 hours a week in patient
care — are concentrated in a
handful of specialties. nearly
half work in five specialty
areas, and over two-thirds
work in ten specialties. the
top three specialties are in
primary care.
Top Ten Specialties, by Number of Active Patient Care Physicians, California, 2009
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CaliforniaMedical Board Data†
CaliforniaAMA Data
United StatesAMA Data
79 80
140 138
118
63
PCPs Specialists
RECOMMENDEDSPECIALIST SUPPLY(85–105)*
RECOMMENDEDPCP SUPPLY(60–80)*
California Physician Facts and FiguresPhysician supply
*the Council on Graduate Medical education (CoGMe), part of the u.s. department of Health and Human services, studies physician workforce trends and needs. the latest CoGMe benchmarks are 60 to 80 PCPs per 100K population, and 85 to 105 specialists per 100K population. CoGMe ratios include dos. the aMa defines active patient care as 20 hours or more a week with a plurality of hours in patient care.
†supply number includes an estimate of dos using aMa data.
note: see Appendix A for PCP specialties.
sources: California HealthCare foundation, Fewer and More Specialized: A New Assessment of Physician Supply in California, june 2009, www.chcf.org. association of american Medical Colleges, 2009 State Physician Workforce Data Book.
California and the nation have
similar per-capita ratios of
primary care physicians and
specialists. However, the state
barely meets the nationally
recognized standard for supply
of primary care physicians,
based on California Medical
Board data.
Active PCPs and Specialists per 100,000 Population, California vs. United States, 2008
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Greater Bay Area
Sacramento Area
Orange
San Diego Area
Los Angeles
Northern and Sierra
Central Coast
San Joaquin Valley
Inland Empire
PCPs Specialists RECOMMENDED
SPECIALISTSUPPLY
(85–105)*
RECOMMENDEDPCP SUPPLY
(60–80)*40
45
54
57
58
58
64
64
78
70
74
112
113
118
124
121
127
155
California Physician Facts and FiguresPhysician supply
*the Council on Graduate Medical education (CoGMe), part of the u.s. department of Health and Human services, studies physician workforce trends and needs. the latest CoGMe benchmarks are 60 to 80 PCPs/100K population, and 85 to 105 specialists/100K population. CoGMe ratios include dos.
notes: data does not include dos. the most recent California data shows 4.3 PCP dos and 3.5 specialist dos per 100,000 population. see Appendix A for PCP specialties and Appendix b for a list of counties within each region.
source: California HealthCare foundation, Fewer and More Specialized: A New Assessment of Physician Supply in California, june 2009, www.chcf.org.
Physician supply varies
by region. some areas
of California do not have
sufficient numbers of
physicians. Both san joaquin
Valley and the inland
empire have fewer PCPs
and specialists than are
recommended by nationally
recognized benchmarks.
Active PCPs and Specialists per 100,000 Population, California Regions, 2008
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Non-PCPsPCPsAll Physicians
92%
69%74%
65%
93%
82%
68% 67%65%69%
74%
93%
Private Insurance Medicare Medi-Cal Uninsured
California Physician Facts and FiguresCoverage
source: Physician Participation in Medi-Cal, 2008, California HealthCare foundation, july 2010.
uninsured Californians and
those with public coverage
have less access to physician
care than those with private
insurance. While over
90 percent of California
physicians have patients with
private insurance in their
practices, just 69 percent
have any Medi-Cal patients,
and only 65 percent have
any uninsured patients.
Physicians with Insured Patients in Practice, by Coverage Type, California, 2008
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Non-PCPsPCPsAll Physicians
90%
57%
73%
46%
94%
79%
59%
47%42%
54%
64%
84%
Any Medicare Medi-Cal Uninsured
California Physician Facts and FiguresCoverage
source: Physician Participation in Medi-Cal, 2008, California HealthCare foundation, july 2010.
for the many Californians
who will become insured
through the expansion of
public programs due to
national health care reform,
access to physicians may
be limited. only 84 percent
of PCPs are accepting new
patients, and just over half
are accepting new Medi-Cal
patients.
Physicians Accepting New Patients, by Insurance Coverage, California, 2008
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0 20 40 60 80 100
U.S.Average
Texas
New York
Illinois
Florida
California
Under Age 40 Age 40 to 60 Age 60 and older
18% 53% 29%
15% 59% 27%
21% 55% 24%
17% 55% 28%
20% 57% 23%
18% 57% 25%
California Physician Facts and Figures
percent of totAl physiciAns
demographics
notes: includes only Mds practicing at least 20 hours a week. segments may not add to 100 percent due to rounding.
source: association of american Medical Colleges, 2009 State Physician Workforce Data Book.
nearly 30 percent of
California’s physicians are
over age 60, the largest
proportion of any state.
this raises concerns about
physician supply as older
physicians begin to retire.
Active Physicians, by Age, California vs. Select States and United States, 2008
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0
20
40
60
80
100
1964 and earlier
1965–19741975–19841985–19941995–20042005–2009
5%
11%
24%
57%
6%
12%
23%
55%
5%6%
12%
21%
56%
7%7%
12%
20%
55%
14%
13%
15%
18%
40%
31%
22%
17%
12%
18%
Hours Worked 1 to 9 10 to 19 20 to 29 30 to 39 40 or more
Medical School Graduation Year
—3% —4%
California Physician Facts and Figuresdemographics
notes: data includes only active California-based Mds who answered relevant questions and worked at least one hour in patient care. excludes residents, fellows, and dos. segments may not add to 100 percent due to rounding.
source: Medical Board of California, survey of licensees, private tabulation, 2009.
later in their careers,
physicians tend to work
fewer hours a week in
patient care.
Patient Care Hours Worked, by Medical School Graduation Year, California, 2009
©2010 California HealtHCare foundation 12
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Male70%
Female30%
Male50%
Female50%
CALIFORNIA ACTIVE PHYSICIANS
CALIFORNIAMEDICAL SCHOOL GRADUATES
U.S.
Male71%
Female29%
U.S.
Male51%
Female49%
California Physician Facts and Figuresdemographics
sources: association of american Medical Colleges (aaMC), 2009 State Physician Workforce Data Book. aaMC data Warehouse, table 27: total Graduates by u.s. Medical school and sex, 2002–2009.
despite gender parity among
medical school graduates
in California and the nation,
the physician workforce is
still dominated by men, with
women representing less
than one-third of the total. as
more women graduate, that
proportion is likely to grow.
Physicians and Medical School Graduates, by Gender, California vs. United States, 2008
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White53%
White41%
Asian21%
Asian12%
Latino5%
African American3%
No Response
12%
Latino37%
Other†
4%
African American6%
Other†
7%
PHYSICIANS* CALIFORNIA POPULATION
California Physician Facts and Figures
*includes only Mds.
†other includes american indian, native american, alaskan native, native Hawaiian, and other.
note: segments may not add to 100 percent due to rounding.
sources: Medical Board of California, 2008 Cultural Background Survey Statistics, www.mbc.ca.gov. u.s. Census Bureau, american Community survey, population estimates, series GCt-t1-r, factfinder.census.gov.
the racial/ethnic composition
of California’s physician
workforce does not reflect
the state’s diversity. While
latinos represent almost
40 percent of the population,
only 5 percent of the state’s
physicians are latinos.
Race/Ethnicity of Physicians and Population, California, 2008
demographics
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0 10 20 30 40 50
San Joaquin Valley
Los Angeles
Inland Empire
Central Coast
San Diego Area
Sacramento Area
Greater Bay Area
Northern and Sierra3%
15%
3% 22%
4% 19%
5% 33%
5% 38%
5% 45%
5% 47%
6% 46%
Latino Physicians* Latino Population
CALIFORNIA AVERAGE (5%) CALIFORNIA AVERAGE (37%)
California Physician Facts and Figures
*includes only Mds.
note: see Appendix b for a list of counties within each region.
sources: Medical Board of California, 2008 Cultural Background Survey Statistics, www.mbc.ca.gov. u.s. Census Bureau, annual estimates of the resident Population by sex, race alone or in Combination, and Hispanic origin for Counties in California: april 1, 2000 to july 1, 2008, www.census.gov.
the latino physician under-
representation is most
pronounced in the inland
empire, los angeles, and
san joaquin Valley. in these
regions, the population is
at least 45 percent latino
but only 5 to 6 percent of
physicians are latino.
demographics
Latino Physicians and Population, California Regions, 2008
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0 5 10 15 20 25
Los Angeles
Central Coast
Sacramento Area
San Joaquin Valley
Inland Empire
Northern and Sierra
Greater Bay Area
San Diego Area11%
6% 5%
14% 9%
5%
15% 3%
2%
16% 8%
12%
19% 3%
5%
19% 5%
9%
21% 3% 3%
22%10%
9%
Spanish Chinese* Other Asian
CALIFORNIA AVERAGE(8% Chinese, 8% Other Asian)
CALIFORNIA AVERAGE(18%)
California Physician Facts and Figures
for patients, not having
access to a provider who
speaks their language can
have a negative impact on
quality of care. statewide, less
than 20 percent of physicians
speak spanish. in los angeles,
where the population is
47 percent latino, 22 percent
of physicians speak spanish.
Physicians who speak Chinese
or other asian languages
are far less prevalent than
spanish speakers.
*Chinese includes Mandarin, Cantonese, and other Chinese.
notes: includes only Mds. see Appendix b for a list of counties within each region.
sources: Medical Board of California, 2008 Cultural Background Survey Statistics, www.mbc.ca.gov.
demographics
Non-English Languages Spoken by Physicians, California Regions, 2008
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0
20
40
60
80
100
Surgical SpecialtiesPCPsAll Physicians
25%
49%
26%
15%
58%
28%
31%
44%
25%
Foreign Other U.S. California
California Physician Facts and Figures
note: see Appendix A for PCP and surgical specialties. segments may not add to 100 percent due to rounding.
sources: California department of Consumer affairs, physician databases, 2004 and 2009, private tabulation. Centers for Medicare and Medicaid, nPi database, May 2009, private tabulation.
California draws a substantial
portion of physicians from
foreign and out-of-state
medical schools. nearly
three-quarters of California’s
physicians attended medical
school out of state, with one
in four studying outside the
united states. almost one in
three California PCPs attended
medical school abroad.
education and training
Physicians, by Medical School Location and Specialty, California, 2009
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0
200
400
600
800
1,000
1,200
1,400
1,600
200920082007200620052004200320022001200019991998199719961995
Medical School Graduates
1,01
2
982
20
22
24
26
28
30
32
34
36
38
40
Population (in millions)
31.7
38.5
California Physician Facts and Figures
sources: association of american Medical Colleges, data Warehouse, table 27, 2009. state of California, department of finance (dof), California County Population estimates and Components of Change by year, july 1, 2000 – 2009; sacramento, Ca, december 2009. dof race/ethnic Population with age and sex detail, 1990 –1999, revised May 2009. dof e-3 race/ethnic Population estimates with age and sex detail, 2000 – 2007; sacramento, Ca, May 2009.
the number of graduates
from California’s eight medical
schools has remained relatively
flat over the last 15 years,
in spite of the 20 percent
growth in population. the
university of California,
which operates five of the
programs, has announced
plans to expand enrollment
in existing programs in
addition to opening two
new medical schools.
Medical School Graduates and Population, California, 1995–2009
education and training
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0
10
20
30
40
50
60
70
80
ResidencyMedical School
62%
39%
69%
47%
California United States
California Physician Facts and Figures
percent of physiciAns prActicing in sAme stAte where educAted
source: association of american Medical Colleges (aaMC), 2009 State Physician Workforce Data Book.
California retains a high
proportion of students who
pursued their education and
residency in the state. in 2008,
California ranked first in the
nation for medical school
student retention, and second
for resident retention.
education and training
Retention of Medical Students and Residents, California vs. United States, 2008
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0
20
40
60
80
100
PrivatePublic0
50000
100000
150000
200000
PrivatePublic
89%84%
$150,000
$177,500
Medical School Graduateswith Education Debt
Median Total Debt
California Physician Facts and Figures
source: association of american Medical Colleges, Medical Student Education: Costs, Debt, and Loan Repayment Facts, october 2009.
new physicians begin their
careers with significant
educational debt. in 2009, over
80 percent of u.s. medical
students graduated with debt.
the median debt for graduates
of public institutions was
$150,000, while the median
for those from private schools
was $177,500.
Medical School Debt, United States, 2009
education and training
©2010 California HealtHCare foundation 20
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0 20 40 60 80 100 120
Family Medicine
Internal Medicine
Pediatrics
Primary Care
Psychiatry
Emergency Medicine
Medical Specialties
Radiology-Diagnostic
Other Specialties
Obstetrics/Gynecology
General Surgery
Anesthesiology
Orthopedic Surgery
Surgical Specialties
116%
87%
85%
80%
100%
83%
65%
71%
56%
42% 45%
California Physician Facts and Figures
percent of students who rAnKed only this speciAlty or rAnKed it first compAred to AvAilAble slots
note: data exclude transitional and preliminary residencies.
source: national resident Matching Program, NRMP Program Results 2005–2009 Specialties Matching Service, www.nrmp.org.
among u.s. medical school
seniors ranking residency
choices, surgical specialties
tend to be more popular
than primary care specialties.
seniors choosing family
medicine as their first or only
choice fill only 42 percent of
the available slots.
Medical Student Specialty Choices Compared to Available Slots, United States, 2009
education and training
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2004 2005 2006 2007 2008CHanGe
2004 – 2008
Primary Care
family and General Practitioners $119,010 $133,420 $136,290 $139,130 $142,620 19.8%
internists, General $168,820 $149,600 $162,340 $160,460 $172,560 2.2%
Pediatricians, General $139,020 $145,210 $148,250 $155,230 $156,830 12.8%
Specialists
anesthesiologists $196,250 $186,390 $193,780 $201,170 $209,900 7.0%
obstetricians/Gynecologists $181,070 $179,270 $178,160 $173,870 $181,520 0.2%
Psychiatrists $180,550 $171,590 $176,700 $151,680 $155,190 – 14.0%
surgeons $168,220 $158,980 $165,570 $171,200 $202,940 20.6%
Consumer Price index (CPi) ($100,000 base)
$100,000 $103,057 $103,419 $103,175 $103,494 3.5%
California Physician Facts and Figures
notes: includes only practicing physicians. does not include self-employed or government-employed physicians. in 2008, salary data for all physicians was based on 53,450 physicians practicing in California. it does not include ancillary income from sources such as directorships, call coverage, etc.
source: Bureau of labor statistics (Bls), occupational employment statistics surveys, May 2000 – 2008; Bls all urban Consumers, all items, Western u.s. CPi – annual (series Cuus0400sa0), www.bls.gov.
family and general
practitioners’ salaries
lagged other specialties,
despite a large increase
between 2004 and 2008.
during the same time,
psychiatrists saw a decline
in income while salaries for
surgeons, pediatricians, and
anesthesiologists rose more
than the CPi.
Average Annual Employed Physician Earnings, Select Specialties, California, 2004–2008
Compensation
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0 20 40 60 80 100 120
Family and General Practitioners
Obstetricians/Gynecologists
Surgeons
Internists, General
Psychiatrists
Pediatricians, General
Anesthesiologists 106%
102%
101%
98%
98%
94%
88%
CPICALIFORNIA AS PERCENT OF U.S.
(106.5%)
California Physician Facts and Figures
notes: includes only practicing physicians. does not include self-employed or government-employed physicians. does not include ancillary income from sources such as directorships, call coverage, etc. Comparison is in nominal dollars; all bars would be 6.5 percent lower if adjusted for the higher cost of living in California.
sources: Bureau of labor statistics (Bls), occupational employment statistics surveys, May 2000 – 2008, www.bls.gov. Bls, Consumer Price index, 2009 – 2010, www.dir.ca.gov.
Compensation
in 2008, most of California’s
specialists averaged earnings
similar to their national
peers, without adjusting
for California’s higher cost
of living. the largest outlier
was family and general
practitioners, who earned
less than 90 percent of the
national average.
AverAge AnnuAl employed physiciAn eArnings As A percent of nAtionAl AverAge
Physician Earnings, by Select Specialties, California vs. United States, 2008
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0
20
40
60
80
100
Income fromMedical Practice
Time to SpendPer Patient
Overall Experiencewith Practicing Medicine
8%
32%
41%
18%
11%
32%
41%
15%
18%
52%
28%
Very Dissatis�ed Somewhat Dissatis�ed Somewhat Satis�ed Very Satis�ed
— 2%
California Physician Facts and Figures
note: segments may not add to 100 percent due to rounding.
source: Health Perspectives in California, 2007 Survey of Primary Care Physicians. Harris interactive. june 2007.
a survey of California primary
care physicians found that four
in five were either somewhat
or very satisfied with their
overall experience practicing
medicine. However, two in
five were somewhat or very
dissatisfied with their medical
practice incomes.
Primary Care Physician Satisfaction, California, 2007
satisfaction
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GroupPractice18%
GroupPractice57%
IPA52%
IPA28%
Foundation7%
CommunityClinic15%
County Group6% UC Group
1%
County Group3%Community
Clinic4%
Foundation7%
UC Group2%
TYPE OF GROUPn=282
ENROLLMENTn=15.8 million
California Physician Facts and Figures
notes: includes medical groups with at least six PCPs and accepting contracts directly from HMos. Physicians frequently participate in more than one iPa. see Appendix A for definitions of medical groups. segments may not add to 100 percent due to rounding.
source: Cattaneo & stroud, Medical Group survey; september 2009, www.cattaneostroud.com.
Physicians are often part of
medical groups. over 280
medical groups provide care
to nearly 16 million health
maintenance organization
(HMo) enrollees in California.
While half of these groups
are independent practice
associations (iPas), group
practices have the largest
total enrollment.
Medical Groups, by Type and Enrollment, California, 2009
Medical Groups
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All Other Groups35%
Top 5 Largest48%
6–15th Largest
11%
6%16–25th Largest
California Physician Facts and Figures
Percent of total HMo enrollMent
notes: includes medical groups with at least six PCPs and accepting contracts directly from HMos.
source: Cattaneo & stroud, Medical Group survey; september 2009, www.cattaneostroud.com.
California’s managed
care enrollees are highly
concentrated in a handful of
medical groups, with the top
five groups enrolling almost
half of all members.
Medical Groups, by Member Enrollment, California, 2009
Medical Groups
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0
50
100
150
200
250
200820072006200520042003
Medical Groups
215 230 228 235 233 229
0
10
20
30
40
50
Physician Participation (in thousands)
40 40
45
40
3535
California Physician Facts and Figures
notes: the integrated Healthcare association, which provides oversight to the Pay for Performance (P4P) program, is a group of health plans, physician groups, and systems that promotes quality, affordability, and accountability of health care providers. its goal is to create incentives that will drive improvements in clinical quality, efficiency, and the patient experience through a common set of measures, a public report card, and health plan incentive payments.
source: integrated Healthcare association, www.iha.org, accessed March 24, 2010.
Many California medical
groups and physicians
participate in Pay for
Performance (P4P), a program
that provides financial
incentives for meeting quality-
of-care and efficiency targets.
the number of physicians
participating in P4P peaked
at 45,000 in 2005 and has
since dropped to 35,000.
Medical Groups and Physician Participation in Pay for Performance, California, 2003–2008
Pay for Performance
©2010 California HealtHCare foundation 27
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0 10 20 30 40 50 60 70 80
Sacramento Area
Greater Bay Area
Northern and Sierra
San Diego Area
Orange
San Joaquin Valley
Central Coast
Los Angeles
Inland Empire 62.1
65.0
67.5
68.5
70.3
70.5
73.5
76.5
76.7
(22 groups)
(65 groups)
(9 groups)
(14 groups)
(18 groups)
(17 groups)
(3 groups)
(30 groups)
(10 groups)
CALIFORNIA AVERAGE(68.6%)
California Physician Facts and Figures
notes: the clinical composite scores in the chart are based on 16 eligible clinical measures in measurement year 2008 (“My 2008”). the measures are equally weighted to form a clinical composite. for any eligible physician organization that had missing data, an adjusted half-scale rule was applied. see Appendix b for a list of counties within each region.
source: integrated Healthcare association Pay for Performance data, Measurement year 2008.
Physician group performance
on Pay for Performance (P4P)
clinical quality measures varies
widely by region. Greater
Bay area physician groups
participating in P4P averaged
76.5 on a composite quality
score, while los angeles
groups performed more than
ten points lower.
P4P Physician Group Clinical Quality Scores, California Regions, 2008
Pay for Performance
©2010 California HealtHCare foundation 28
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0 20 40 60 80 100
California Average
Inland Empire
Los Angeles
Orange
San Diego Area
San Joaquin Valley
Sacramento Area
Central Coast
Greater Bay Area
Northern and Sierra 14% 86%
2 7% 42% 50%
6% 6% 50% 38%
13% 50% 38%
7% 14% 46% 32%
9% 26% 48% 17%
10% 31% 41% 17%
14% 32% 40% 15%
22% 33% 39% 6%
9% 20% 40% 31%
Poor Fair Good Excellent
California Physician Facts and Figures
notes: each medical group’s patient records are compared to a set of national standards for quality of care on an annual basis. sixteen quality measures such as immunizations for children, cholesterol tests for people with heart disease and diabetes, and pap smears for women are evaluated. each group is awarded an aggregate quality score of excellent, Good, fair, or Poor. segments may not add to 100 percent due to rounding. see Appendix b for a list of counties within each region.
source: office of the Patient advocate, Medical Group ratings, May 2009 ratings based on 2008 data, www.opa.ca.gov.
an annual public report card
issued by California’s office of
the Patient advocate shows
how well groups participating
in P4P have performed on
16 quality measures. in 2009,
Greater Bay area medical
groups scored well on these
measures — 92 percent of
groups received a “Good”
or “excellent” rating. only
45 percent did so in the
inland empire.
Pay for Performance
P4P Physician Groups Meeting National Standards of Care, California Regions, 2008
©2010 California HealtHCare foundation 29
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0 10 20 30 40 50 60 70 80
Actionable Report/Data Warehouse
HEDIS Results
Computerized Registries
Electronic Lab Results
Accessing Clinical Notes of Other Practitioners
Physician Preventive/Chronic Care Reminders
Electronic Messaging
Electronic Drug Checks
Accessing Clinical Findings Such as Blood Pressure
Ordering Lab Tests
Electronic Prescribing 31%
38%
39%
39%
49%
51%
56%
56%
62%
63%
67%
Point of Care Population Management
California Physician Facts and Figures
source: integrated Healthcare association, Pay for Performance (P4P) 2008 Results Report, august 2009.
Physician groups participating
in Pay for Performance (P4P)
are measured and rewarded
for their use of health
information technology (it).
almost 62 percent of these
groups use it to create
patient registries. use of it at
the point of care is less well-
established within P4P groups,
although over half use some
of these technologies such as
accessing electronic lab results
and clinical notes of other
practitioners.
P4P Physician Groups Using Health Information Technology, California, 2008
Pay for Performance
©2010 CALIFORNIA HEALTHCARE FOUNDATION 30
<< R E T U R N TO CO N T E N T S
F O R M O R E I N F O R M AT I O N
California HealthCare Foundation
1438 Webster Street, Suite 400
Oakland, CA 94612
510.238.1040
www.chcf.org
CAL I FORNIAHEALTHCAREFOUNDATION
California Physician Facts and Figures
AuthorCraig Paxton, Ph.D., Cattaneo & Stroud, Inc.
AcknowledgmentsThe author would like to thank Emily Willig for
diligent data compilation, and partners Penny Stroud
and Grant Cattaneo for critical expertise.
Data ResourcesAssociation of American Medical Colleges
Semi-annual reports on state physician workforce, as well as data on medical
school students and graduates, and medical student tuition and debt.
www.aamc.org
California Department of Consumer Affairs Physician licensing data on doctors of medicine and osteopathic medicine.
www.dca.ca.gov
California HealthCare Foundation “Fewer and More Specialized: A New Assessment of Physician Supply in
California.” The first comprehensive study of the Medical Board of California
survey data on practicing physicians in the state, with an Excel spreadsheet
showing the number of physicians, by specialty, for each California county.
www.chcf.org
Cattaneo & Stroud Medical group survey reports.
www.cattaneostroud.com
Integrated Healthcare Association Reports on physician participation and performance in California’s Pay for
Performance program.
www.iha.org
Medical Board of California Annual reports on physician cultural background and foreign language
proficiency, by zip code and county; physician level survey data.
www.medbd.ca.gov
Office of the Patient Advocate Reports on medical group ratings.
www.opa.ca.gov
©2010 California HealtHCare foundation 31
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medical groupsMedical groups are organized and managed in several
different ways:
Community Clinic.• a clinic that operates under
California Health and safety Code 1204(a), which
requires that it provide care to low-income and
underserved populations, and charge fees based on
patients’ ability to pay. a community clinic is operated
by a tax-exempt nonprofit corporation, supported by
either public or private donations and contributions.
County Group.• a county-formed group of
physicians that typically provides services through
the county health department.
Foundation.• a type of group practice under
California Health and safety Code 1206(l), which
stipulates that a medical foundation must operate
a not-for-profit, tax-exempt clinic, conducting
research as well as providing patient care and
health education. the foundation must have at least
40 physicians, at least ten of whom have to be board
certified, and at least two-thirds of all physicians
must practice on a full-time basis at the clinic. the
physicians are independent contractors to the
foundation, but the foundation owns the facilities,
equipment and supplies, and employs all non-
physician personnel.
Group Practice.• a corporation, foundation,
partnership, or other type of organization formed
for the purpose of providing patient care. Group
practices are more regulated than iPas. to be
recognized by CMs as a group practice, the
organization must direct the majority of its physicians’
bills through the organization, pay for their own
overhead, and follow other regulations specified
under California Health and safety Code 1206(l).
Independent Practice Association (IPA).• an
association that contracts with independent
physician practices so that they may work together as
one when contracting with HMos and other payers.
University of California Medical Center.• a medical
group operated by the university of California as part
of one of its medical schools.
specialtiesMedical Specialties include: aerospace Medicine,
allergy and immunology, Cardiology, Complementary
and alternative Medicine, Critical Care, dermatology,
emergency Medicine, endocrinology, Gastroenterology,
Hematology, infectious disease, Medical Genetics,
neonatal-Perinatal Medicine, nephrology, neurology,
occupational Medicine, oncology, other Medical Practice,
Pain Medicine, Physical Medicine and rehabilitation,
Psychiatry, Public Health and General Preventive,
Pulmonology, rheumatology, and sleep Medicine.
PCP Specialties include: family/General Practice,
internal Medicine, Pediatrics, adolescent Medicine, and
Geriatric Medicine.
Surgical Specialties include: anesthesiology, Colon
and rectal surgery, Cosmetic surgery, facial, Plastic and
reconstructive surgery, General surgery, neurological
surgery, obstetrics and Gynecology, ophthalmology,
orthopedic surgery, otolaryngology, Plastic surgery, spine
surgery, surgical oncology, thoracic surgery, urology, and
Vascular surgery.
Other Specialties include: nuclear Medicine, Pathology,
radiation oncology, and radiology.
California Physician Facts and Figuresappendix a
source: Cattaneo & stroud, Medical Group survey; september 2009, www.cattaneostroud.com.
Definitions
©2010 California HealtHCare foundation 32
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central coast Monterey, san Benito, san luis obispo, santa Barbara, santa Cruz, Ventura
greater bay Area alameda, Contra Costa, Marin, napa, san francisco, san Mateo, santa Clara, solano, sonoma
inland empire riverside, san Bernardino
los Angeles los angeles
northern and sierra alpine, amador, Butte, Calaveras, Colusa, del norte, Glenn, Humboldt, inyo, lake, lassen,
Mariposa, Mendocino, Modoc, Mono, nevada, Plumas, shasta, sierra, siskiyou, sutter,
tehama, trinity, tuolumne, yuba
orange orange
sacramento Area el dorado, Placer, sacramento, yolo
san diego Areaimperial, san diego
san Joaquin valley fresno, Kern, Kings, Madera, Merced, san joaquin, stanislaus, tulare
California Physician Facts and Figures
Region Counties appendix B
©2010 California HealtHCare foundation 33
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Age group primAry cAre1medicAl
speciAlties2surgicAl
speciAlties3other
speciAlties4 totAl
0 to 17 95 10 16 29 149
18 to 24 43 15 54 48 159
25 to 44 59 23 52 62 196
45 to 64 89 41 59 81 270
65 to 74 175 97 125 145 543
75 and older 270 130 161 220 781
notes: authors calculated ratios based on physician use patterns and patterns of care in 2000. 1. includes general and family practice, general internal medicine, and pediatrics. 2. includes cardiology and other internal medicine subspecialties. 3. includes general surgery, obstetrics/gynecology, ophthalmology, orthopedic surgery, otolaryngology, urology, and other surgical specialties. 4. includes anesthesiology, emergency medicine, pathology, psychiatry, radiology, and other specialties.
source: u.s. department of Health and Human services, Health resources and services administration, Bureau of Health Professions, The Physician Workforce: Projections and Research into Current Issues Affecting Supply and Demand, december 2008.
California Physician Facts and Figuresappendix C
Estimated Requirements for Physicians per 100,000 Population, by Patient Age, United States, 2000