BILL ANALYSIS AB 1855 APPR: YES SENATE COMMITTEE ON EDUCATION Staff Analysis of AB 1855 (Isenberg) As Amended: April 14, 1993 SUMMARY This bill requires the University of California (UC) to ensure, šby January 1, 1996, that 50% of its actual medical residency špositions are primary care residency positions and that 40% of šthose residencies are actual family practice residencies. BACKGROUND UC has the exclusive jurisdiction in public higher education šover graduate programs in the profession of medicine. The šannual Budget Act contains an appropriation to the UC for the šsupport of its health sciences programs, including medical šinstruction. In 1973, the Family Physician Training Act (Song-Brown Act) šwas enacted to increase the number of physicians in family špractice. The Office of Statewide Health Planning and šDevelopment (OSHPD) is allocated approximately $2.75 million šannually to increase the number of family physicians to serve šin currently underserved rural and urban areas of the state. In 1981-82 UC budgeted 1,999 medical residency positions in šprimary care. In 1991-92, the budgeted number for primary šcare residency positions was 1,989 and the actual number was š2,018. During that ten year period, the total number of šmedical residency positions has annually been between 4,100 šand 4,200, therefore, there has been no appreciable increase šin the percentage of primary care residencies. Last year, AB 3593 (Isenberg) which was identical to this šbill was passed by the Legislature, but was vetoed by the šGovernor. In connection with the Governor's veto, UC agreed što conduct a study identifying recommendations and a štimetable for implementation of a plan designed to increase šthe number of primary care physicians UC trains every year. šAlthough that study has not yet been officially released, the šfinal draft sets a timetable for increasing the number of šprimary care resident positions over the next seven years. šUC's goal is to increase the percentage of primary residents šfrom 44.6% in July, 1993, to 53.5% by July, 2001; and šincrease the percentage of family practice resident positions šwithin primary care residencies from 26.9% in July, 1993 to š34.1% by July, 2001. The bill was vetoed by the Governor šwith the following message: AB 1855 Page 2 This bill would require the University of California to allocate 50% of its medical residencies to primary care specialties, and 40% of those positions specifically to family practice. It would, beginning in 1995-96, require the Department of Finance to reduce the University's annual General Fund appropriation by up to $8 million, based upon the University performance in meeting those statutory quotas. I share the author's commitment to increasing access to primary health care, and believe a greater investment in family practice residencies is necessary to provide needed medical professionals for underserved areas. That is why I proposed additional funding for the Song-Brown Family Physician Training Program. Additionally, it is clear that the state's accelerated movement to managed health care generally, is dependent upon a ready supply of family physicians. While the University currently allocates 50% of its residency positions to primary care, I am advised that the effect of the additional 40% family practice requirement may, in the short-run, lead to an increase in one primary care specialty at the expense of other specialties. I am concerned that such an outcome could hamper the University's ability to fulfill all of its health-related missions --training physicians in a variety of specialties, providing tertiary and indigent care, conducting biomedical research, and training future faculty physicians. I believe the University should be provided an opportunity to assess the important issues involved and prepare a plan which can be implemented beginning in fiscal year 1993-94 to significantly enhance the number of family practice residencies in the most effective manner. University of California President David Gardner, with the concurrence of President-designate Jack Peltason, has pledged that the University will review the medical education programs in the context of the state's urgent need for primary care and family practice physicians, report back to me and to the Legislature on its findings, and submit by June 1993, a specific implementation plan and time-table for making desirable changes. I am advised the University will assess the need to change the mix of its residency program in the context of demographic changes and changes in the state's health care system, and that the University's medical school deans will consult with the director of our state Department of Health Services, Dr. Molly Joel Coye, and director of our Office of Statewide Health Planning and Development, Dr. David Werdegar. I am confident that the University, in cooperation with Dr. AB 1855 Page 3 Coye and Dr. Werdegar, will prepare and implement a responsible plan for enhancing the residency and training opportunities for family practice physicians through the University's medical schools so that California's need for these primary care professionals can be addressed. However, if these efforts fall short of our mutual objective, I would be willing to revisit this issue in legislation. ANALYSIS This bill: 1) Requires the UC, by January 1, 1996 to develop and implement š a plan to achieve a goal, its good faith and best efforts, that 50% of the graduates in each graduating class with medical degrees shall practice primary care; 2) Requires UC to ensure by January 1, 1996 that 50% of its š actual medical school residency positions are primary care residency positions and that 40% of those are actually family practice residencies that are filled; 3) Commencing with the 1996-97 fiscal year, financially š penalizes UC if it does not meet both the 50% and 40% goals by reducing from the UC's state general fund appropriation an amount equal to three times the marginal state cost of instruction for each University of California and University of California affiliated medical resident student; however, the total reduction shall not exceed $8 million; 4) Defines "primary care residencies" as a residency in which š the physician is responsible for initial, primary, continuity, and referral care of the patient, and his or her practice is limited to family practice, general internal medicine, general pediatrics, or general obstetrics/gynecology; 5) Requires reports and verification of report data to the š Legislature by August 15 annually; and 6) Sunsets the provisions of the bill on June 30, 2005. SUPPORT Aids Project Los Angeles California Academy of Physician Assistants California Health Federation College of Osteopathic Medicine of the Pacific Health Net Osteopathic Physicians and Surgeons of California Planned Parenthood Affiliates AB 1855 Page 4 OPPOSITION University of California DR 07/07/93