Celia Hernandez of Santa Ana and her fellow students at Taller San Jose’s medical careers academy receive hands-on clinical training, case management, externship opportunities and job placement services that help to prepare them to enter the workforce.

Paging New Talent

More Health Professionals Needed To Address Workforce Shortages Affecting California’s Growing Diverse Populations

By David B. Littlefield and Adriana Godoy Leiss

As a high school student in the Inland Empire, Louisa Hanna enjoyed her classes in anatomy and physiology but she wasn’t sure what it would take for her to become a nurse, emergency medical technician — or even a physician.

“I wanted to explore the possibility of becoming a doctor,” Hanna said, “but coming from high school, I did not understand the amount or type of studying it would take to succeed as a pre-medical student.”

Not deterred, the Rialto native applied for college and was overjoyed when she was accepted into the biomedical sciences program at the University of California, Riverside (UC Riverside). Soon thereafter, she was invited to apply for its FastStart Summer Academy, an intensive five-week program for incoming freshman who aspire to medical and other health-science-based careers.

New Talent
In addition to being immersed in science and mathematics, students of UC Riverside’s FastStart Summer Academy receive academic counseling, study skills assistance, peer mentoring, financial aid information and much more.

The goal of the program — which received a $180,000 core operating support grant from TCWF in June 2009 — is to increase the number of disadvantaged students in the health careers pipeline.

“FastStart was a ‘crash course’ in what college would be like and put me in a much better position to succeed,” said Hanna, a first-generation American whose mother and father emigrated from Mexico and Egypt, respectively. “The staff and mentors set high expectations for me. It was very motivating to know that even when I did not believe in myself, they did.”

Hanna completed her undergraduate work at UC Riverside and earned her medical degree from the David Geffen School of Medicine at UCLA. Now a third-year family medicine resident at Kaiser Permanente Medical Center in Fontana, Dr. Hanna plans to practice in her community after her residency.

“I hope that by being able to provide medical services to patients in their own language, I can improve overall health in the Inland Empire,” she said.

A number of organizations and programs funded by TCWF (like FastStart, further profiled on the next page) are successfully cultivating similar opportunities for Californians across the state. These programs are helping to increase the number of culturally and linguistically competent health care workers, who are in very short supply.

These are the kids we want in the health care workforce. These are kids you will want to take care of you if you’re sick.

“As California’s population continues to age and grow in size and diversity, increasing our state’s health workforce and its diversity is essential if we are to provide optimal access to health care with providers who have the cultural competence and language proficiency necessary for high-quality care for all Californians,” said Gary L. Yates, TCWF president and CEO.

Significant workforce shortages exist across the industry, not just among primary care physicians and nurses. In fact, the most urgent need lies within the allied health field — a sector that includes a wide range of clinical, administrative and support positions.

According to “Help Wanted,” a 2009 report conducted by Beacon Economics and funded by a TCWF grant to Fenton Communications, the total demand for health care employment stands to increase by 61 percent between 2010 and 2030. Allied health employment, which will increase faster than that for health care workers overall, will grow by approximately 63 percent.

New Talent

Experts warn that these shortages will be exacerbated by the influx of Californians who will gain insurance coverage in 2014 — through the recently enacted health care reform legislation.

So, how will training programs be streamlined or restructured to increase the workforce to address the urgent need? How do we address the misdistribution of health workers in underserved communities? Policymakers and researchers will be asking these and other tough questions in the years ahead as they lay the groundwork for implementing the new law. See sidebar on page 23 to read about the efforts of one such research organization, the Center for the Health Professions at the University of California, San Francisco (UC San Francisco).

In the meantime, a number of grantees are steadily working to address critical shortages by preparing, training and providing financial assistance to tomorrow’s doctors, nurses and allied health professionals.

Preparing Underrepresented Minority Students for Success

For many high school seniors preparing to enter college in the fall, the summer after graduation is the time to say goodbye to friends, earn some money, and get ready to leave home and move into a dorm room. But, at UC Riverside, summer is the time when entering freshman from disadvantaged Inland Empire communities are offered a head start toward their dreams of careers in science and health.

For five weeks in July and August, about two dozen incoming freshmen participate in the FastStart Summer Academy. They attend daily classes in biology, chemistry and math; live in the dormitories; participate in evening study sessions; and receive campus orientation and personalized academic and career advising.

As a result, the FastStart program ensures that these students are prepared at week one of the fall quarter. They know where the library is; they have received a taste of college-level coursework; and they have a network of advisors and colleagues in place.

The academic demands of the pre-med program can intimidate most students but are particularly challenging for students coming from high schools with fewer resources or those who are the first in their families to attend college. The program’s goal is to help these socio-economically disadvantaged students complete their bachelor’s degrees and enter medical school or an allied health career training program.

“We look for students who are interested in health careers, who will receive little or no parental financial support, and who have performed community service during high school,” said Craig Byus, dean of biomedical sciences at UC Riverside.

A number of students enter the program with a strong interest in becoming primary care physicians or working in communities like the ones in which they grew up.

“They have experienced the health care system as it is; they’ve translated for family members at the doctor’s office,” Byus said. “They are motivated to give back.”

Ultimately, the university hopes that these students will remain in the Inland Empire — providing medical care to underserved communities.

“These are the kids we want in the health care workforce,” Byus said. “These are kids you will want to take care of you if you’re sick.”

The program can document its success through the achievements of participants like Hanna, who was enrolled in the summer of 2001. As a group, FastStart students enter college with lower GPAs than those of the overall freshman class, but they graduate at a rate two to three times higher. They pass their science courses at a rate of 90 percent, compared to only 50 percent for students overall.

“These students have shown a lot of initiative,” said Byus. “They are exceptional and bright — but need support.”

Helping Medical Professionals Provide Care in Underserved Communities

Support, of course, also comes in the form of financial aid, which is indispensable for students because of the high cost of tuition and other academic expenses. It is particularly necessary for low-income and disadvantaged young people wanting to pursue a health career, especially those who would like to provide care in medically underserved areas of California.

The average debt load for graduating medical students in California is $155,000 — and that only accounts for medical school. Students with loans from their undergraduate years or other debts can owe significantly more. Nursing students graduating with four-year degrees are often in debt to the tune of $40,000.

Repaying this debt is a key barrier for many health professionals. Positions at community clinics and other safety net providers typically pay less than similar positions in more affluent communities.

The Health Professions Education Foundation (HPEF) provides a financial lifeline in the form of loan repayments and scholarships for underrepresented and economically disadvantaged health professions students and graduates who commit to practicing in medically underserved communities in California. Since its inception in 1987, HPEF has provided $41 million in assistance to more than 3,500 health professionals. Currently, it supports professionals working in 56 of California’s 58 counties. The organization, which was established by legislative statute as a nonprofit corporation, receives administrative support — but no general fund revenue — from the Office of Statewide Health Planning and Development, a state agency.

HPEF received a two-year, $300,000 grant from TCWF in September 2008 to provide loan repayment and scholarship support for physicians, nurses, nurse educators, mental health professionals and dental health providers.

Lupe Alonzo-Diaz, HPEF executive director, differentiates between these two strategies.

“With loan repayment, the intent is to identify culturally competent providers and give them the support they need to stay in their positions. It’s a retention strategy,” she said. “Scholarships, on the other hand, help us work on the front end to increase the numbers of students entering professional training programs and to help meet demands. This is a recruitment strategy.”

Both strategies can make an impact. In rural areas with less developed health infrastructure and limited numbers of providers, loan repayments can allow providers to keep their lower-paying jobs in safety net clinics and help communities retain these vital resources. In urban areas like Los Angeles with a large number of vacant positions, recruiting professionals via scholarship programs can be more appropriate.

HPEF’s programs target a very specific set of health professionals: those who are making a lifestyle choice to practice in underserved areas.

Depending upon the program, applicants typically commit to a service obligation of one to three years. More than 95 percent of awardees successfully fulfill this commitment, and HPEF works with those who don’t to negotiate a payment plan to recoup the assistance they were given.

“They are passionate about this,” Alonzo-Diaz said. “Many have come from underserved communities.”

Creating Pathways Into the Allied Health Workforce

These programs are helping to increase the number of culturally and linguistically competent health care workers, who are in very short supply.

Another successful program that is launching the careers of students from disadvantaged backgrounds is Taller San Jose (Taller) in Santa Ana. With a mission to help underserved young people in Orange County secure and maintain employment in jobs that pay living wages and provide health benefits, Taller offers a range of job training and case management services to help clients prepare to enter the workforce.

The organization — whose name translates from Spanish as St. Joseph’s workshop (the patron saint of workers) — offers a medical careers academy to train young people for jobs in two tracks: as medical assistants or as administrative personnel in medical offices.

In September 2009, Taller received a three-year grant of $190,000 to help fund the training program and to help the organization expand the number of partner organizations that offer externship locations and other employment assistance for clients.

“We’re not a community college,” said Shawna Smith, Taller’s executive director. “Our niche is short-term, intensive programming that lasts no more than 16 weeks for young people with immediate need for employment.”

Most Taller students come from Santa Ana or other central Orange County communities where chronic poverty, unemployment and low high school graduation rates impact the lives of young people. They range in age from 18 to 28. More than 80 percent of Taller’s students are Latino, 77 percent are unemployed and many have never held regular jobs.

Classes in the medical assistance track train students to measure vital signs, administer medications and give injections, draw blood samples and perform basic laboratory tests. The administrative assistance track focuses on medical terminology, medical recordkeeping, health insurance issues, and telephone and computer techniques. Students also receive extensive job readiness training that includes resume development, mock interviews and job search assistance.

At the end of the classroom component, students from both tracks participate in a four-week paid externship at a local medical center or community clinic.

“We learned that our students won’t get hired without work experience, so we built in this opportunity for them to work alongside other professionals,” Smith said.

In addition to the classroom training and externship experience, each student is matched with a case manager who monitors their progress in the program. Case managers work with students to meet Taller’s seven steps for success: obtaining a high school diploma; remaining crime and drug free; opening and learning to use a bank account; securing a driver’s license; registering to vote; taking a computer class; and finding employment. The organization believes that these factors help students retain employment over the longer term.

Strengthening a Challenged Sector

“These are bright young people,” Smith said. “They just don’t know how to navigate the health field.”

Valeria Guillen, a graduate of the medical front-office assistant course, arrived at Taller as a single mother of two young children.

“It was very difficult — I had little time to study and a lot to learn,” Guillen said, describing the experience. “I immediately loved being there. It felt like home. Everyone was so supportive. They genuinely wanted me to have a better life, a better living.”

After completing the program, she was hired by CalOptima, where she now administers member benefits to clients enrolled in Medi-Cal and Healthy Families.“I celebrated two years of employment there,” she said. “I am now making $15 an hour and have full medical benefits for my family — paid by my employer.”

A Foundation for Success

Stories like those of Valeria Guillen and Dr. Louisa Hanna, the family medicine resident at Kaiser Fontana, demonstrate the value of creating career opportunities in the health field for California’s diverse population.

“A larger and more diverse workforce that mirrors our population will increase access to care and increase the quality of care that is delivered,” said Saba Brelvi, TCWF program director. “Moreover, providers of color can recognize and account for the cultural beliefs and mores of their patients, and they can serve as role models and mentors for minority students who may not have access to other health professionals.”

Looking back, Hanna credits pipeline programs like UC Riverside’s FastStart Summer Academy for helping medical students achieve academic and professional success. She looks forward to also contributing to the success of medical students she works with in her residency.

“I hope that by showing them a good family medicine experience,” she said, “I can convince more trainees to stay in the Inland Empire — an area that so desperately needs more primary care doctors.”

Anticipating Workforce Impacts of Health Care Reform in 2014

The Center for the Health Professions at UC San Francisco (the Center) operates a number of projects designed to assess whether California has the health workforce it needs to provide adequate care to its diverse population.

The Center received a three-year, $325,000 grant from TCWF in June 2008 to fund the work of its Health Workforce Tracking Collaborative (HWTC), which identifies critical questions, collects needed data, evaluates progress, and makes assessments of efforts to improve and support California’s health workforce. Recent topics of research include diversity in the health professions, mapping health workforce needs in California, and California’s mental health workforce. HWTC publishes its findings in research briefs that are widely disseminated to policymakers and other key audiences interested in the health care system in California.

In the interim — between passage of health reform and implementation in 2014 — researchers will be looking at a number of workforce-related issues and considering how California can recruit and retain a larger and more diverse health workforce.

Ed O’Neil, director of the Center, articulates that there are opportunities to meet the increased need using the wide range of professionals in the allied health workforce.

“There will be a ton of pressure for researchers to get at data about shortages of primary care physicians, but let’s make sure [health care reform] doesn’t become the primary care physician employment act,” said O’Neil.

For example, one of the goals of expanding access to insurance coverage through reform is to better manage chronic diseases. While many patients may expect their physicians to help them make dietary changes or create an exercise plan, other members of the allied health work force may be better suited to the task.

This opens up opportunities for interaction between patients and other culturally and linguistically competent health care workers, including medical assistants and promotoras — models that have been successfully piloted at safety net clinics in communities around the state.

“So much of the attention around reform has focused on coverage,” O’Neil said. “We need to make the transition to also look at how care is delivered.”

Selected health workforce components of health care reform:

  • Establishes a 15-member National Health Care Workforce Commission to examine workforce needs, shortages, training programs and other factors, such as education financing, that will impact health workforce development.
  • Increased funding for the National Health Service Corps for loan repayment and other assistance for medical professionals who commit to service in underserved areas.
  • Grants to expand primary care residency programs, including those at FQHC clinics.
  • Loan repayment programs for nursing school faculty members.
  • Loan repayment programs for public health professionals and mid-career scholarships in public health and allied health.
  • Tuition assistance for students who commit to working as direct care workers in geriatrics, disability services, and long-term or chronic care management.

Public ed campaign websites information on health jobs and policy

  • HealthJobsStartHere.com – This is the official website of TCWF’s public education campaign to increase California’s health workforce and its diversity. Funded by a TCWF grant to Fenton Communications, the site is a one-stop resource for job postings, training programs and financial aid advice.
  • CalHealthJobs.org – Also funded by a grant to Fenton, this site is a resource for journalists, policymakers and partner organizations working to grow and diversify the health workforce in California. It provides information on new research and experts on the issue, as well as the latest headlines on the state’s allied health workforce.

Featured Grantees Online

Featured Grantees
FastStart Future Health Taller San Jose HPEF
FastStart Future Health Taller San Jose HPEF