Shortchanged: Health Workforce Gaps in California

An estimated 11,226,111 people in California live in an area that has a shortage of primary care providers. Approximately 150,675 people are experiencing homelessness and in need of housing, health, and social services. It is critically important to fill the health workforce gaps across California to meet these needs.

These data illustrate the magnitude of the health workforce shortages around the state. Almost a third of Californians are in a Primary Care Health Professional Shortage Area, including people who are experiencing homelessness — many of whom have extensive health needs. Those who live on the streets die an average of 20 years earlier than people who are housed. Primary care providers (including physicians, nurse practitioners, physician assistants, and certified nurse midwives) can develop sustained relationships with patients and practice in the context of family and community. Having a usual primary care provider is associated with a higher likelihood of receiving appropriate care and lower mortality. Having greater access to primary care providers of all kinds can save lives. What are the numbers in your region?

Regional maps, a state map, and the data file are available under Document Downloads.

Definitions

Health Professional Shortage Area. Areas and population groups that are experiencing a shortage of health professionals are designated by the US Health Resources and Services Administration (HRSA) as Health Professional Shortage Areas (HPSAs). There are three categories of HPSA designation, based on the health discipline that is experiencing a shortage: (1) primary medical, (2) dental, and (3) mental health. The primary factor used to determine a HPSA designation is the number of health professionals relative to the population with consideration of high need. Federal regulations stipulate that, to be considered as having a shortage of providers, an area must have a population-to-provider ratio above a certain threshold. For primary medical care, the population-to-provider ratio must be at least 3,500 to 1 (3,000 to 1 if there are unusually high needs in the community). (This definition was excerpted from KFF’s “State Health Facts: Primary Care Health Professional Shortage Areas.”) For data on designated Health Professional Shortage Areas, see “Shortage Areas,” Health Resources and Services Administration.

Homelessness. The federal government uses different definitions of homelessness depending on the agency. The US Department of Housing and Urban Development (HUD), which is principally responsible for programs addressing homelessness through the Continuum of Care program, uses a comparatively narrow though complex definition of homelessness (PDF). This definition is used for the annual point-in-time count, which is widely cited as the official estimate of homelessness in the US, despite widely recognized problems with the point-in-time count. The data provided for these maps are based on 2019 point-in-time counts for each county and the HUD Continuum of Care reports. See regional maps for links to county-specific data.

Methods

Small County Population Extrapolation Methodology. 2018 one-year estimates for geographical areas with fewer than 65,000 residents were extrapolated from the US Census Bureau’s American Community Survey 2014–18 five-year estimates. Five-year estimates are the average population over those five years. The American Community Survey (ACS) does not publish one-year estimates for counties or cities with fewer than 65,000 residents, nor for any other subcounty geographical areas (such as census tracts) regardless of population. The ACS does produce one-year estimates for small counties grouped contiguously together to form aggregate populations of 100,000 or more. These areas are called Public Use Microdata Areas. For example, Colusa (population 21,333 in 2014–18), Glenn (27,524), Tehama (62,708), and Trinity (12,663) have a combined 2018 one-year population estimate (123,884) published in the ACS. The difference in five-year average population between 2014–18 and one-year population in 2018 was distributed between these four counties proportionate to their 2014–18 five-year estimates.

HPSA Population Extrapolation Methodology. HPSAs are defined as groups of census tracts, so the populations of their component tracts (2014–18 five-year average) were summed. The component census tracts of each HPSA were identified using an ArcGIS Geographical Information System. Each HPSA’s 2018 one-year estimate was extrapolated proportional to its county’s change from its five-year 2014–18 estimate to its one-year 2018 estimate. For example, if the county’s population increased by 1% between the 2014–18 five-year average and the 2018 one-year average, the population for all the county’s HPSAs were extrapolated to have increased by 1%.