Today's Law As Amended

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SB-1110 Health care workforce development: California Medicine Scholars Program.(2019-2020)

As Amends the Law Today

 (a) The Legislature finds and declares all of the following:
(1) California is facing a growing shortage of primary care physicians.
(2) It is projected that, by 2030, our state will face a skills gap of 1.1 million workers with bachelor’s degrees. Failure to keep up with demand for skilled workers will curtail economic growth, limit economic mobility, and increase inequality. The result will be a less productive California economy, limited social mobility, and lower incomes and tax revenue.
(3)  In addition, our health care workforce continues to lose hundreds of thousands of doctors and nurses each year, with the majority of them leaving before retirement age. Reducing attrition would change the projected shortages more than any other single factor.
(4) Our nation, along with rest of the world, is currently experiencing the devastating effects of the COVID-19 pandemic. Future pandemics are not merely possible, but likely, and California is acutely at risk for these events due to the state’s global travel hubs and metropolitan population. Patients must have access to culturally competent care that they can trust, and that understands their experience and limitations.
(5) Attracting and keeping quality physicians in California is a constant challenge that has reached crisis proportions in some areas, and is a particularly acute challenge in rural areas.
(6) According to a 2017 report from the University of California San Francisco Healthforce Center, California is predicted to see a shortage of over 4,000 primary care clinicians by 2030. In regions such as the central valley, the Inland Empire, and the Imperial Valley, communities are already experiencing the pains of a shortage. Patients in these regions face longer than average wait times to see a physician or extensive time to travel to the closest physician. These barriers discourage working families from seeking regular care. As a result, the state incurs higher costs to cover Medi-Cal patients who are pushed to utilize urgent care and emergency rooms once they are affected by more acute medical conditions that could have been prevented with earlier and more regular access to a primary care physician.
(7) Although the need is great in the Inland Empire, that region, unlike the San Joaquin Valley, has an established medical school with the University of California, Riverside, School of Medicine. A second, privately funded medical school, the California University of Science and Medicine, was also recently accredited in 2018. By comparison, since 2015, the central valley region has only begun to establish a medical school presence through the University of California, San Francisco (UCSF), Fresno, and the San Joaquin Valley Program in Medical Education (PRIME) program. Only in the last year has the central valley region seen the establishment of a second medical school in this area with the privately funded California Health Sciences University, and the development of the University of California (UC), Merced, Center for Medical Education and Health Sciences.
(8) The central valley also has shown strong evidence of a partnership development to address preparing community college students through the existence of multiple health workforce pathways through the California Community Colleges’ Health Workforce Initiative, the Rural Health Equity and Learning Collaborative (HEAL) program at Bakersfield College, the engagement of the University of California, the California State University, and community colleges through the Central Valley Higher Education Consortium, the new partnership between UC Merced and UCSF Fresno, and the San Joaquin Valley Coalition for Medical Education.
(9) As of 2015, the majority of California’s population has been made up of minority groups. Therefore, it is now critical that efforts to increase access to care are driven by efforts to increase the number of diverse physicians entering the practice. Latino, African American, Native American, and Pacific Islander physicians are significantly underrepresented across California. Researchers from the University of California, Los Angeles, Latino Policy & Politics Initiative (LPPI) reported in 2018 that the scarcity of Latino physicians in California has led to a deficit of 54,655 Latino physicians required to achieve parity with non-Latino white physicians. Should existing trends in recruitment and training of physicians in the state efforts continue, LPPI researchers calculated it will take California five centuries to achieve parity. A total of six legislative districts have populations that are at least 65 percent African American, Latino, or Native American, and at least 15 percent noncitizen, including Congressional Districts 16 and 21, State Senate Districts 12 and 14, and State Assembly Districts 31 and 32.
(10) Researchers have also found that African American and Latino doctors are more likely to practice in communities that reflect their cultural background. Further studies have found evidence that the gaps in mortality between African American and white patients can be reduced when African American patients are treated by African American physicians. Without a comprehensive, statewide strategy to increase the number of diverse doctors, the existing realities of continuing disparities in care and other indicators of well-being for communities of color hamper the state’s bold leadership in actually improving health outcomes for our most vulnerable populations.
(11) Doctor shortage is a significant deterrent to recruitment. Doctors are facing an enormous amount of debt when finishing medical school. This profession requires extensive education, training, and skills. In addition to bringing more young people into the profession, we must also find ways to keep quality doctors in California.
(12) Currently, the California Community Colleges do not offer a pipeline for students that would facilitate their ability to attend medical school.
(13) The California Community Colleges comprise the largest system of higher education in the nation, with 2.1 million students attending 115 colleges.
(14) While our state’s universities offer extensive and innovative health and science programs, many communities are not geographically close to a four-year university that offers the courses for students entering medical school.
(15)  Existing and proposed pipeline programs for increasing the diversity and capacity of the health care workforce, including UC PRIME and the proposed California Health Careers Opportunity Program, have provided exemplary lessons to date in support of medical students to serve minority populations and fill critical gaps in the overall need for health workers.
(16) Across the segments of higher education in California, the diversity in the state’s community colleges most closely reflects the diversity of the state’s population. Among aspiring and enrolled medical school students, research from the Healthforce Center at UCSF has found that the cost of higher education proved to be one of the single greatest barriers to underrepresented minorities seeking to pursue a medical degree. With the steadily rising cost of tuition in the University of California, the California State University, and among private, not-for-profit colleges in California, coupled with rising costs of living across the state, first-generation and underrepresented minority students are increasingly choosing to start their postsecondary education in community colleges despite being academically competitive applicants to those institutions. Among first-time postsecondary Latino and African American enrollees in California’s higher education institutions, nearly two-thirds enter via the community colleges.
(17) The California community colleges have made notable gains in improving their infrastructure for on-time transfer and career preparation in health-training pathways as a result of recent state legislation and state-funded initiatives, including the California Guided Pathways Project and the Strong Workforce Program. While these initiatives have improved the capacity of the community colleges to support underrepresented minorities to transfer or pursue health care workforce opportunities, those initiatives have not yet led to specific practices to adopt advisory or other resources to initiate premedical training for students who may wish to consider a path to transfer and to eventually apply to medical school.
(18) In light of the overall increases in postsecondary enrollment among first-time college students, if the state seeks to expand its physician pool, building this pathway opportunity from the community college system is a natural first step. National studies in 2014 and 2018 conducted by the University of California, Davis, School of Medicine have also found that over 25 percent of United States medical school graduates utilize a community college at some point in their higher education path. Furthermore, these studies found that graduates who attended community college while in high school, in a traditional post-high school transfer pathway, or after completion from a four-year undergraduate college or university, were more likely to train in family medicine than medical graduates who did not attend a community college.
(b) Therefore, it is the intent of the Legislature to create the California Medicine Scholars Program, a pilot program, to build upon existing programs to improve the premedical infrastructure by creating a pipeline from the California Community Colleges’ system, the second largest and most diverse higher education system in the world, to the practice of primary medicine. The California Medicine Scholars Program, as established by this act, will help produce physicians, and, upon completion of their training, these physicians will care for patients in vulnerable and underserved communities. These physicians will also come from backgrounds that will help provide them with an understanding of the way of life in those communities, which is integral to enabling them to help stop or limit future pandemics.

SEC. 2.

 Article 2.8 (commencing with Section 127960) is added to Chapter 2 of Part 3 of Division 107 of the Health and Safety Code, to read:

Article  2.8. California Medicine Scholars Program
 (a) The Office of Statewide Health Planning and Development (office) shall establish and facilitate the California Medicine Scholars Program (CMSP), as a five-year pilot program, commencing January 1, 2022. The purpose of the pilot program is to establish a regional pipeline program for community college students to pursue premedical training and enter medical school, in an effort to address the shortage of primary care physicians in California and the widening disparities in access to care in vulnerable and underserved communities, by building a comprehensive statewide approach to increasing the number and representation of minority primary care physicians in the state. The CMSP shall be implemented through the creation of four Regional Hubs of Health Care Opportunity (RHHO), as described in Section 127962.
(b) (1) The office shall contract with an appropriate entity to serve as the managing agency of the pilot program in accordance with this article. By June 30, 2021, the managing agency, as selected by the department, shall provide dedicated staffing for the pilot program’s planning and management. Programmatic operations shall be overseen by the executive board or other governing entity of the managing agency.
(2) The managing agency, as selected by the department, shall be a nonprofit or for-profit organization with demonstrated expertise in areas including, but not limited to, health profession education and health equity.
(c) To implement this section, the department may enter into exclusive or nonexclusive contracts, or amend existing contracts on a bid or negotiated basis. Any contract entered into or amended pursuant to this subdivision shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and the review or approval of any division of the Department of General Services.
(d) Implementation of the pilot program is contingent upon the appropriation by the Legislature of sufficient funds for its purposes. The office may also accept private funds for purposes of increasing the cohort size.
 The duties of the managing agency shall include, but not be limited to, all of the following:
(a) Collecting, tracking, documenting, and reporting to the office on all of the following:
(1) Program data.
(2) Enhanced institutional practices.
(3) System improvements.
(b) Providing ongoing technical assistance to the RHHOs in tracking and implementation, convening RHHO project leads, providing statewide professional development to RHHO administrators and educators, and supporting the facilitation of improved linkages across the participating institutions, regions, and various programs engaged together with the RHHO project leads and the RHHO advisory boards established pursuant to Section 127962.
(c) Managing and disseminating statewide communications and publications, and coordinating statewide annual meetings of higher education and health industry leaders and professional development for administrators and educators across the RHHOs.
(d) Coordinating annual events for all California Medicine Scholars across the RHHOs to foster a statewide cohort of aspiring primary care physicians coming out of California’s community colleges.
 (a) (1) Each RHHO shall be selected through a competitive process, whereby interested collaborations of higher education institutions, community organizations, and local health centers may apply to an issued request for applications and selected by the committee convened pursuant to subdivision (b).
(2) Each proposed RHHO shall include, at a minimum, all of the following institutions and entities:
(A) Three California community colleges.
(B) One public four-year undergraduate institution in California.
(C) One public medical school in California.
(D) Three local community organizations. At least one of those organizations shall be a local community health center, and one shall be a hospital. The selected hospital shall serve underserved communities and regions, and that hospital shall be aligned with the mission of the pilot program to prepare community college students from underserved communities in order to serve those communities.
(3) At least one of the selected RHHOs shall be located in the central valley.
(b) (1) The managing agency shall appoint an objective RHHO selection committee that includes, at a minimum, all of the following members:
(A) One state-level representative from each of the following:
(i) The California Community Colleges.
(ii) The University of California.
(iii) The California State University.
(iv) The California Primary Care Association.
(B) One or more individuals with legal expertise, particularly in the requirements of the California Civil Rights Initiative, who shall review the committee’s preliminary RHHO selections to ensure adherence to those requirements.
(2) The Secretary of the Senate and the Chief Clerk of the Assembly shall each appoint one member of their respective house to the RHHO selection committee, and those two appointees shall serve in an advisory capacity.
(3) The selection committee shall establish evaluation criteria based on applying each applicant’s submission of baseline metrics on student enrollment, transfer and academic measures for community colleges and four-year institutions, the capacity to establish, and prior existence of, the proposed partnerships, and the proposed region’s need for primary care physicians. The committee shall also take into consideration an applicant’s proximity to medical schools and give special consideration to community colleges that are working to expand health care facilities.
(c) The RHHO selection process shall be completed by June 30, 2021. Once an RHHO is selected and established, the RHHO shall implement the pilot program in accordance with requirements established in memoranda of understanding that shall be entered into by the RHHO participating entities by January 1, 2022. The requirements shall include, at a minimum, all of the following:
(1) To hire an RHHO project lead, whose position shall be funded with state funds. The RHHO may also accept private funds for this purpose.
(2) For each RHHO participating educational institution, to identify a faculty advocate, a program lead, and a data and research lead to represent the various interests of the RHHO partners. In addition, participating local health centers and other community organizations shall jointly identify programmatic and data leads.
(3) To implement data sharing, analysis, and the continuous testing of data-informed practices, to foster a statewide collaboration of mutual accountability for improvement, consistent with applicable state and federal law.
(4) To establish an advisory board, comprised of local business, education, health industry, and other community leaders to oversee and guide the programmatic direction of the RHHO with the RHHO project lead. The advisory board shall help to guide the unique establishment of regionally specific RHHO partnerships and opportunities for students along the pathway to support the accomplishment of its targets for student outcomes. These opportunities may include, but need not be limited to, scholarships, internships, shadows of clinical rotations, and research or community service to ensure students gain a familiarity with the unique needs and challenges for primary care in their region and are instilled with a sensitivity to the culture and unique patient populations of the region.
 (a) By January 1, 2022, each RHHO shall be operational and shall have recruited and selected at least 50 California Medicine Scholars across every partnering community college, with 15-20 students per college, for a total of 200 students in the initial CMSP cohort statewide. Participating students shall have completed at least one semester of study in a California community college before selection.
(b) (1) Subsequent recruitment and selection of California Medicine Scholars shall occur by each RHHO by January 1 of every year from 2023 to 2025, inclusive, consistent with the criteria established in subdivision (a). The final year of recruitment and selection of California Medicine Scholars shall also be a critical measurement point to evaluate the initial success of the CMSP, as provided in Section 127964, with a focus on supporting all 200 students of the first pilot cohort to be eligible for transfer and acceptance into a participating University of California, California State University, or four-year private college in one of the four RHHOs.
(2) An RHHO shall encourage any student who elects to leave the CMSP to independently pursue a career in health or the health services, and shall facilitate for that student any connections to those programs if that student chooses to pursue those fields.
 (a) By December 31, 2022, and by December 31 of every year from 2023 to 2025, inclusive, each RHHO shall provide a status report on the implementation of the pilot program to the managing agency and the office. The report shall include data and information collected by each RHHO during the program year as required by this article.
(b) (1) By June 30, 2026, the managing agency and the office shall jointly prepare and submit to the Legislature a final report evaluating the success of the CMSP, including the data and information provided by the RHHOs under subdivision (a). The report shall evaluate CMSP based on all of the following metrics:
(A) The competitive selection and establishment of the four RHHOs across California with a full-time RHHO program lead in each RHHO, and the participation of at least the institutions for each RHHO as described in Section 127962.
(B) The implementation and adoption of premedical advising standards or standardized guidelines as set out by the managing agency and specific to each RHHO by at least 12 California community colleges and four-year undergraduate institutions across the four proposed RHHOs. These standards or standardized guidelines shall be endorsed by the participating schools of medicine, by June 30, 2023.
(C) The implementation and adoption of a student-identifying marker in the institutional data systems of the RHHO participating community colleges and four-year undergraduate institutions to identify students as “California Medicine Scholars,” by June 30, 2022.
(D) (i) The application and selection of at least 400 full-time enrolled students in a California community college who have completed a minimum of one term in the community college, who are identified as “California Medicine Scholars” in their participating colleges by January 1, 2022.
(ii) The application and selection of at least 150 additional California Medicine Scholars who match the above criteria by January 1, 2023, as provided in Section 127963.
(E) At least 200 California Medicine Scholars’ enrollment and completion of a health internship, research apprenticeship, or at least 6 weeks of part-time employment in a health, public health, or primary care-related position or setting by June 30, 2023, while enrolled as California community college students.
(F) An overall increase in the percentages of African American, Latino, and Native American student populations enrolled full time in participating California community colleges who successfully achieve transfer-level math and English by the completion of their second year enrolled in a California community college. For purposes of this subparagraph “transfer-level math and English” has the same meaning as defined by the California Community Colleges’ management information systems.
(G) An overall increase in the rate of acceptance to participating four-year undergraduate institutions for transfer students applying from participating California community colleges.
(H) At least 80 percent of the California Medicine Scholars eligible to transfer, and accepted to attend, a participating four-year undergraduate institution after completing two years of full-time enrollment in a California community college.
(I) The establishment of a CMSP planning and management office with four full-time and one part-time employees hired by June 30, 2021.
(J) The execution of memoranda of understanding and data sharing agreements among all participating entities within each of the RHHOs, with each other, and with the CMSP planning and management office by January 1, 2022.
(2) A report submitted under this subdivision shall be submitted in compliance with Section 9795 of the Government Code.
 The provisions of this article are severable. If any provision of this article or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.
 This article shall become inoperative on June 30, 2026, and, as of January 1, 2027, is repealed.