The San Joaquin Valley has a severe doctor shortage. Federal lawmakers have ideas to help

The San Joaquin Valley is a doctor desert.

It has the least number of doctors, nurses and practitioners per 100,000 people of any area in California. There are 22% fewer primary-care physicians than the state average. Those who do practice are aging toward retirement.

The region has among the state’s highest concentrations of patients on Medi-Cal, California’s Medicaid system for low-income people. It pays less than Medicare and far less than private insurance for the same services, meaning doctors often can’t afford to serve low-income areas.

Members of Congress representing the San Joaquin Valley, a farming-reliant region with some of the worst air quality and poorest health in California, have introduced a series of bills in the last few weeks intended to attract and keep more physicians.

Federal efforts to get San Joaquin Valley doctors

Rep. John Duarte, R-Modesto, joined Democrats and Republicans in introducing the Rural Hospital Technical Assistance Program Act at the end of July. It would make permanent a U.S. Department of Agriculture program to help prevent closures, improve services and optimize staff performance for rural hospitals. It comes after Madera County’s only adult acute care hospital closed in January.

“Our Valley is all too familiar with the challenges faced by rural hospitals, especially with the Madera Community Hospital closing in 2022,” Duarte said. “This legislation creates programs to ensure that these facilities get the resources they need.”

Rep. David Valadao, R-Hanford, introduced the bipartisan Conrad State 30 and Physician Access Reauthorization Act of 2023 to renew and modify a waiver program that lets foreign doctors studying in the U.S. get a visa after residency if they practice in a medically-underserved area for at least three years.

“Rural communities like many throughout the Central Valley too often lack basic and necessary healthcare services, forcing people to drive long distances for routine medical treatments or forego care altogether,” Valadao said. “Programs like Conrad 30 are a critical part of correcting this problem.”

The program — created in 1994 and named after former Sen. Kent Conrad, D-N.D. — has brought more than 15,000 doctors to rural, inner city and other underserved communities. Every state has used it, Valadao’s office said.

The legislation extends the program for three years and starts a process to increase the number of waivers per state; creates for immigration flexibility for spouses and children, and requires annual use reports from the U.S. Citizenship and Immigration Services to the Department of Health and Human Services, among other changes.

Rep. Josh Harder, D-Tracy, reintroduced his Train More Doctors Act to expand residency slots in local hospitals.

Hospitals that operate residency programs in underserved areas can get funding from the U.S. Centers for Medicare and Medicaid Services after five years. The five-year period is meant to give the program time to grow; that growth helps determine how much funding the hospital gets.

In San Joaquin County, St. Joseph’s Medical Center started a residency program in 2018 and was expected to finish building it by 2022. But the pandemic stalled recruitment.

Harder’s bill would extend the timeline for certain teaching hospitals affected by the pandemic to determine how much funding they could qualify for.

“The Train More Doctors Act cuts some of the red tape that prevents doctors from coming to, training in, and staying in the Valley,” Harder said. “We know 57% of new doctors settle in the communities where they completed their residency, which means we need to make it easier for folks to enroll in these programs locally.”

Rep. Jim Costa, D-Fresno, led Democrats in reintroducing the Expanding Medical Education Act. It authorizes federal grants for medical school construction, expansion and training in regions like the San Joaquin Valley that lack health care access.

Grants would target new medical and osteopathic medicine schools as well as existing institutions like UC-Merced and UCSF-Fresno. Money would help recruit and retain students from underserved backgrounds, expand curriculum on treating rural and underserved communities, hire diverse faculty and modernize medical infrastructure, Costa’s office said.

“We simply don’t have enough doctors for our growing population, a problem only made worse by the pandemic,” Costa said. He added, “Growing our own doctors is the only way of confronting this shortage and ensuring people have access to quality healthcare.”