March 26
The San Luis Obispo Tribune on doctor drought in California:
Think it’s tough getting in to see a doctor now?
It will only get worse as the population ages and needs more medical care.
Remember, too, that doctors are growing older right along with the rest of us; more than a third of the state’s health care professionals are over 55, so prepare for a wave of retirements.
If we don’t step up recruitment and training, California will be short 4,100 primary care doctors in 10 years, according to a newly released study by a statewide commission. That should be wake-up call for the Central Coast, which already is medically underserved.
The Central Coast now has 50 primary care physicians per 100,000 people; the recommended number is between 60 and 80 per 100,000 people though only one region - the Bay Area - is within that range.
When it comes to specialists, there are 93 per 100,000 people on the Central Coast. That’s within the recommended range of 85 to 105, but below the statewide average of 104. And with its large population of retired residents on the Central Coast who need more medical care, those numbers should be on the higher side of the recommendations.
The California Future Health Workforce Commission, co-chaired by UC President Janet Napolitano and Dignity Health President and CEO Lloyd Dean, has a plan to close the state’s medical workforce gap by 2030 - just a little over 10 years away.
It’s an ambitious plan, and with 27 separate recommendations that would cost $6 billion to implement, it’s going to be a heavy lift. But this also is a rare opportunity to retool California’s medical work force to more closely resemble our diverse population.
As the commission points out, Latinos make up nearly 40 percent of the state population, yet only 7 percent of doctors are Latino, and fewer than 20 percent of medical professionals speak Spanish.
That matters: Patients are more likely to follow a doctor’s advice when they can fully understand it. They also are more likely to share information with a health care provider they feel comfortable with, and that can be critical to their treatment.
So, how are we to remake the health care work force of the future?
Here are some proposals:
-Expand the educational pipeline to recruit more students into health careers. The commission proposes mentorships, and other support programs with a goal of adding 5,700 low-income and underrepresented minority professionals to the state’s health care workforce during the next 10 years.
-Fund scholarships for qualified students who pursue health care careers and commit to serving in underserved and rural communities.
-Expand the home health care worker “family of jobs” to provide more career paths and training. California will need an estimated 600,000 home care workers by 2030. Investing in their training could save billions by reducing spending on unnecessary emergency department visits and hospitalizations.
-Develop a psychiatric nurse practitioner program.
-Maximize the role of nurse practitioners.
-Sustain and expand medical programs across UC campuses.
Some current efforts provide hope for the future.
California Northstate University plans to open a 250-bed teaching hospital in Elk Grove to help train new doctors. This year, CNU will graduate its first class of 60 new physicians.
In addition, Proposition 56, the tobacco tax increase passed in 2016, has provided tens of millions of dollars to fund doctor residencies and training.
Yet the question remains: Can California move a new generation into health care careers before the situation becomes an emergency?
The commission’s report provides a critical plan for progress; we strongly urge lawmakers, the medical community and educators at all levels to take its prescriptions seriously.
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March 26
Los Angeles Times on it being OK to bend the rules to make Californians safer from wildfire:
Gov. Gavin Newsom declared Friday what had already become apparent last year: California needs an emergency response to reduce the risk of more deadly, devastating wildfires.
Fire officials have long warned that California is facing a growing threat. An epidemic of dead and dying trees, a profusion of dry vegetation, the effects of climate change and the development of homes in high fire-risk areas have all laid the foundation for the extreme fires that raged across the state over last two years, killing more than 100 people and charring or destroying thousands of homes. Last year was the worst fire year in modern state history.
While lawmakers have approved billions in new funding in recent years to help with fire prevention, Newsom took it a step further by declaring a state of emergency, thereby suspending environmental and regulatory review requirements for certain fire-risk reduction projects and allowing the state to hire companies for those projects without competitive bidding.
The governor’s order specifically waives the normal requirements for 35 priority projects near high-risk communities, from Malibu to Big Sur to Ukiah. They include projects to cut down dead and hazardous trees, clear brush, bulldoze fire lines, carry out controlled burns and create additional evacuation routes. The latter was a big issue in Paradise, where residents fleeing the Camp Fire got trapped in traffic. The 35 projects were chosen based on both the fire risk facing the communities in question and the vulnerability of the population; that meant considering whether areas had higher numbers of residents with disabilities, seniors, non-English speakers and households without a car.
Bending the rules for those projects makes sense. After the death and human suffering witnessed in Paradise, Redding and Santa Rosa, it would be callous and utterly careless for California to let process and procedures slow the vital work needed to make the most threatened communities safer.
Environmental groups quickly lined up in opposition, arguing that Newsom’s decision to shortcut regulations is “Trumpian.” Indeed, President Trump has regularly and wrongly blamed “bad environmental laws” for wildfires, and his allies in Congress have sought to relax environmental laws to allow more commercial logging in the national forests.
But there’s a big difference between the kind of large-scale logging that the Trump administration has proposed and the targeted “fuel reduction” projects around vulnerable communities that the California Department of Forestry and Fire Protection has planned. Newsom’s order is narrow and conservative, applying to the riskiest of the high-risk areas. The 35 projects that would be exempted from environmental regulations represent a tiny fraction of the public and private lands that need attention. In fact, the order would affect only about 90,000 acres, compared with an estimated 15 million acres of forest that need restoration, plus the vast stretches of dense and highly flammable shrub lands across Southern California.
And it’s not like all environmental protections will be lifted for these projects. The heads of the California Environmental Protection Agency and Natural Resources Agency would still need to sign off on the projects to make sure the work adequately protects the public health and the environment.
Of course, even with an emergency declaration, California won’t be able to reduce risks significantly before the coming wildfire season. The state has to catch up with decades of deferred maintenance in its wild-land areas. Then, there are some 2.2 million homes in the wild-land-urban interface where houses and businesses abut foothills, forests or other open land. Many of those properties need to be retrofitted to make them fire resistant.
Newsom’s order is really a down payment on the work that lies ahead. Sure, streamline environmental regulations for few dozen fire-safety projects. But if California is truly in a “condition of extreme peril,” then the state needs far more radical interventions, including curtailing housing development in previously undeveloped, high-fire-risk areas and forcing utilities to reduce the fire risk from their power lines.
This isn’t an emergency that will end any time soon.
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March 26
San Francisco Chronicle on Trump’s disingenuous crusade for free speech at UC Berkeley:
President Trump’s ceaseless attacks on the press make him an unlikely First Amendment crusader, but that didn’t stop him from signing an executive order last week that vaguely and redundantly commands federal agencies to withhold funding from universities deemed hostile to free speech.
Trump’s proximate cause celebre is one Hayden Williams, a conservative activist whose silly slogans so enraged a misguided passerby on UC Berkeley’s Sproul Plaza that their encounter ended with a lavishly recorded and broadcast punch in the face. Williams’ black eye was cited as the latest evidence of liberal campuses’ violent suppression of conservative views.
The president’s ultimatum to Berkeley and other campuses, which he said threatens “billions and billions” in research grants, promotes the misunderstanding that the First Amendment protects expression from every imaginable interference or inconvenience. In fact, it’s government infringement of free speech that the founding document forbids.
It follows that a man who in his private capacity socks another man for his expressed opinions, while rightly subject to ostracism and arrest, does not normally raise constitutional questions. A president wielding federal power to punish or compel expression, however, is a more likely First Amendment offender.
College campuses have indeed seen a troubling increase in intolerance of certain views, and protests of conservative speakers at Berkeley and other universities have occasionally turned violent. This is an educational challenge and potentially an institutional one. In 2017, when Berkeley officials found themselves in the difficult position of mediating between deliberately inflammatory conservative speakers and dangerous demonstrators, they made the mistake of appearing insufficiently eager to facilitate free expression.
The university soon rectified those missteps, however, by developing a consistent policy and making extraordinary efforts to accommodate controversial speakers. It also came to an agreement with a conservative group that sued the school.
As a public university, Berkeley is obligated by the First Amendment and more to ensure free expression. But despite the evident desire of conservative activists and media to portray last month’s assault as a case of the university falling short of that obligation, it wasn’t. Neither Williams nor his alleged assailant, Zachary Greenberg of Oakland, is a Berkeley student, and the university couldn’t have foreseen the assault. Campus police sought the public’s help identifying the suspect the next day, the administration rightly denounced the “reprehensible incident” the day after that, and Greenberg was arrested the following week.
This isn’t a conspiracy to suppress political views; it’s a street crime that is being appropriately prosecuted. If anything here is a state-sponsored menace to free expression, it’s the president’s readiness to threaten higher education budgets on such a flimsy basis.
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