As California expands health coverage to millions under President Obama's Affordable Care Act next year, the state won't have enough doctors to treat this influx of new patients.
Only 16 of California's 58 counties can meet the federal government's recommended supply of primary physicians.
"If we're going to mandate every person in this country to buy health insurance, we have to make sure that that care is available to them," said state Sen. Ed Hernandez (D-Los Angeles). Hernandez is also an optometrist.
Senator Hernandez and other lawmakers propose to let nurse practitioners, physicians' assistants, optometrists and pharmacists treat patients for some illnesses. Most in those professions agree they have more training than they're allowed to use. Nurse practitioners would even be able to set up their own practice.
But the proposed shake-up in the medical establishment is ruffling some feathers at the California Medical Association. Doctors have long been the gatekeepers of medical care and worry about patient safety under the plan.
"The concern would be that they have adequate training and adequate experience for exactly the kind of patients they're seeing," said Dr. Ruth Haskins, California Medical Association. "And if they're not adequately trained, they might miss something."
Patient Cindy Ball, though, liked being treated by a nurse practitioner after her back surgeries and supports the idea of giving other staff more responsibilities.
"I really, really like them. Just like having a doctor but they would talk a lot about my pain. I had many epidurals for my spinal cord," said Ball.
The California Medical Association would rather see the state give more money to UC Riverside's medical school so it can accept more students and expand the loan repayment program for graduates who take jobs in rural areas. But neither will produce more doctors by January when federal healthcare reform takes effect.
CMA is also pushing the state to fund more residency slots in California hospitals. Residents can see patients immediately and each one can see an average of 600 patients during his or her training.