Sacramento Head Start Alumni Association

Nearly Half of State's Doctors Do Not Treat Medi-Cal Patients

Feb 22, 2002

February 11, 2002


Nearly Half of State's Doctors Do Not Treat Medi-Cal Patients
Most Physicians Hold Negative Views of the Program

Nearly half of California's primary care physicians (45 percent) and specialists (43 percent) say they do not have any Medi-Cal patients in their practices, according to a new report published by the California HealthCare Foundation's Medi-Cal Policy Institute (MCPI). Medi-Cal, California's version of the federal Medicaid program for low-income families and elderly and disabled individuals, pays for health services for 6.1 million Californians. Conducted by the University of California, San Francisco in 1998, this study reports the percentage of California's physicians that serve this population and their attitudes toward the program.

The survey, based upon responses by a representative sample of California's primary care providers and specialists, found that those physicians who do participate in the Medi-Cal program do not generally accept large numbers of Medi-Cal patients. On average, Medi-Cal patients made up only 11 percent of the caseload of California's primary care doctors and only seven percent of that of specialists. Consequently, the ratio of primary care physicians available to Medi-Cal patients (38/100,000) was significantly below the population standard recommended by the Health Resources Services Administration (60-80/100,000). Access to physicians for Medi-Cal patients varied widely by specialty, from obstetrician-gynecologists, 67 percent of whom treat Medi-Cal patients, to orthopedic surgeons, only 41 percent of whom do so.

"We found that physicians who belong to under-represented minority groups, speak Spanish, or work in community clinics are more likely to accept Medi-Cal patients," said Dr. Andrew Bindman from the UCSF Primary Care Research Center. "These attributes may enhance the cultural competence of the physicians available to Medi-Cal patients. On the other hand, international medical graduates and physicians who are not board certified are also more likely to participate in the Medi-Cal program, which raises questions about whether Medi-Cal patients have access to the same quality of physicians as privately insured patients."

The survey also found that most doctors held negative opinions about Medi-Cal, including the program's reimbursement levels and the amount of required paperwork. Many of the state's physicians also felt that Medi-Cal patients have more complex clinical and social problems than other patients and are less compliant with their doctor's instructions.

"The findings from this survey raise concerns about whether enough of the state's physicians are available to care for the nearly one in five Californians who are enrolled in Medi-Cal," noted Christopher Perrone, acting director of MCPI. "Although the state increased Medi-Cal physician payment rates significantly in 2000, Medi-Cal rates are on average only 65 percent of what Medicare pays for the same services. Given the payment rate reductions included in the Governor's proposed budget, Medi-Cal beneficiaries' access to care could get worse before it gets better."

The survey was first conducted in 1996 and again in 1998 by UCSF's Center for California Health Workforce Studies and the UCSF Primary Care Research Center under the direction of Dr. Andrew Bindman and Dr. Kevin Grumbach. During this time period Medi-Cal managed care grew significantly but primary care physician participation in the program remained stagnant. This study will act as a baseline against which future surveys can track trends in physician participation in Medi-Cal. The full report, Physician Participation in Medi-Cal, 1996-1998, can be found on the Medi-Cal Policy Institute Web site.

For more information please contact:

California HealthCare Foundation
Charles Stewart (510) 238-1040