Research Publications

Accelerated programs, clinical doctorates, and for-profit programs are growing trends in health professions education in California. These approaches are often cited as strategies to address workforce shortages, expand access to education, and improve quality of care. However, evidence across the…

For-profit educational institutions have been on the rise in recent decades in the United States. This brief reviews the literature on for-profit healthcare education programs nationally and analyzes the enrollment, tuition, and demographic characteristics of students in programs in California.…

For-profit educational institutions have been on the rise in recent decades in the United States. This appendix supports the issue brief that examines for-profit healthcare education programs nationally and analyzes the enrollment, tuition, and demographic characteristics of students in programs in…

Primary care is the foundation of California’s health care system and a critical driver of population health and equity. Yet access to timely, comprehensive primary care remains out of reach for millions of Californians.Delivering all recommended care to an average patient panel would require a…

Recent federal student loan policy changes have fundamentally altered the financial landscape for aspiring physicians and dentists. The "One Big Beautiful Bill" (H.R. 1) enacted in July 2025 introduced significant borrowing caps to educational loans that disproportionately impact students pursuing…

Physicians, especially in primary care, likely faced substantial revenue loss during the COVID-19 pandemic due to decreases in patient volume and deferred healthcare utilization. While studies have focused on projections and limited surveys, the impact of the pandemic on physician revenue is…

More than 83 million people in the United States live in primary care shortage areas. As the US healthcare system faces a contracting primary care physician workforce, advanced practice providers are playing an increasingly important role in the delivery of primary care services. In parallel,…

Communication barriers are known to adversely affect patient safety. Yet few health systems assess and track physician non-English language proficiency for use in clinical settings. Barriers to current assessments (usually simulated clinician oral proficiency interviews) include time constraints…

Is nurse practitioner (NP) care associated with end-of-life outcomes for nursing home residents with Alzheimer disease and related dementias (ADRD), and do these associations differ between states with full versus restrictive NP scope of practice regulations? The results of this cohort study…

Clinicians who speak the language of the patients they care for can help increase access to care and improve patient health outcomes. Researchers, including Healthforce Center’s Director Sunita Mutha, looked at the barriers and facilitators to primary care physicians’ willingness to have their…

Patients with language barriers suffer significant health disparities, including adverse events and poor health outcomes. While remote language services can help improve language access, these modalities remain persistently underused. The objective of this study was to understand clinician…

Older adults with serious mental illness (SMI) often have multiple comorbidities and complex medication schedules. Shortages of behavioral health specialists (BHSs), especially in rural areas, frequently make primary care providers (PCPs) the only clinician managing this complex population. The aim…

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs…

The California Improvement Network (CIN) is focused on effectively integrating equity into health care improvement projects. Informed by its Racial Health Equity Workgroup and developed in partnership with HealthBegins, this practical toolkit is designed to help health care organizations —…

Objective/Issue Little is known about the contributions of different provider specialties in prescribing medications for nursing home residents living with dementia. In this study, we examine prescribing patterns for common psychiatric medications and for opioid and non-opioid analgesics in long-…

Compared to white individuals, Black, Indigenous, and Latinx individuals have decreased access to addiction care, lower rates of addiction treatment, and higher rates of incarceration, non-fatal overdose, and death. Racial/ethnic concordance between patients and clinicians has been associated with…

The California Improvement Network (CIN) is a community of health care professionals committed to identifying and spreading ideas for better primary care delivery. This issue of CIN Connections offers ways to implement quality improvement efforts that intentionally advance health equity in primary…

The Centers for Medicare and Medicaid Services’ (CMS) State Innovation Models (SIMs) initiative funded 17 states to implement health care payment and delivery system reforms to improve health system performance. This study aimed to evaluate SIMs role in improved health information…

California is facing a shortage of health professionals to meet the needs of its large, diverse, and aging population, and the situation is worsening. Shortages exist across professions and geographies, with sizeable urban and rural underserved populations. Despite increasing population diversity,…

Although the number of active physicians increased by 21% between 2006 and 2018, and exceeded the 10% population growth, many areas in California face substantial shortages of primary care providers and specialists. California Physicians: A Portrait of Practice presents detailed…

This report provides California policymakers with up-to-date information about the state’s physician workforce and the pipeline of trainees in the state’s medical schools and graduate medical education (GME) programs, often referred to as residency programs. 

Proposition 209 prohibits the use of affirmative action – the practice of considering an individuals’ race, sex, color, ethnicity or national origin – in public education, employment and contracting. This brief expands on previous studies that analyzed the impact of Proposition 209 on the…

One of the most important possibilities of value-based payment is its potential to spur innovation in upstream prevention, such as attention to social needs that lead to poor health. However, there is uncertainty about the conditions under which value-based payment will encourage health care…

Medical providers are significant drivers of care in post-acute long-term care (PALTC) settings, yet little research has examined the medical provider workforce and its role in ensuring quality of care. This study examined the impact of nursing home medical staffing organization (NHMSO)…

Holistic review is a conceptual framework that encourages medical schools to consider a wide range of criteria in deciding which applicants to admit. It promotes a balanced approach to the admissions process, taking into account both the need to admit students whose Medical College Admissions Test…

Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of…

The delivery of medical care services in US nursing homes (NH) is dependent on a workforce comprised of physicians, nurse practitioners (NP), and physician assistants (PA). Each of these disciplines operate under a unique regulatory framework while adhering to common standards of care. NH provider…

This report presents an overview of California’s allopathic (MD) and osteopathic (DO) physicians. Allopathic medical schools grant the Doctor of Medicine (MD) degree, while osteopathic medical schools grant the Doctor of Osteopathic Medicine (DO) degree. Graduates earning an MD typically complete…

The California Improvement Network’s (CIN) latest report, CIN Connections: Foundations for Health, features tips for resilient leadership and building partnerships between health providers and community-based organizations from Access Community Health Network’s chief operating officer, Donna…

Ongoing payment reforms are pressing health systems to reorganize delivery of care to achieve greater value, improve access, integrate patient care among settings, advance population health, and address social determinants of health. Many organizations are experimenting with new ways of unleashing…