MERCED, CA – The University of California at Merced's Valley Telehealth Partnership is too new to have made an impact on the physician and nurse shortages in the San Joaquin Valley.

"The hope is the program will do a lot to alleviate the shortage and bridge the gap going forward," said project manager Jennifer Smith.

In the San Joaquin Valley, there were 51.2 primary care physicians (PCPs) per 100,000 persons, compared to 67.4 PCPs for every 100,000 persons in California in 2000, according to a 2004 California State University at Fresno report. In the Valley, there were only 73.2 specialists per 100,000 persons, compared to 122.2 specialists per 100,000 persons in California.

The eight San Joaquin Valley counties have been designated Medically Underserved Areas/Populations by the U.S. Health Resources and Services Administration, Bureau of Health Professions because of the severe shortages in dental, mental health and primary care professionals.

Although the impact of telemedicine on rural and underserved areas is significant, Smith admitted that the equipment-intensive programs are expensive to get started and lose money. Most programs are vulnerable because they are funded mostly by grants. Equipment is typically good for only five years and then needs to be replaced, she said.
Specialists in the area have not shown interest in making investments, paying monthly fees or training staff, Smith said. "It's a business within a business; it has to make financial sense," she said. "These programs have to be mission driven."

Smith is hoping the networks can be monetized. Income can be generated by having private payers foot the bill to drive members to less-expensive telemedicine visits with physicians. Patients themselves may be willing to pay for the convenience of such visits. Health systems may pay to have medical education programs broadcast over the network, she said. Health systems may also want to help fund programs if telemedicine visits offset preventable trips to and relieve congestion in emergency departments.

Valley Telehealth Partnership, which is funded by the California Emerging Technology Fund, the California Partnership for the San Joaquin Valley and AT&T, was looking to add as many as 20 sites in 2010. The economy and the state budget deficit, however, have made a negative impact on those efforts, Smith said. "That opportunity has vanished," she said. "We don't have the funding to do expansions in the state." Not only have telemedicine initiatives in the University of California system taken a hit, but strapped healthcare groups can no longer afford to support these programs.

Nonetheless, Smith is optimistic. Vendors may be forced to bring down the cost of equipment and make telemedicine more affordable. Why? "This is going to be the future of how people are going to access healthcare services," she said. The future is in home healthcare; that is the silver lining."

The technology already exists, the industry is being forced to do more with less and delivering flexibility will favor telemedicine programs, she said. "We just need to bring this to the mainstream," Smith said.