California’s Physician Shortage in the Central Valley and Inland Empire
A referral should open the door to care. For families in California’s Central Valley and Inland Empire, it can begin another search: finding a doctor who accepts their insurance, arranging transportation, and taking time away from work or school. When appointments are difficult to obtain, the cost extends beyond the medical bill.
These regions need a coordinated response that strengthens primary care and access to specialists, including dermatologists. The goal must be timely, affordable care close to where people live.
Understanding the shortage
California’s physician workforce is unevenly distributed. The California Health Care Foundation’s 2025 Physicians Almanac found that the Inland Empire and San Joaquin Valley were among four regions below the recommended supply of primary care physicians. The San Joaquin Valley also fell below the recommended supply of specialists. The report notes that only 40% of California physicians provided at least 40 hours of patient care weekly in 2023, showing why license counts alone do not measure access. [1]
Geography matters when interpreting these findings. The Central Valley includes the Sacramento and San Joaquin valleys; findings about the San Joaquin Valley should not automatically be applied to the entire Central Valley. The Inland Empire generally refers to Riverside and San Bernardino counties, where access can differ considerably between urban centers, mountain communities, and desert areas.
It would also be inaccurate to assume that every specialty has an identical shortage in every county. A regional specialist total can conceal gaps in individual fields, insurance networks, or locations. Planning must examine primary care, pediatrics, obstetrics and gynecology, psychiatry, cardiology, oncology, surgery, dermatology, and other specialties separately.
The effects reach beyond the waiting room
When primary care is difficult to obtain, patients can lose opportunities for preventive services, medication adjustments, and early evaluation of symptoms. When specialty access is limited, the next stage of care can stall even after a diagnosis or referral.
The consequences can include:
• Delayed diagnosis and treatment. A patient may wait to have a changing skin lesion evaluated, a persistent symptom investigated, or a chronic condition reassessed.
• Greater reliance on urgent and emergency care. When scheduled care is unavailable, patients may turn to settings designed for immediate problems rather than ongoing management.
• Financial strain. Long trips can require gasoline, childcare, unpaid leave, and help from family members.
• Fragmented care. Patients may move between distant offices and health systems, increasing the burden of transferring records and completing follow-up.
• Pressure on the existing workforce. Heavy workloads and inadequate support can make it harder to retain clinicians and maintain appointment availability.
These are pathways through which limited access can harm patients; their magnitude should be measured locally rather than assumed to be identical across both regions.
Dermatology belongs in the conversation
Dermatology addresses skin cancer, inflammatory conditions, infections, hair and nail disorders, and diseases that can affect sleep, mobility, work, and emotional well-being. Access to medical dermatology should be part of regional workforce planning.
A 2022 California audit study compared appointment access for a changing pigmented lesion concerning for melanoma in the Central Valley and San Francisco Bay Area. Both dermatology and family medicine practices were less likely to accept Medicaid than private insurance. The study demonstrates that insurance participation can restrict access even where a practice exists. It does not provide a current dermatologist shortage count for either region or directly measure Inland Empire access. [2]
For patients with eczema, psoriasis, hidradenitis suppurativa, or other persistent conditions, barriers can mean prolonged symptoms and disrupted daily life. For a suspicious lesion, timely evaluation and access to a biopsy are essential parts of a functioning referral system.
Improving dermatology access should therefore include clinicians trained to recognize disease across skin tones, affordable medical treatment, and dependable routes to procedures and follow-up.
What can be done?
1. Build local pathways into medicine
A sustainable workforce starts before medical school. Schools, community colleges, universities, hospitals, and community organizations should create connected pathways that include mentorship, academic support, paid clinical or research experiences, and application assistance.
Recruitment should reach students from rural communities, low-income households, and groups
underrepresented in medicine. Students with strong local ties should have meaningful opportunities to train and establish careers in their communities.
Existing efforts offer foundations to build on. UCSF Fresno was established to address the San Joaquin Valley’s physician shortage, while UC Riverside’s medical school developed in response to Inland Southern California’s workforce needs. [3,4]
2. Expand residency training alongside medical education
More medical school seats need to be paired with residency positions, faculty, clinical training sites, and jobs. Regional investments should use documented needs to determine which primary care and specialty programs to expand.
UCSF Fresno reports that 40-50% of its trained physicians remain in the Central Valley to practice. This is a useful example of local training contributing to the regional workforce, although retention is not guaranteed. [5]
Dermatology planning could include additional underserved-community rotations, partnerships with community health centers, and expanded training capacity where faculty, funding, and accreditation requirements can be supported.
3. Make staying professionally and financially sustainable
Recruitment incentives should be matched by long-term retention support: manageable workloads, adequate staffing, mentorship, competitive compensation, and opportunities for teaching and professional growth.
California already offers loan repayment programs tied to service in qualified settings. The Steven M. Thompson Physician Corps Loan Repayment Program supports eligible physicians and surgeons providing direct patient care at qualifying facilities. Eligibility and service requirements vary by program. [6]
Hospitals and communities should also address practical barriers to staying, including housing and family needs.
4. Improve access for Medi-Cal patients
Adding physicians will have limited impact if patients cannot obtain appointments through their insurance. Policymakers and health plans should strengthen payment and administrative arrangements that support participation, maintain accurate provider directories, and assess whether listed practices actually accept new patients.
Accountability should include appointment availability, travel distance, and completed referrals – not simply the number of clinicians on a network list.
5. Bring specialist expertise closer to communities
Regional systems should invest in specialist electronic consultations, visiting specialty clinics, and tele-health linked to local care.
For dermatology, secure photographs and a clinical history can help a dermatologist advise a primary care clinician or prioritize an in-person appointment. These services require appropriate image quality, consent, language support, and reliable follow-up. Patients must still be able to obtain physical examinations, biopsies, and procedures when needed.
Mobile services and community events should connect to ongoing care. Identifying a concern is only useful when a patient can complete the next step.
6. Strengthen care teams and patient navigation
Physicians work within teams. Nurses, nurse practitioners, physician assistants, pharmacists, community health workers, interpreters, and referral coordinators can improve access and continuity when roles, training, and escalation pathways are clear.
A referral coordinator can help ensure that an appointment was scheduled, transportation was arranged, and results returned to the referring clinician. These practical steps can prevent patients from becoming lost between services.
7. Measure what patients experience
Both regions should track specialty-specific appointment waits, insurance acceptance, travel burden, referral completion, and physician retention. Results should be examined by county, rurality, language, and insurance coverage.
For dermatology, useful measures include time from referral to evaluation and, when indicated, from evaluation to biopsy and treatment. Community members should help decide which problems receive priority.
A commitment to care close to home
The Central Valley and Inland Empire need sustained investment across the full path to care: local education, residency training, physician retention, accessible insurance networks, and reliable follow-up.
Community organizations can contribute through mentorship, health education, transportation partnerships, and patient navigation. Health systems and policymakers must provide the staffing, funding, and accountability that make those efforts effective.
A stronger health system is one in which a family can find a primary care physician, complete a specialty referral, and receive timely dermatologic or other medical care without geography becoming a barrier to health.
Sources
1. California Health Care Foundation. California Physicians Almanac – 2025 Edition.
https://www.chcf.org/resource/almanac/california-physicians
2. Disparities in access for melanoma screening by region, specialty, and insurance: A cross-sectional audit study.
2022. https://escholarship.org/uc/item/9ks9b94z
3. UCSF Fresno. Overview. https://fresno.ucsf.edu/About-Us
4. UC Riverside School of Medicine. History. https://medschool.ucr.edu/history
5. UCSF Fresno. Facts and Figures. https://fresno.ucsf.edu/facts-and-figures
6. California HCAI. Steven M. Thompson Physician Corps Loan Repayment Program.
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