California leads the nation in doctor shortages.

A Kaiser Family Foundation analysis of federal data shows that 6 million Californians live in Primary Care Health Professional Shortage Areas (HPSAs), where less than half of the state’s
primary care needs are being met.

In the Inland Empire, the ratio of primary care physicians falls to as low as 35 per 100,000 residents. The federal benchmark is 60 to 80 ber 100,000. The San Joaquin Valley sits at 39 per 100,000.

Sacramento’s answer, as always, is more “pipeline”: More medical school slots. More residency seats. More loan-forgiveness programs aimed at the same exhausted doctors who are already leaving.

The state’s own Legislative Analyst’s Office reported this February that the flagship residency expansion programs, Song-Brown and CalMedForce, have produced only limited gains in the number of resident slots.

California has a retention crisis disguised as a shortage, and until lawmakers admit that, no number of new doctors will be enough.

I know this. I am an ear, nose and throat surgeon. I completed five years of residency, built my own practice, and last year, at the height of my career, I walked away from clinical medicine entirely.

What pushed me out is what’s hollowing out California medicine at scale. I was one of thousands.

The data are unambiguous. A 2025 study in the Annals of Internal Medicine, led by researchers at UC San Francisco with colleagues at Yale and UCLA, tracked more than 712,000 physicians and found that clinical attrition rose from 3.5 percent in 2013 to 4.9 percent in 2019 — a 40 percent jump in six years.

The researchers pinned the cause squarely on administrative burden, electronic health record demands, prior authorization, and inadequate staffing. Pipeline gaps did not even register.

A 2025 MedCentral survey of more than 1,100 physicians found that 35 percent had considered leaving clinical medicine since the start of 2025. A McKinsey analysis put the five-year exit number at 35 percent, and roughly 60 percent of those intend to leave clinical practice entirely, rather than switch employers.

These are the doctors California spent years training and the ones it can least afford to lose.

Ask any physician who left, and you will hear the same two words first: prior authorization.

The American Medical Association’s 2024 prior authorization survey found that a single physician consumes the equivalent of 12 hours of physician and staff time each week on “prior auth” for insurance purposes. Those are 12 hours that should be spent with patients, but which are spent fighting insurers instead.

Ninety-five percent of physicians say it contributes to their burnout. Forty percent of practices now employ staff dedicated solely to filing paperwork against insurance companies that already collected their premiums.

Then there is private equity (PE). A 2024 Health Affairs study found that PE-acquired physician practice sites grew from 816 in 2012 to 5,779 by 2021, with a single PE firm holding more than 50 percent market share in 50 specialty-and-metro markets.

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A separate 2024 Health Affairs analysis of ophthalmology practices found that physician turnover jumped 13 percentage points after PE acquisition — a 265 percent increase relative to comparable practices.

Sacramento has had years. Newsom vetoed AB 3129, the bill that would have brought attorney-general scrutiny to private-equity health care acquisitions. The prior-auth fix he did sign barely dents the volume problem.

California’s doctors keep walking and the patients paying the price are farmworkers in Tulare. Seniors on fixed incomes in Fresno. Working families in San Bernardino who cannot drive three hours to see a specialist. The retention crisis is their crisis.

What would actually move the number?

Reform prior authorization with hard turnaround caps and a real cause of action when insurers deny medically necessary care.

Bring antitrust scrutiny to private equity consolidation of physician practices.

Pass meaningful whistleblower protections so the physicians who report unsafe staffing or unsafe conditions stop being retaliated against by their hospitals. Right now, silence is the rational career choice. That is a patient safety problem as much as a workforce problem.

None of this is soft. None of it is about feelings. It is straightforward operational logic: if you want physicians to stay in California, you have to make California a place where practicing medicine
is sustainable.

The system will keep burning through talented, committed doctors until someone decides retention deserves the same urgency as the pipeline.

Build all the medical schools you want. The graduates will keep walking out the back door.

Frances Mei Hardin, MD, is the author of Surgeon on the Edge (Hippocratic Press, 2026) and the host of the podcast, Surgeon, Interrupted.