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USDA recommendation brings California dairy farmers closer to equitable milk pricing
dairy pic1
Milk continues to be Merced County’s leading commodity with an overall gross value of $1,050,940,000. Production of the region’s milk increased by 15% in 2020, and its price increased by $2.30 since last year (Journal file photo). - photo by Journal file photo

Just like the cow in the beloved nursery rhyme, local dairy producers are over the moon following the U.S. Department of Agriculture’s recommended decision last week to establish a California Federal Milk Marketing Order— a move that could potentially lead to more equitable milk pricing to prices paid to California milk processors.

“We are heartened that USDA’s Recommended Decision reflects the FMMO we proposed,” said Rachel Kaldor, Executive Director of the Dairy Institute of California. “If California dairy farmers approve a FMMO based upon the Recommended Decision, the same basic milk pricing and revenue pooling structure in place in the other FMMOs would apply to California farmers and processors as well.”

Two years ago, California Dairies Inc., Dairy Farmers of America, and Land O’Lakes — three California dairy cooperatives that represent over 75 percent of the milk produced in the state — submitted a public hearing proposal to the USDA for the establishment of a California FMMO.

In August 2015, the USDA announced its decision to hold a public hearing on a proposed California FMMO one month later. This move was instantaneously praised by a number of dairy producers throughout the state, including the California Dairy Campaign, which is a statewide membership association of family dairy farmers, and the Dairy Institute of California, a non-profit trade association that represents dairy producers on legislative and regulatory matters at the state and federal level.

The marketing area of the recommended FMMO, which published in the Federal Register on Tuesday, would incorporate the entire state of California and compel California milk processors to be fully regulated. This recommended decision is based on a two-month long public hearing that included over a month of extensive witness testimony and nearly 200 exhibits.

As detailed by the USDA, FMMOs are legal instruments that regulate the purchase of milk between dairy farmers and first buyer. Where appropriate, the recommended California FMMO proposes adoption of uniform order provisions contained in the 10 current FMMOS. These uniform provisions include, but are not limited to, dairy product classification, end-product price formulas and the producer-handler definition. The proposed order would recognize the unique market structure of the California dairy industry through tailored performance-based standards to determine eligibility for pool participation. The proposed order provides for the recognition of producer quota as administered by the California Department of Food and Agriculture.

The California Dairy Campaign echoed the Dairy Institute of California’s approval of the USDA’s decision to establish a California FMMO.

“Since California Dairy Campaign was established it has called for California to join the federal milk marketing order system to bring California dairy producer prices and the process for determining prices in line with the rest of the federal order system,” the CDC website stated. “CDC welcomed the announcement of the USDA decision and will be fully engaged in the public comment process to ensure the USDA Final Decision on a California Federal Milk Marketing Order is equitable for California dairy producers.”

California represents over 20 percent of all nationwide milk production and is currently regulated by a state milk marketing order administered by California Department of Food and Agriculture. Comments on the recommended decision will be accepted for 90 days after official publication in the Federal Register. After analyzing and considering public comments, USDA will issue a final decision.

USDA is scheduled to host a public meeting from 9 a.m. to noon Wednesday in Clovis to answer questions relating to how the proposed California FMMO would operate and how the proposed California FMMO would operate and how the public can submit comments for USDA consideration. The meeting will also be available via a live webcast at ams.usda.gov/caorder.

 

Costa, Gray propose congressional bill to address critical physician shortage in rural areas
Costa and Gray
San Joaquin Valley congressional members Rep. Jim Costa, D-Fresno, left, and Rep. Adam Gray, D-Merced, are shown discussing their bill H.R. 2106 in a virtual press conference on Tuesday.

BY TIM SHEEHAN

CV Journalism Collaborative

Two San Joaquin Valley congressional representatives have introduced a bill that could help address the vast shortage of doctors in the region, particularly in underserved areas. 

Rep. Jim Costa, D-Fresno, and Rep. Adam Gray, D-Merced, say the Medical Education Act would, if passed, establish a program of grants to support expanded medical education programs in underserved areas of the nation.

The Valley could be one of the key areas that would benefit from the legislation. California has about 90 primary care doctors per 100,000 residents statewide, the federal Health Resources & Services Administration reported in November 2024. 

That’s more than the ratio in some states, and less than some others. The nationwide ratio is about 84 doctors per 100,000 residents.

But in the San Joaquin Valley, home to about 4.3 million people, doctors are much more scarce – about 47 primary care physicians per 100,000 residents, according to Dr. Tom Utecht, chief medical officer at the Fresno-based Community Health System.

That number is “a little over half of what is necessary to take care of a population,” Utecht said Tuesday in a video press conference. “We have the lowest physicians-per-capita rate in all of California, in the San Joaquin Valley.”

Introduced last month, the Medical Education Act is something of a placeholder for the time being until the Congressional Research Service can weigh in with financial estimates of what is needed in different parts of the country, Costa said. 

A companion version was introduced in March in the U.S. Senate by Sen. Tim Kaine, D-West Virginia, and Sen. Alex Padilla, D-Los Angeles.

At this point, the legislation does not specify how much money will ultimately be sought or how grants would be structured.

Costa said the shortage of doctors in the region “is combined with language barriers, cultural barriers and distances … and that would really go for rural parts of our country regardless where folks live.”

“If you live in rural areas, it’s just more difficult to have access to good quality health care,” he added.

Costa said the legislation, if it can survive a Republican-controlled House and Senate and a Republican president, “would be transformative because it would invest expanded resources to minority-serving institutions and colleges located in rural and underserved areas to establish schools of medicine and osteopathic medicine.”

The bill would also create an avenue for more historically Black colleges and universities, as well as Hispanic-serving institutions, to establish medical education programs, Costa said.

Gray noted that when he was in the state Legislature, he and colleagues “worked to get hundreds of millions of dollars in funding to expand the UC Merced campus, to ultimately secure the funding to put the first medical education building up on campus.”

Gray added that the UC San Francisco’s medical education program in Fresno “is an important part of creating the (medical) workforce of the future for the valley, but more importantly, solving this access to care issue that plagues Valley communities.”

At UC Merced, director of medical education Dr. Margo Vener said there has been a surge of interest in the university’s program that funnels students through an undergraduate program for their bachelor of science degree through a medical school degree in collaboration with UC San Francisco.

“All the students that we are enrolling are from the Valley and for the Valley, because they want to really make a difference in promoting health in their communities,” Vener said. That, she added, is likely to eventually translate to those would-be doctors to stay in the Valley to practice medicine.

“The data suggests that two factors really strongly influence where physicians stay to practice,” Vener said. “One of them is where they’re from, which, of course, is why we’re recruiting students from the Valley for the Valley just to stay (and) be doctors for their community. And the other factor is where you went to residency. Those are the two biggest drivers.”

That’s something that was underscored by Dr. Kenny Banh, assistant dean of undergraduate education at UCSF Fresno. “Regional campuses such as UC Merced and UCSF Fresno not only grow doctors, but they take those doctors, physicians and medical students from their communities in the region, and train them in those regions to go back to be physicians in those areas,” he said.

While the costs of the Costa-Gray legislation are yet to be determined, Banh said there are also costs associated with doing nothing to expand medical education.

“There’s health care costs, regardless of how we work it, if we don’t invest in having an adequate supply of physicians,” Banh said. “There’s a cost on the human that can’t access care” and doesn’t get to a doctor until a condition is not treatable “or with significantly worse morbidity and mortality outcomes.”

“And that cost is borne by health systems taxpayers, one way or the other,” Banh added.

But even if the Costa-Gray bill were to pass in this congressional session, the payoff of home-grown medical schools producing a bumper crop of physicians in the Valley or other deprived parts of the country would be years down the road.

“I think it’s really important to understand why we need to invest now for our future, because it takes so darn long” for a student to go from being a college freshman to a practicing doctor, surgeon or specialist, UC Merced’s Vener said. 

After a four-year bachelor’s degree, a student must then complete four years of medical school, which in turn is followed by a residency of three to five years.

“Then often people will do a fellowship to become, for example, a cardiologist or a gastroenterologist or something like that,” she added.

“If you start investing in just one student now, it’s going to take such a long time before they really are there to take care of you at that moment when you need them to be your gastroenterologist, your cardiologist, your emergency physician, or, dare I say, your family doctor,” Vener said.

That, she said, is why it’s also necessary to expand residency programs that can attract would-be physicians into the region in hopes that they will remain once they complete their training. “We need those doctors now, and that’s why this effort is important,” Vener said, “because this is what will both inspire people to stay, but also inspire people to really come and embrace the communities and serve them.”

In a related development, state Assemblymember Esmeralda Soria, D-Fresno, recently introduced a bill for the University of California system to develop a comprehensive funding plan for expanding the current SJV Prime+ BS-to-MD partnership between UC San Francisco and UC Merced, with the goal of transitioning the program to a fully independent medical school operated by UC Merced.

“We have seen firsthand the impacts of medical workforce shortages throughout the Central Valley,” Soria said in a prepared statement. “AB 58 would help ensure the Legislature is equipped with the information needed to secure appropriate funding for the medical education provided for our community at UC Merced.”

— Tim Sheehan is the Health Care Reporting Fellow at the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at tim@cvlocaljournalism.org.