“California is facing a perfect storm — elderly who will need care and a lack of healthcare providers,” said Karen Bradley, president of the California Assn. for Nurse Practitioners. “This bill would have allowed nurse practitioners to be part of the solution.”

Many more doctors will need to be trained in California if the state wants to meet the healthcare needs of residents, said Janet Coffman, a professor at Philip R. Lee Institute for Health Policy Studies at UC San Francisco.

More than 60% of California’s students who attended medical school in 2017 left the state for their schooling, according to the commission’s report. The national average of medical school students per 100,000 people is 30.3; California has 18.4 students per 100,000. That’s the third-lowest rate among the 45 states that have at least one medical school.

Despite this, California has made relatively few investments in increasing enrollment at medical schools in the state. The only new public medical school to open in California in the last four decades is at UC Riverside.

“And it’s relatively small,” Coffman said. “We’ve expanded class sizes in other medical schools some but not much.”