We don't have enough doctors, nurses or allied health personnel in the United States, and many are worried that health care reform will exacerbate existing shortages by bringing millions more patients into an already-overburdened system. That's why I'm surprised that there isn't more discussion about the provisions in the proposed legislation that are intended to increase the ranks of health care professionals.
There's no debate about the problem. The US Department of Health and Human Resources' Health Resources and Services Administration reports that "[a]s of March 31, 2009, there are:
- 6,080 Primary Care HPSAs with 65 million people living in them. It would take 16,585 practitioners to meet their need for primary care providers (a population to practitioner ratio of 2,000:1.
- 4,091 Dental HPSAs with 49 million people living in them. It would take 9,579 practitioners to meet their need for dental providers (a population to practitioner ratio of 3,000:1).
- 3,132 Mental Health HPSAs with 80 million people living in them. It would take 5,352 practitioners to meet their need for mental health providers (a population to practitioner ratio of 10,000:1).
The reasons for concern about the likely impact of health care reform are also well-documented also. An article published September 10 by the Kaiser Health Foundation reports:
"The shortage of primary care physicians could prove a major challenge to health reform. To make matters worse, some doctors are considering early retirement because of the high cost of practicing medicine."
So the challenge is not only to increase the numbers of doctors, but to give them reasons to stay in practice. There are already loan repayment and financial incentive programs designed to attract doctors and nurses to under-served communities. The House health reform bill includes incentives the following provisions to boost the health care workforce:
- Establishment of an Advisory Committee on Health Workforce Evaluation and Assessment to monitor size and stability of the health care workforce
- Expands scholarship incentives for medical students to become primary care practitioners working in community settings.
- Expands scholarships for nursing students to enhance the diversity and cultural competency of the nursing corps.
- Incentives to boost interdisciplinary training
Is this the right mix of incentives? Fausta says it's all moot without tort reform:
A couple of years ago, a pediatrician told me that he had to pay $250,000 per year in malpractice insurance coverage. The amount of money that his practice had to spend on that added to over a million dollars a year.
The Kaiser report points to this CNN article confirming that the cost of malpractice insurance is driving doctors out of medicine:
A first-ever survey of 12,000 primary care physicians conducted last October by Merritt Hawkins and the Physicians' Foundation, an organization that represent the interests of physicians, showed that 10.1% of respondents planned to seek a job outside of health care in the next one to three years.
When it comes to encouraging more women to enter demanding careers such as medicine, the obstacles are not just financial, but cultural. Back in 2007, The Curvature derided a culture that discouraged from pursuing high-powered careers because the pursuit might lessen the chances of finding a husband.
Personally, I'm interested in understanding what works. We've had the National Public Health Corps for decades; we've been trying to get more kids into science-related fields since Sputnik was launched, and we've had scads of school-based and community programs aimed at getting kids in the health professions pipeline. What are the best practices emerging from those efforts? I'd like to see that wisdom incorporated into any final legislation or programmatic initiatives.
What do you think we can do to address the need for more health care workers, particularly if health reform passes?
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