What healthcare workforce issue?
Imagine this, you are new to healthcare insurance. For the first time in your life you are going to be able to go see a provider without worrying about if you can afford the outcome of the visit. You are covered and you are ready to take care of your health. Who the healthcare workforce consists of and who you are going to see is really not even on your mind.
Only there is a problem.
When you call to find a provider, it becomes clear that within your community most of the providers are “full” or “not accepting new patients”. You start to research this and come to find out that your community is in a “Health Professional Shortage Area” or HPSA. You dig a bit deeper and find that HPSA “are designated by HRSA as having shortages of primary medical care, dental or mental health providers and may be geographic (a county or service area), demographic (low income population) or institutional (comprehensive health center, federally qualified health center or other public facility).”
You continue reading on the HRSA website about HPSA and learn:
As of August 16, 2012, there are
- 5,721 Primary Care HPSAs with 54.4 million people living in them. It would take 15,162 practitioners to meet their need for primary care providers (a population to practitioner ratio of 2,000:1).
- 4,406 Dental HPSAs with 43.8 million people living in them. It would take 8,806 practitioners to meet their need for dental providers (a population to practitioner ratio of 3,000:1).
- 3,689 Mental Health HPSAs with 87.1 million people living in them. It would take 5,791 practitioners to meet their need for mental health providers (a population to practitioner ratio of 10,000:1)
While the numbers seem staggering, you still have to believe that there are programs working to add more healthcare providers to the workforce and therefore be available to deliver care.
But then you read about medical schools and residencies not expanding to add more slots for students.
You read about how fewer medical students are going into primary care.
You read about how even if we had the adequate supply of providers, they were not evenly distributed geographically to help rural and urban areas equally.
You read an article on improving the supply and distribution of primary care physicians in Academic Medicine which states:
“The current medical education system and reimbursement policies in the United States have contributed to a maldistribution of physicians by specialty and geography. The causes of this maldistribution include financial barriers that prevent the individuals who would be the most likely to serve in primary care and underserved areas from entering the profession, large taxpayer subsidies to teaching hospitals that provide incentives to act in ways that are not in the best interest of society, and reimbursement policies that discourage physicians from providing primary care.”
To make matters worse, you learn that you are in a medically underserved area defined by HRSA as a population that has too few primary care providers, high infant mortality, high poverty and/or high elderly population.
All of this seems quite overwhelming. It is in the face of this challenge that you begin to see why so many people were making such a fuss over “workforce” when the debate around health reform was happening. So what can be done? Obviously, you want access to a provider in your community.
And while you see some solutions like reducing financial barriers for medical students who are interested in becoming a primary care physicians and offering better financially incentives for providers in primary care, it doesn’t appear like much is being done.
Possible healthcare workforce solutions?
Create more opportunities for students and young physicians to trade debt for service, through effective programs such as the National Health Service Corps.
Reduce or resolve disparities in physician income.
Admit a greater proportion of students to medical school who are more likely to choose primary care, rural practice, and care of the underserved.
Study the degree to which educational debt prevents middle class and poor students from applying to medical school and potential policies to reduce such barriers.
Shift substantially more training of medical students and residents to community, rural and underserved settings.
Support primary care departments and residency programs and their roles in teaching and mentoring trainees.
Reauthorize and revitalize funding through Title VII, Section 747 of the Public Health Service Act.
Study how to make rural areas more likely practice options, especially for women physicians.
New medical schools should be public with preference for rural locations.
So maybe this workforce issue is not just something that policy wonks and healthcare systems need to worry about. In reality, not having an adequate healthcare workforce impacts everyone.