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:
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?
Comments
Kids Love Science
Adela
www.theblacktortoise.com
Getting kids interested in something, anything, is a grass roots effort. Kids don't get interested in Little League because they have an innate interest in baseball; they get interested because other kids, their siblings, and their parents think it's fun.
I grew up on a farm with a passle of sisters. We were expected to do
the work, some pretty hard physical work, because we were part of the
family. We never knew there was boys work and girls work; there was
just work that needed to be done. Still, when I picked up a rock and asked "why does this look like this?" someone took the time to help me find out why. When I came home from school and said, "did you know people used to scrub their pans with sand?" someone said, "let's see if that works."
I'm a woman who went to college with classrooms full of young men: future doctors, chemists, microbiologists, physicists, all of us. It never occurred to me that I was out of place. I just loved what I was learning.
One of my grandsons is sure that Grandma is actually Mrs. Frizzle, a popular kids' book character. (Okay, my hair is red, and it does get out of control sometimes.) Another grandchild drew a picture of a woman who looked suspiciously like me when her teacher asked the class to draw a picture of a scientist. Everytime I see them I ask what they learned in school, and I'm ready with some really interesting tidbit, like "did you know there weren't any earthworms in America before the Pilgrims got here?" And I record some interesting stuff from Nova Now, like "Medical Uses for Leaches" to watch together when they visit. So far, everyone loves science. Will they be our next healthcare providers? Who knows? This I am sure, they all know it is a possibility.
I am happy to see the incentives in the House Affordable Health Care Bill. Are they enough? I'm not qualified to say, but this I know: money isn't the only incentive we need. Not very many kids say "I want to be a (you name it) because I'll make a lot of money." That usually comes later.
No earthworms before the pilgrims?
Really? I must look that up! My nerdy kids will be interested in this information.
:-)
~Denise BlogHer Community Manager
Flamingo House Happenings
Education reform is the answer
Our problem as a society is that we want to solve every problem in isolation from every other. Well, that's one problem, and the other is that we want to solve all of them without spending any public money except to enrich corporations.
This article makes it clear that in order to solve our "health care problem" we need to solve our public education problem. Kids who can't read or write a coherent sentence obviously cannot become doctors or nurses. On the other hand, we are bemoaning an economic downturn that has thrown millions out of work, and medical careers are well paying and secure. So rather than rationing health care so we don't overtax our health care providers, we need to improve the quality of our educational system so that kids who graduate from public schools can get those good medical jobs, and also can get the health benefits that come with them.
But the same problem that is plaguing the health care reform debate - that we don't want to spend any public money caring for people, is the problem that plagues our educational system. It's not that kids are dumb or unmotivated, it's not that parents are uncaring and don't want to be involved, and it's not that teachers are lazy or incompetent. It's that our public school system is being eviscerated by people who don't believe in public education, and are using things like privately run charter schools and vouchers to break unions and take money out of the public school system. Teachers are being told to do more with less, and we act as if threatening them with testing and punitive measures is going to make up for the lack of planning periods, art and music and sports programs, all the things that were taken for granted in the (not particularly good) public schools I grew up in.
If we stop rationing education, we won't need to ration health care and we will all thrive.
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Where there is oppression, there will be resistance.
health jobs
there are too many health workers already. that's what inflates costs. if we can make the system more efficient and squeeze out the 30% of care that's unneeded, fewer people will be needed. anyhow, in medicine, we have proof that supply drives demand. areas with more doctors deliver more deserves and have higher bills without any improvement in health status. there may be a more irresponsible idea than promoting health employment, but I can't think of it offhand.
Could you support that contention with some
data, please?
I have worked in and out of health care and science writing for 30 years, and I have bever seen a shred of evicence to support your assertions. Please point us to any credible analysis that shows that there is an oversupply of physicians, nurses or allied health personnel.
Kim
BlogHer Contributing Editor|KimPearson.net|
Echoing Professor Kim
Too many healthcare workers? Where???
~Denise BlogHer Community Manager
Flamingo House Happenings