By Kate Bleasdale
The “what” and “when” are perfectly clear. The healthcare bill signed by the President on March 23rd is expected to be fully realized by 2014 and to extend healthcare coverage to as many as 32 million people who had previously been uninsured. But the “how” is something we are only beginning to explore, and the answers will not come as easily. In fact, when it comes to the sufficient staffing that will be a critical component of any reform’s success, those answers will require thinking both outside the box, and beyond the U.S. borders.
Let’s start where so many individuals seeking care also will: with our primary care physicians. Simply put, there are not enough of them to meet our current demands – let alone the additional strain reform will create, especially in rural areas. The American Academy of Family Physicians recently predicted a shortfall of 40,000 primary-care providers by 2020. By 2025, the Association of American Medical Colleges expects a shortage of nearly 160,000.
How long will we be willing to wait for a non-urgent appointment with our primary physicians, for the routine care that is necessary to prevent more complex care and costly conditions down the road? We should not forget that when Massachusetts instituted its own reform, requiring residents to be insured by 2007, both wait times for primary care doctor’s appointments and the number of emergency visits surged.
We could next arguably turn, as so many individuals also do, to our skilled force of nurses and physician assistants. However, our current nursing shortage already sits at 260,000 (for RN vacancies), and was predicted even before this reform bill became law to rise to 1.2 million by 2014. Our nurses are aging and retiring along with our baby boomers. Shortages are especially dire in critical care, cardiac, intensive care and operating rooms-precisely the services that our increasing elderly population will need-and it takes years to “build” medical professionals in these areas. How will reform worsen this aspect of our predicament?
The situation calls for increased flexibility, on all fronts.
For starters, it is to be hoped that the reform bill’s promise of insured patients, increased Medicaid imbursements, and other financial assistance will inspire more talented medical students to pursue primary care practices – despite the greater financial rewards that specialization usually offers.
But more needs to be done. Greater training and education need to be offered. This applies not only to doctors, in the form of increased residencies and reimbursements for those willing to pursue a primary care career path, but for nurse practitioners and physician assistants who can then take on greater responsibilities-for example, managing clinics under doctors’ supervision-especially in rural areas.
On the nursing front, this educational effort will be especially challenging, given our current insufficient numbers of nursing schools, and funding for same, that has led to tens of thousands of potential nursing students being turned away annually.
In the meantime, therefore, we must take advantage of the pipeline of internationally trained medical professionals from other countries who are waiting – often for as long as four years, under current Visa and immigration policies – to come here and help. Broad immigration reform is climbing ever higher on the Washington agenda, but whatever the fate of that broader legislative push it is vital that Congress make immigration reform specifically for these medical professionals a priority. Failure to explore this option could prove fatal to the public health system in the coming years.
Those hesitant to factor this solution into the mix need to understand, if this is the source of their hesitation, that internationally-trained nurses will not be taking any jobs away from US workers, but in fact are filling only a small percentage of the critical nursing shortage in this country. Of course it goes without saying that any international recruitment must be done ethically, from countries where no similar shortage exists, and with keen attention paid to qualifications, proficiency in medical – not just basic – English, as well as cultural and other acclimation.
Last but certainly not least, we cannot forget about supporting our healthcare professionals once they are in positions. This includes making sure they receive the mentorship and other support they need, and paying close attention to their levels of stress and job satisfaction.
If we follow all of the above steps, hospitals and other healthcare providers, healthcare reform may indeed provide us with an opportunity to truly heal ourselves.
Kate Bleasdale is President of HCL Consulting
