The November issue of Health Affairs highlights the U.S healthcare workforce and how to provide expanded coverage and new models of care as well as address the needs of an aging population. The Association of American Medical Colleges (AAMC) report that unless the U.S acts now, America will face a shortage of more than 90,000 doctors in ten years.
Keynoter Uwe Reinhardt, James Madison Professor of Economy and Professor of Economics and Public Affairs at Princeton University opened the Health Affairs briefing jointly held with Academic Medicine to announce their new issue on November 14th.
He favors operating independent clinical practices of primary care by utilizing properly trained nurse practitioners. It is important to recognize the important role of non-physician primary care givers and to eliminate the payment differentials as well.
He also said that if Congress believes that there is and will be an acute shortage of primary care physicians, Congress should realign the levels of compensation of physicians under Medicare and Medicaid more in favor of primary-care physicians.
George E. Thibault, MD, President, Josiah Macy Jr. Foundation in his Health Affairs article “Reforming Health Professions Education will Require Culture Change and Closer Ties between Classroom and Practice” stressed the need for new ideas.
The article outlines how private foundations should play a bigger role in supporting the design of innovative educational programs to create the future optimal healthcare workforce. First, healthcare needs to be delivered by well-functioning multi-professional teams. Today, the educational model is set up to educate and train members of different health professions separately until they are fully trained. At that point, it is very often too difficult to get everyone to work in teams.
Another problem is that most healthcare is delivered outside of the hospital and often includes patients with chronic diseases requiring the most healthcare. However, a large amount of the health professional’s education remains hospital-based with short rotations focusing on acute episodes of care. More home-based care needs to be incorporated in present and future healthcare delivery.
The article sums up by saying, “The overall picture for the healthcare workforce of today and tomorrow is to understand systems of care, principles related to quality improvement and patient safety, health economics, ethics, population health, and the social determinants of disease. This is so needed due to the complexity of the practice of medicine that exists now and will continue into the future.
To further support workforce needs in the U.S., leaders on Capitol Hill have introduced legislation that would increase the supply of residents needed today and in the future. AAMC supports legislation on the House side introduced by Allyson Schwartz (D-PA) and Aaron Schock (R-IL). The “Training Tomorrow’s Doctors Today Act” (H.R. 1201) would address short and long-term workforce demands by increasing the number of Medicare-supported residency positions nationally by 3,000 each year from 2014-2018. At least half of the available new slots each year would be used for a shortage specialty residency program.
In another legislative move on the Senate side, Senators Bill Nelson (D-FL) and Senate Majority Leader Harry Reid (D-NV) introduced “The Resident Physician Shortage Reduction Act of 2013” (S.577). The act would increase by 15,000, the number of Medicare direct graduate medical education and indirect medical education slots. This legislation would increase the number of residency slots nationally by 3,000 each year from 2015-2019.
Another important issue discussed by David Auerbach PhD Policy Researcher at the RAND Corporation in his article “Nurse-Managed Health Centers and Patient-Centered Medical Homes Could Mitigate Expected Primary Care Physician Shortage”. The impact of two emerging models of care to include the patient-centered medical home and the nurse managed health center are analyzed. Both of these models of care use a provider mix that is richer in nurse practitioners and physician assistants then today’s predominant models of care delivery.
For more information on the Health Affairs November issue, go to www.healthaffairs.org.