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The Short End of the Stick

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Photo by Oles kanebckuu

If you get your primary care locally and you are healthy, you may not have noticed that much of the healthcare system is experiencing a severe workforce shortage. Thanks to good management and careful planning Southern Humboldt is blessed to be somewhat sheltered from a nationwide phenomenon that is predicted to leave us nearly 125,000 physicians short by 2030.

Non-urgent surgeries are being delayed, hospital departments are closing.

However, if you have been referred to a specialist elsewhere in Humboldt or further afield, you may have confronted the shortages by being told it will be months before you can be seen. It is not only physicians we are becoming short of, but nurses and support staff as well. Non-urgent surgeries are being delayed, hospital departments are closing because they can’t be staffed, and in many areas, even basic primary care cannot be accessed without long waits, driving more patients into already stressed and expensive emergency departments.

“The physician shortage can justly be characterized as a looming public-health crisis,” says James Taylor, group president of the leadership solutions division at AMN Healthcare, the largest healthcare staffing agency in the U.S. “Healthcare delayed is often healthcare denied,” he adds.

Specialty care will be hard hit, with psychiatry, neurology, pulmonary, and critical-care medicine to suffer the greatest shortages. However, primary care shortages will render an estimated 83.7 million Americans underserved as their areas of residence are expected to be designated as a Health Professional Shortage Area (HPSA).

Cause and effects

These shortages actually predate the arrival of Covid-19.

Besides driving patients into expensive and over-stressed emergency departments, shortages often end up leaving sick individuals waiting until issues become more serious before being seen, further driving up costs.

While the growing US population has created a demand for more physicians, the number of US medical schools has stagnated, not keeping up with census numbers. The Centers of Medicaid and Medicare Services, which provide funding for internships and residencies required of new docs before they can begin practicing, has not expanded since 1997.

Often tossed into the catch-all drawer of blame, the pandemic, these shortages actually predate the arrival of Covid-19, but indeed the pandemic has worsened them. Many people dropped out of the healthcare field for a wide range of reasons, burnout chief among them, and now young people are changing their minds about going into healthcare after witnessing the pandemic hardships, as well as weighing in the ever-rising cost of higher education in the US. Enrollment in healthcare programs has dropped 4.6% among undergrads in the past year.

Exacerbating the problem is the fact that the shortages are driving many nurses out of permanent positions into higher paying outside contract roles, as hospitals are forced to close staffing gaps with temporary workers. The contract companies, or “temp agencies,” have been accused of price-gouging during the worst days of the early pandemic, costing hospitals and clinics a lot more than having permanent nurses on staff.

Projections from the Bureau of Labor Statistics estimate U.S. healthcare organizations will have to fill almost 200,000 open nursing positions every year until 2030, with many of those slots resulting from the need to replace nurses who leave for different occupations or retire.

Furthermore, the educational pipeline is clogged as sky-rocketing costs contribute to lower college enrollment and the relatively poor salaries of healthcare educators has stagnated.

In 2020, 80,000 qualified nursing students were turned away from programs due to lack of availability of programs and faculty shortages.

Healthcare has always been a reliably excellent field to go into if you are interested in job security. An aging population of baby boomers and gen-Xers guarantees that all levels of medical workers should be able to launch successful careers. Yet here we are with not enough healthcare to go around.

What are some potential solutions to these issues?

Government funding will bring more qualified personnel into the field sooner.
  1. Government investment in increased enrollment in healthcare field education, including student debt relief and improved funding for Medicare-sponsored residency programs. This could reverse the drop in healthcare education enrollment and encourage new providers to seek permanent stable jobs rather than higher paid contract positions they might need to repay debt.
  2. Technology, as it has become more acceptable to patients to have online consultations with providers through the pandemic years, can help patients get more streamlined access to specialty care that would otherwise be logistically difficult to access.
  3. Bringing more physician’s assistants and nurse practitioners into care teams will give patients more access to care. Training more of these mid-level providers takes pressure off physicians per se by saving money both in education and providing patient care.
  4. Removing time-consuming paperwork burdens from a provider’s duties and having those tasks performed by medical scribes would allow providers more time to see patients.
  5. Funding support for hospital and clinical alliances with healthcare educators. Often once a nurse’s coursework is finished there are not enough clinical training positions available in nearby hospitals to complete the required training. Government funding of expanded clinical experience in various settings will bring more qualified personnel into the field sooner.
  6. Relax “scope of practice” restrictions. These scope of practice laws exist in many states across the US and prevent a provider from performing services they are trained and qualified to perform. Relaxing them would allow providers to expand their offerings.

While most of rural America has been experiencing these growing trends of reduced access to care over decades, we are very lucky locally to be able to be seen within a couple days for most cases involving primary care. However, as pressures increase in the healthcare world, we will see more barriers to specialty care, something more of us need at younger ages now than ever before.

Write to your congressmen about your experiences of healthcare shortages and demand they prioritize funding for what should be a basic right in a modern developed nation.

Ann Constantino, submitted on behalf of the SoHum Health’s Outreach department.