Doctor Shortage Issues - Research Paper Example

? Doctor Shortage Issues Concern has been raised about the impending shortage of health care practitioners, particularly physicians in the United States. The recent outcry over the shortage of physicians became more vocal after it got confirmed that millions of previously uninsured Americans would gain medical insurance cover under legislations spearheaded by the Obama administration. The figures of people expected to acquire health cover by 2015 when the legislation takes effect stands at more than 32 million people, while another 36 million people will enter Medicare. The population is also rapidly ageing, and this means an increased need for physicians. Is there a general shortage of physicians or only in key areas (geographically and by specialty)? Experts in the medical field have stated that the country in its present state does have enough doctors to deal with patients who frequently hospitals. They are of the opinion that this state will more likely than not become far worse than it currently is, as a result of the legislation that will see many people legally gaining medical insurance under the law. Projections into the future have revealed that given present graduation and training figures, America will possibly experience a shortage of as much as 150,000 doctors over the next 15 years. These reports got confirmed by the Association of American Colleges that documented that there will be a shortage of 91,500 specialized physicians by 2020. The association predicts that the population will require an additional 45,000 primary care doctors and 46,000 medical specialist and surgeons. This is despite the push to increase enrollments into medical school and residency in teaching hospitals (Anthony, 2011). Though the country currently has an estimated 954,000 doctors, this number barely meets the requirements of the growing population. Studies have indicated that primary care physicians will be of immense demand. This is because, under the new legislation, family physicians, internists, pediatricians and general practitioners will have a crucial role of coordinating patient care. They will be required in their numbers. Primary care doctor numbers currently stand at 353,300 and their need gets expected to increase exponentially over the years. Since 2002, as many as 33 states have looked into present and future physician needs (Anthony, 2011). Generally, these audits have pointed out shortages in primary care doctors, and in specialties such as immunology and allergy, dermatology, psychiatry, cardiology, neurosurgery and child psychiatry. There exists vast disparity in the distribution of doctors in America. Most of the doctors get concentrated in the urban areas and cities where as the rural America has little number of doctors. This creates a precedence of physician shortage in the rural areas (Anthony, 2011). What are the key barriers to increasing the number of physicians? (Consider primary care and specialty physicians). Increasing the number of physicians has been affected by a number of factors. Though there have been increased admissions in medical schools, these efforts will all prove futile if the residence slots are not equally increased. These residency positions currently stand at a limited number in teaching hospitals. According to the Association of American Physicians, there are about 120,000 resident slots in the United States, a number far lower than the number of students graduating from medical school each year. This was worsened by the Balanced Budget act of 1997 that limited funding for medical residency, which hospitals attest has increasingly affected their ability to increase the number of positions (Dewar, 2009). Primary care gets especially plagued with poor reimbursement as primary care physicians have significantly less income and low status than their specialist counterparts. The services rendered by primary physicians get undervalued by the payment systems in place. This is evident in the number of primary physicians who are now specializing, and also those who quit practice altogether. Though specializing in a specific area is favorable due to increased levels of income, it takes relatively longer, and the costs involved are unwelcoming. This could be the reason why many physicians quit before becoming specialists. The niche associated with specialists is a fraction of the population, and this may lead some physicians to opt for general practice (Harry, 2010). What policies might be used to address these issues? Several policies can be used to reduce the barriers to increasing the number of physicians as highlighted above. The government should improve recruitment, training and retention of primary care doctors. This is possible through the creation of incentives for medical students to encourage them to pursue primary care careers and practice in unpopular parts of the nation. It has been suggested that the government should write off student debts of physicians who choose to pursue primary care in order to entice others to take up primary care (Dewar, 2009). The income of Primary care physicians should be increased in order to attract new entrants into the field and to help get rid of the low status associated with primary physicians. The payment given to primary care physicians should be commensurate with the value associated with primary care. Some are in favor of providing bonus payments to primary care physicians while others are fronting for increased Medicaid and Medicare payments (Harry, 2010). There should be increased support in education and training through increased funding to encourage medical schools and teaching hospitals to improve training programs in primary care and specialist care. This will increase the level of enrollment in medical schools and residency slots in hospitals. The cost of specializing in a field of medicine should be reduced through the provision of grants and scholarships in areas such as dermatology, psychiatry, cardiology and neurosurgery that have physician shortages. This will help to increase the number of specialists. Some residency slots in teaching hospitals should be reserved for specialists so as to act as an incentive (Dewar, 2008). What can hospitals do to recruit and retain physicians? Hospitals should accord physicians quality care and service while offering them the opportunity to make use of hospitalists to take of their admissions. Hospitals should offer employment to doctors both in academic and clinical roles. This will not only boost the physician’s earnings but will also ground the doctors, making them available at the hospital. Providing sufficient support staff like nurses and assistants will attract physicians to some hospitals. This is because physicians get overworked and charged with roles that neither fit their profile nor job description (Blumberg, 2008). Hospitals should offer incentives such as bonuses for doctors in order to retain them especially after they have exhibited exemplary performance. Hospitals should also offer certain benefits to their best physicians in a bid to retain them and attract new talent. Common benefits include life insurance, retirement insurance, medical insurance, paid vacations and a potent combination of off days that are flexible and attractive to the physician. Allowances offered by hospitals for their physicians to attend conferences and workshops should be attractive and competitive (Harry, 2010). What impact does physician-hospital integration and alignment have on the physician shortage? Proper physician-hospital integration and alignment creates a precedence of adequacy in as far as physician shortage is concerned. If there is proper physician hospital alignment, the physicians will get equitably distributed in the various hospitals based on their strengths and expertise; therefore, reducing the impact that physician shortage has on the population (Blumberg, 2008). What impact do international medical programs have on the physician shortage? International medical programs help to alleviate the physician shortage in the country. This is because they allow for medical students from across the globe to train and qualify in medical practice in America. Some of the medical students who have trained abroad are awarded the chance to practice in the country, thereby reducing the deficit associated with physician shortage. Using a table or chart include the projected physician shortages. State by State Physician Numbers in 2006 and Projection Need for 2020 State 2006 2020 State 2006 2020 AL 2,248 2,912 MT 300 413 AK 208 302 NE 525 666 AZ 1,773 3,114 NV 895 1,599 AR 1,322 1,781 NH 412 593 CA 10,560 15,181 NJ 2,680 3,551 CO 1,421 1,989 NM 611 851 CT 1,118 1,447 NY 5,856 7,345 DE 290 416 NC 3,206 4,777 DC 330 346 ND 195 242 FL 7,035 11,497 OH 4,031 5,031 GA 2,919 4,302 OK 1,463 1,896 HI 393 530 OR 1,105 1,595 ID 408 615 PA 5,253 6,652 State 2006 2020 State 2006 2020 IL 3,723 4,747 RI 335 438 IN 2,077 2,691 SC 1,867 2,639 IA 913 1,142 SD 236 303 State 2006 2020 State 2006 2020 KS 825 1,064 TN 2,650 3,692 KY 1,844 2,409 TX 6,661 10,091 LA 2,249 2,879 UT 682 1,017 ME 438 589 VT 201 277 MD 1,794 2,529 VA 2,287 3,302 MA 1,974 2,565 WA 1,872 2,758 MI 3,226 4,165 WV 893 1,098 MN 1,542 2,153 WI 1,696 2,268 MS 1,631 2,102 WY 159 211 MO 2,099 2,764 United States 100,431 139,531 The above table shows the number of family physicians deficit as recorded in 2006, and the expected shortage in 2020. As is evident in the table above, America will experience an acute shortage of physicians in the coming years Given the layered aspects of the physician shortage and the understanding that filling this gap reaches beyond the medical schools, what are some alternative strategies? Alternative strategies that should be considered include the strengthening of the capacity of medical practitioners such as nurses, nurse midwives, physician assistants and nurse anesthetists to deal with some aspects of primary care and mild condition. Provision of adequate primary care is vital in reducing the need for physicians in the country, therefore, reducing the impact of the shortage (Blumberg, 2008). Some experts argue that the problem is not the lack of physicians in the country, but is the fact that the population is disease infested as a result of lifestyle choices. They are of the opinion that a change in the lifestyle of Americans will reduce the need for health care and subsequently reduce the shortage experienced. References Anthony R. Kovner, S. J. (2011). Jonas and Kovner's Health Care Delivery in the United States. New York: Springer Publishing Company. Blumberg, M. S. (2008). Trends and projections of physicians in the United States, 1967-2002. New York: Carnegie Commission on Higher Education. Dewar, D. M. (2009). Essentials of Health Economics. Burlington: Jones & Bartlett Learning. Harry A. Sultz, H. S. (2010). Health Care USA. Burlington: Jones & Bartlett Publishers. Read More