Rebecca Vesely: This is Rebecca Vesely, reporter at
Modern Healthcare magazine, and we're talking today about foreign medical education and workforce planning with Dr. Gerard Anderson, professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. Welcome, Dr. Anderson.
Gerard Anderson: Thank you for having me.
Rebecca Vesely: You recently returned from Copenhagen, where you attended a conference on healthcare workforce planning. What similarities do you see between these the U.S. and European countries in terms of healthcare workforce challenges?
Gerard Anderson: Well, all the countries have problems since they don't have enough physicians as the baby boomers age, so they're really trying to figure out the best way to get more physicians, more nurse practitioners, more nurses into the pipeline, recognizing that it takes a long time to get people into the pipeline. So they're looking for ways to fund more medical education.
Rebecca Vesely: And so in terms of funding medical education and getting more physicians and nurses into the pipeline, I mean what strategies are they using to do that?
Gerard Anderson: Well, unlike the United States, which really gave up on the whole concept of health planning, they're really actually going in and really doing health planning. So they're trying to model the number of nurses, the number of physicians, the number of primary-care physicians that they're going to need over the next 50 years, and then strategically trying to go through and think, ‘How can we incentivize the medical schools? How can we incentivize the residency programs to train more people in the areas we need them?' And what are the incentives? So it's more of a government-run operation in most of these European and Australian countries, whereas, in the United States, we seem to rely on the market a lot more and are really focusing on, ‘How can we pay more to primary-care physicians?' And so it's a very different approach to try to tackle exactly the same problem.
Rebecca Vesely: And medical students in Europe don't have the large amount of school debt that American students do, so why aren't they going into primary care?
Gerard Anderson: Well, one of the factors that you've got to take a look at is: How much does debt really influence medical school students' choice? And it's a factor, but it's probably not the primary factor in the United States and in other countries as well. People can pay off their debt in three, four, five years often, and so it's not their primary decisionmaking point. In some European countries, physicians who are in primary care make more than specialists; in other countries they don't. They're all taking a look at this issue. The U.K. wanted to increase the number of physicians going into primary care, and so they increased primary-care salaries by 60%, and over a three-, four-year period, they got an increase in the number of primary-care physicians by about 15%. So they think they got a very good return on their dollar in terms of getting their physicians to change specialties or choose to go into primary care.
Rebecca Vesely: So because we live in a market-based system, what tools do we have available to make sure that everyone has access to the right care at the right time, and do you think that the new healthcare reform law helps in this area?
Gerard Anderson: Well, it does to some extent, but probably not enough. So, one of the things that we've been trying for the past 20 or so years is to have the National Health Service Corp. provide more slots so that people can have their debt forgiven if they go into medically underserved areas. That's working to some extent, but they really do have a great deal of difficulty with retention. Once people's obligation ends, many of them move to the big city, many of them move to places that really have enough physicians. So we're really struggling with the answer; we're hiring and training more nurses. The problem there is we just don't have enough nursing schools and enough nursing educators to try to do this particular issue. So we're struggling with the problem. We know that we don't have enough primary-care physicians, but we're going to try to pay through medical homes more money to primary-care physicians and a variety of other things, but I think the marketplace really is not going to get at exactly the place that we want it to. We just don't have enough pricing levers. And so we're going to really have to look at what's going on in terms of health plans in the European countries because they seem to have a better mix of physicians and an adequate number of nurses. And our system just doesn't seem to do that.
Rebecca Vesely: Well, thank you so much for taking the time, Dr. Anderson. I appreciate it.
Gerard Anderson: I enjoyed it.
Rebecca Vesely: This is Rebecca Vesely, reporter at Modern Healthcare magazine.
