As is usually the case during tough economic timeswhether its because of painful necessity or to seize an opportunitymore Americans are heading back to school. The medical fields are certainly seeing some of that. In the case of healthcarewhere even in this dismal economy workforce shortages are ongoingwill any influx of students be enough? And are they steering into the jobs where they can make the most difference?
Time for some remedies
As the health reform debate heats up, primary care must remain a top-tier issue
Medical schools continue to see their numbers climb, with first-year enrollees rising nearly 2% in 2008 compared with the previous year. Anecdotal reports, meanwhile point to increasing numbers of applicants looking to medicine for a more recession-proof future.
Of course, in the arena of primary care, the news could always be better. Consider:
Late last month, while the National Resident Matching Program marked its biggest match day ever, the number of medical school seniors choosing internal medicine continued its decades-long decline, falling another 1%a cumulative slide of more than 30% since the mid-1980s.
A new report from the National Association of Community Health Centers has documented another increase in a population designated as the medically disenfranchisedAmericans who the group says lack adequate access to the basic services they need in large part because of shortages of primary-care physicians. That figure, now pegged at 60 million, is up from 56 million estimated in a 2007 report.
Plenty of organizations, including government agencies, have been pointing to the long-term drop in primary-care docs. Those naturally include physician associations such as the American College of Physicians and the American Medical Association, which have been vocal in calling for solutions to reverse the trend, urging changes such as revising the Medicare physician payment formula as well as initiatives to ease the education debt burdens carried by newly minted docs.
Some of the proposals have merit and should be given a hearing in Washington. The practice of legislating physician payment reductions, only to have Congress come to their rescue at the last minute, needs to end with an equitable, long-term fix. Meanwhile, financing higher educationfor more and more of our young people, grad and undergradis becoming unobtainable. This too deserves a long-term remedy.
Lets also acknowledge that attracting more MDs isnt the only answer here. Nurse practitioners and physician assistants already play a vital role, and their ranks continue to rise.
The number of practicing PAs, for instance, has been climbing since about 1970, according to an industry census by the American Academy of Physician Assistants, posting an 8% gain last year alone. A large share of these professionals serve in primary-care roles, and the totals would likely be higher if not for the fact that when it comes to regulation and licensing, some states are more flexible than others regarding these providers.
Nurse practitioners also play essential roles, working in tandem with docs in many medical practices, and they appear to be the caregiver of choice for the convenient-care clinic chains. A key obstacle here: the dearth of nursing faculty limits the number of women and men wishing to enter the nursing workforce.
With the policy debate over the direction of healthcare reform likely to soon become fast and furious, the state of our primary-care system must remain a top-tier issue. If we truly expect wellness efforts and preventive medicine to slash away at our $2.5 trillion healthcare tab, these are the folks best positioned to lead. If the medical home concept is ever to take off, who better to handle the requisite care coordination?
Of course, with leadership comes responsibility. It will fall to these caregivers to embrace tools such as information technology and develop innovative, cost-effective approaches to care that improve access and quality.
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