The recently proposed $624 billion fund to overhaul healthcare presented by President Barack Obama proves that his administration is serious about healthcare reform, and universal coverage is the mantra both in Washington and within the healthcare system. But once universal coverage is achieved, who will provide care for these 47 million newly enfranchised Americans?
The fact is that we face a serious shortage of healthcare resources to care for the people who are insured. Hospitals are on the ropes with the current credit crisis. Virtually everyone knows there is a severe nursing shortage. But whats less well-known is that there is a shortage of physicians, including primary-care doctors and physicians who specialize in hospital care, and its growing.
When the healthcare system is deluged by an influx of people, well need strategies to manage them all. I urge healthcare leaders to consider the following solutions. Some will require government interventions and some are already in place, but need to be leveraged for larger populations.
One way to do that is to invest in cutting-edge medical technology, which is in keeping with Obamas plan to invest $10 billion annually over the next five years in health information technology. Physicians need technology at their fingertips to help them ensure best practices, expedite tests and treatments, and communicate regularly with primary-care physicians, specialists, patients and their families. Technology is also critical in post-discharge transition management to keep tabs on patients when they return home to prevent medical setbacks and readmission to the hospital. We also need to make our physicians more productive with better practice management infrastructures. Additionally, the current work-hour guidelines in medical schools during residency training dont prepare physicians for the real world. We need to change our attitude toward medical training, and better prepare doctors for dealing with crisis and stress.
Physicians will function best if they work as private practitionersnot as hospital employees. The private practice hospital model gives physicians autonomy and control of their practice group, which prevents physician burnout and also benefits cash-strapped hospitals without the funds or organizational structure to sustain practice groups over the long term.
Steps for alleviating the workforce shortage include: relying more on midlevel providers (physician assistants and nurse practitioners); lobbying for changes in visa laws to bring in qualified foreign doctors; and advocating for faster issuance of new medical licenses. With only 2% of graduating medical students planning to work in primary-care internal medicine, according to a survey that appeared in the Sept. 10, 2008 issue of the Journal of the American Medical Association, there must also be meaningful incentives to attract more students to general medicine.
As universal coverage creates a pressing need for universal access to care, healthcare policymakers need to involve hospital medicine leaders in their decisionmaking processes. They must work in tandem at this critical time to assure the delivery of timely, quality healthcare to millions of Americans.
Adam Singer, M.D.Founder, chairman and CEO IPC-the Hospitalist Co. North Hollywood, Calif.