Healthcare experts have been predicting the impending primary care physician shortage for years because it is the result of long-term trends in healthcare. Therefore, truly solving the shortage will take long-term solutions. "Systematically solving the shortage will take some time," says Jordan Battani, the managing director of CSC's Global Institute for Emerging Healthcare Practices. However, she also says that to solve the shortage, it is important to work on it from both long- and short-term angles.
Here, she discusses three ways that hospitals and health systems can protect themselves from the physician shortage in the short-term, before long-term solutions take root nationally.
For example, in 27 states, including Texas, Illinois and New York, nurse practitioners cannot diagnose, treat or prescribe medication without physician involvement. Comparatively, 15 states and the District of Columbia allow nurse practitioners to diagnose, treat and prescribe medicine with no physician involvement, according to Community Catalyst, a national non-profit advocacy organization.
The problem with the limited licensing of PAs and NPs is that where the scope of practice is limited, they aren’t especially effective in extending the “reach” of primary care. At the macro level, the restrictions discourage people from choosing a career as does not encourage people to choose being a mid-level provider "Why would someone choose to be a [mid-level provider] if they are facing an environment where they are trained for clinical activities but licensing laws prevent them from doing that?" Ms. Battani says.
So instead of a hospital simply hiring NPs and PAs, it can also get involved on a legislative level. Hospitals and health systems can use their influence to increase the amount of authority given to mid-level providers by the state, thus encouraging more people to enter the profession and safeguarding against a mid-level provider shortage.
"You don't want to implement changes to solve the primary care provider shortage but then create a problem for yourself in nursing capacity," she says. "They get overloaded and overstressed and then move out." Therefore, it is important for hospitals to make sure their nursing staff, as well as their employed and affiliated physicians, is happy.
Ms. Battani acknowledges that changing work flows in a hospital is not an easy task, but has a suggestion to make it a bit easier. "I think hospitals need to embed this kind of thinking in all of the continuous quality improvement efforts," she says. "Because there are critical resource shortages, the continuous quality improvement needs to be applied to the throughput question."
Besides helping with the use of scarce resources, improving efficiency in an organization will also help reduce cost. "The reduced cost can help pay for how hard [improving work flows] is to do," Ms. Battani says.
While these three tips can help hospitals with the physician shortage in the short-term, the nation still needs to make long-term changes to really solve the shortage problem. According to Ms. Battani, one indicator that the nation is moving in the right direction is the announcement from CMS about fee schedule and payment rate changes for Medicare and Medicaid programs that favor primary care physicians. "One long-term trend that has exacerbated the primary care shortage was the longstanding decreases in primary care provider incomes, as a result of lower payment for primary care services, relative to specialty services.” Ms. Battani says. The payment structure made becoming a primary care physician unattractive, from an economic and lifestyle perspective, for medical students planning to enter the clinical workforce. "I was pleased to see those announcements because that is one of the things we need to change; we need to create incentives to practice primary care."
For more information, view CSC’s paper: U.S. Healthcare Workforce Shortages: Caregivers.
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Here, she discusses three ways that hospitals and health systems can protect themselves from the physician shortage in the short-term, before long-term solutions take root nationally.
Support increased scope of care for mid-level providers
Many healthcare consultants are encouraging hospitals to add more mid-level providers, such as physician assistants and nurse practitioners, to lessen the workload of primary care physicians and help combat the physician shortage. "The part that is naïve about those recommendations is that every state has different rules for the scope of practice for mid-level providers," Ms. Battani says. There are several states where the level of care that NPs can provide has been limited by licensing regulations.For example, in 27 states, including Texas, Illinois and New York, nurse practitioners cannot diagnose, treat or prescribe medication without physician involvement. Comparatively, 15 states and the District of Columbia allow nurse practitioners to diagnose, treat and prescribe medicine with no physician involvement, according to Community Catalyst, a national non-profit advocacy organization.
The problem with the limited licensing of PAs and NPs is that where the scope of practice is limited, they aren’t especially effective in extending the “reach” of primary care. At the macro level, the restrictions discourage people from choosing a career as does not encourage people to choose being a mid-level provider "Why would someone choose to be a [mid-level provider] if they are facing an environment where they are trained for clinical activities but licensing laws prevent them from doing that?" Ms. Battani says.
So instead of a hospital simply hiring NPs and PAs, it can also get involved on a legislative level. Hospitals and health systems can use their influence to increase the amount of authority given to mid-level providers by the state, thus encouraging more people to enter the profession and safeguarding against a mid-level provider shortage.
Retain caregivers
In a world where physician supply is starting to run low, it is paramount for hospitals and health systems to retain the physicians they already employ, because recruiting physicians is becoming more difficult. While it is important for hospitals to retain quality physicians to combat the shortage, Ms. Battani says it is also important for hospitals to focus on retaining nurses and mid-level providers, especially as they are given more responsibility to lessen the workload of primary care physicians."You don't want to implement changes to solve the primary care provider shortage but then create a problem for yourself in nursing capacity," she says. "They get overloaded and overstressed and then move out." Therefore, it is important for hospitals to make sure their nursing staff, as well as their employed and affiliated physicians, is happy.
Improve throughput
Improving patient and work flows will allow each caregiver in the system or hospital to perform more efficiently and productively. This becomes especially important when resources, in this case primary care providers, are scarce. If hospitals improve work flows within the organization, primary care physicians are able to use their time more efficiently.Ms. Battani acknowledges that changing work flows in a hospital is not an easy task, but has a suggestion to make it a bit easier. "I think hospitals need to embed this kind of thinking in all of the continuous quality improvement efforts," she says. "Because there are critical resource shortages, the continuous quality improvement needs to be applied to the throughput question."
Besides helping with the use of scarce resources, improving efficiency in an organization will also help reduce cost. "The reduced cost can help pay for how hard [improving work flows] is to do," Ms. Battani says.
While these three tips can help hospitals with the physician shortage in the short-term, the nation still needs to make long-term changes to really solve the shortage problem. According to Ms. Battani, one indicator that the nation is moving in the right direction is the announcement from CMS about fee schedule and payment rate changes for Medicare and Medicaid programs that favor primary care physicians. "One long-term trend that has exacerbated the primary care shortage was the longstanding decreases in primary care provider incomes, as a result of lower payment for primary care services, relative to specialty services.” Ms. Battani says. The payment structure made becoming a primary care physician unattractive, from an economic and lifestyle perspective, for medical students planning to enter the clinical workforce. "I was pleased to see those announcements because that is one of the things we need to change; we need to create incentives to practice primary care."
For more information, view CSC’s paper: U.S. Healthcare Workforce Shortages: Caregivers.
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