The US government and/or a private organization should mandate how physicians are trained. According to Russell Robertson M.D., the chair of the Council on Graduate Medical Education (COGME), there is a lack of interest, support and funding for our nations primary care physician residency programs.
Similarly to Great Britain or Canada, we should have either the government or a group of private "provincial ministries of health care" (negotiations between the medical schools, provincial governments, and physician associations) finance all residency slots and controls the number of positions by specialty (Shi and Singh p 129). According to Robertson, about 65 percent of all physicians in the U.S. are sub-specialists and 35 percent are primary care physicians. It is necessary to create incentives to entice medical students to pursue careers in primary care. In Great Britain, the primary care physicians known as “gatekeepers” are paid bonuses for keeping their patients healthy and not needing specialty care. Our reform would also offer the same financial opportunities to those going into NPP positions, such as NPs; PAs; etc. due to the fact that they can improve primary care access to those individuals in rural settings, provide high quality and cost effective care, and show greater interest in patients (Shi and Singh p 144).
There would be a more balanced and controlled distribution of specialists and generalists as well as NPPs. We need to start transforming the current system, and start pushing for primary health care and a wellness perspective. The promotion of preventive care with primary care physicians and NPPs will reduce the number of patients seeking care from specialists. Increasing the funding for NPPs education by having a portion of taxes designated to help compensate those students pursuing a degree in a NPP field. This would allow for the medically underserved communities to receive high quality, low cost primary healthcare in order to prevent diseases that in the long run will cost more money over time.
At first this would be a costly change, however, over time costs would level off because of increased access and therefore more people would utilize primary care instead of putting off medical problems until they become something bigger, and NPPs deliver high quality care with cost effectiveness in mind.
Arvantes. J. (2009, September 23). Primary Care Physician Shortages Can Be Traced Largely to Pipeline Issues, Says FP. Retrieved February 25, 2010 from http://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/20090923medpac-pcps.html
Center for American Progress. (2010). Closing the Health Care Gap. RetrievedFebruary 15, 2010 from http://www.americanprogress.org/issues/2010/01/health_workforce.html
U.S. Department of Health and Human Services, Health Resources and Services Administration. (2006). The United States Health Workforce Profile. Retrieved February 15, 2010 from http://bhpr.hrsa.gov/healthworkforce/reports/#multiple
REFORM #2
ReplyDeleteState and federal governments are involved in this reform. In Minnesota, the Governor has proposed cutting $350 million from health and human services. Limiting the number of budget cuts a specific section w/in the health care workforce can experience in a given year. For example, not allowing a state government to continually cut funding in the area of human services, thus human services is forced to cut many positions as well as beneficial programs. The individuals and families affected by the cuts of these beneficial programs including, health care, cash assistance, and food assistance are already struggling in this economy. If they lose these basic needs they are more at risk for illness/death and abuse to self and others. If the allied health professionals such as social workers are being forced to carry heavier caseloads due to positions being cut or positions remaining vacant, then it is the vulnerable individuals and families who will suffer. They may be neglected or get lost in the system. It should be a priority to enforce those who have the ability to work or pursue an education to do so. But to do this we need more allied health professionals not less.
Begin a nation-wide health and wellness promotion and education chamber which will be established to coordinate, develop, and implement programs funded by the federal government in order to promote primary prevention. A community-based approach would be taken in order to allow for the preventative services to best fit the needs and capacity of the community so the services provided from the governmentally funded programs can be utilized to their full potential.
Programs would not be cut altogether but would just be forced to make budget cuts. Each different area of health care would be on an equal playing field, in that they would all feel the effects of budget cuts, but no program would be completely eliminated. Individuals who are able to work should be expected to work or get an education for future employment, so that they can support themselves.
In order for the newly provided health and wellness promotion education chamber to carry out these new programs, a fund would be enacted to sustain the financial backbone of these new programs as well as help provide funding for health education programs at universities nation wide. This fund would help students attending universities with accredited health education programs to receive grants upon acceptence into the health education program.
This reform would allow for cost containment down the road due to the utilization or primary preventative programs and care as well as the educational aspect the federally funded programs would provide. Initial costs may be a fee for service or fee to participate in a program, but once the fund has been established, those who had to initally pay would be reimbursed if they so desired. The fund would continue to financially support programs geared towards health promotion and wellness so that hopefully down the road medical care costs will decline because of increased education and awareness. This reform would insure that a service that is especially helpful for an under-served population, does not continually face losses. Instead, budget cuts would be equally felt throughout many different areas of health care, but each would not suffer as severe cuts as they would if they were the only one facing cuts. Those who genuinely need the services would continue getting them and those abusing the system would be cut from getting services.
ReplyDeleteThis reform would assist individuals nation wide with making healthier life choices, including those of low socioeconomic status (SES). Establishing a fund for health education will not only increase access for those in need of health care but would increase the rate of health educators available for services by helping fund their education. Those receiving services and already vulnerable would not lose needed services such as health care and cash assistance. This reform would increase the quality of health care in the United States by providing education and health and wellness/promotion programs that would occur on a community level. This would increase quality of care because the health educators and chamber would be able to better focus their efforts on the community and the individuals in those communities by working in smaller groups instead of trying to work with bigger populations.
Health and Human Services is the backbone for many communities. When services/employees are cut it has a direct impact on the basic needs humans rely on and should have access to such as food, clothing, shelter, and health care. The government is depriving these individuals of those basic needs in a time when we are expected to help those who do not have them. By having a fund that supports health educators and promoting the health of United States by having community based programs, its intentions are to cut health care costs down the road that are associated with secondary and tertiary care.
Sources:
Center on Budget and Policy Priorities. (2010). An Update on State Budget Cuts:Governors Proposing New Round of Cuts for 2011; At Least 45
States Have Already Imposed Cuts That Hurt Vulnerable Residents. Retrieved March 11, 2010 from http://www.cbpp.org/cms/?fa=view&id=1214
Minnesota Budget Project. (2010). Governor’s Supplemental Budget Proposes Widespread Cuts in Health and Human Services. Retrieved March
11, 2010 from http://minnesotabudgetbites.org/2010/03/09/governors-supplemental-budget-proposes-widespread-cuts-in-health-and-human services/
Palfreman, J. (Writer, Producer, and Director) & Reid, T.R. (Writer). (2008, April 15). FRONTLINE: Sick Around the World. Boston: WGBH educational foundation.
Shi, L., & Singh, D. A. (2008). Delivering Health Care in America: A Systems
Approach (Fourth ed. ). Sudbury: Jones and Bartlett .
U.S. Department of Health and Human Services, Health Resources and Services
Administration. (2006). The United States Health Workforce Profile. Retrieved
February 15, 2010 from http://bhpr.hrsa.gov/healthworkforce/reports/#multiple
In addition to your suggested incentives, I believe there needs to be more training programs for primary care physicians and NPPs. I know many qualified students who haven't been accepted to those educational programs because the number of spaces is limited.
ReplyDeletePrimary care is going to be where I will be practicing when I graduate from optometry school, so I 100% agree that there needs to be a push towards primary care first. There are so many patients that come in who say they go to ophthalmologists for the same care we will provide to them. Ophthalmologists are the specialists, and they get paid a lot more to do an eye exam than an optometrist; however, it is the optometrists job to do the exam, and if anything is out of line, that's when they are referred to a specialist. This happens in many other fields as well. I think if primary care was focused on as preventative, and everyone had insurance to get the primary care they needed every year, then this transition to primary care first, and specialists second would happen without a doubt.
ReplyDeleteComing from a small community I think spreading specialists, NPPs, etc. is essential. Many times for any services that may be needed we have to travel an hour away. Of course there are hospitals near by, but many of them do not offer services that are needed. It is easy to appeal doctors to large cities, but how would you do the same to smaller communities?
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