Healthcare workforce: A patient’s perspective

Over the last ten years I have had long experiences with the health care system and have been significantly involved with the workforce in that industry. I have had 14 surgeries, from carpal tunnel surgeries to four spinal fusions and the removal of a cancerous kidney. I have spent weeks in hospitals, hours in clinics and doctor’s offices and read volumes of outdated magazines in waiting rooms. I have been in the care of primary care physicians, specialists, surgeons, physician’s assistants, nurse practitioners, nurses, various technicians as well as clerical and administrative personnel. My experiences have been generally positive and I am optimistic about the care we receive as patients. At the same time I foresee difficulty looming in the health care industry.

The national health care debate has focused our awareness on the dichotomy between the increasing demand for healthcare personnel as the population ages and the lagging supply of these vital workers. In addition there is a disconnect between the number of practitioners and where they contribute to the system. In effect we have too few necessary riders on the bus and more tragically we have those who are aboard in the wrong seats.

The attraction of the medical profession, particularly for physicians, has eroded recently, especially among men. There are competing professions that offer significant comparative financial reward without the grueling years of schooling and the huge accumulation of debt from student loans. Those who do opt for the degree of MD are attracted to the specialties rather than the practice of primary care due to the compensation system that places the highest financial rewards in these more elite fields. Obviously the incentive system is flawed and the result is that the shortage of personnel to serve the greatest number of patients that have conditions that can be best be addressed by early intervention as well as provide services to the most needy such as the populations in rural areas and the most needy sections of major cities.

Further, there are too few nurses. There are many out there who would very much like to join this profession but there are barriers that loom to retard that. Due to economic pressures there is less hiring and even layoffs. Fewer nurses are forced to work longer hours and increase productivity by having more patients assigned. In addition we cannot produce the nursing component of the workforce due to the lack of ability to train new candidates that arises from the shortage of nursing instructors. Huge waiting lists exist across the country for seats in nursing schools.

Some of this is exacerbated by the need for the clerical and administrative demands of the modern health care industry. I was advised that in a rather small hospital there were 473 job categories that did not include doctors, nurses or technicians. These are the necessary employees that manage billing, insurance, government forms and reports and customer relations. While these roles are necessary they also demand a vital portion of the resources of the institution that could be dedicated to the actual and direct service to the patient.

The solutions seem to be obvious but the devil as always is in the detail. The incentive system for recruitment at the beginning level needs to entice more candidates to the practice of general medicine. Many of the problems can be diagnosed and remediated at this level. The addition of PA and NP at this level would be a great value.

We will have to increase the schools for training nurses and other technicians and that presents a manpower dilemma and large expenditures of money. We will have to retain the nurses we have and be prepared to fill the ranks for the people who are reaching the end of their tenure due to changing demographics.

We will have to realign the resources that do now exist by increasing the productivity of clerical staff by the use of more technology and reduced burdens of documentation that is currently constipating the system. The monies and resources saved here can be used to support the other more vital functions.

There is much to be done and the solutions as always are the use of our people and the expansion and improvement of our workforce.

(Jim Flora; Christina's Grandpa)