Posts Tagged ‘Association of American Medical Colleges’

National Health Service Corps Caring for More Medically Underserved Americans

Wednesday, October 19th, 2011

In the last three years, membership in the National Health Service Corps (NHSC) has tripled, according to Kathleen Sebelius, Secretary of Health and Human Services (HHS).  The NHSC is a national network of 10,000 primary-care providers and 17,000 sites in underserved communities with limited access to healthcare.

“When you don’t have access to primary care, small health problems grow into big ones,” Sebelius said.  “Way too many Americans have gone without check-ups, preventive screenings, vaccines, routine dental work and other care simply because there was no one to see,” Sebelius said.  The agency estimates that its providers care for approximately 10.5 million patients, compared with just 3,600 providers who cared for roughly 3.7 million patients three years ago.

The program, which is almost 40 years old — is administered by HHS’ Health Resources and Services Administration (HRSA) — and provides financial, educational and professional resources to medical, dental and behavioral healthcare providers.  According to HRSA the NHSC has awarded approximately $900 million in scholarships and loan repayment to healthcare professionals since 2008 to expand the agency’s primary-care workforce. That funding has come from the Patient Protection and Affordable Care Act (ACA), the American Recovery and Reinvestment Act (ARRA) and base appropriations.  “Eighty-two percent of NHSC clinicians continue to serve in high-need areas after they fulfill their service commitment,” HRSA Administrator Mary Wakefield said.  “These awards help ensure that underserved communities across the country have access to quality healthcare both today and in the future.”

“When you don’t have access to primary care, small health problems grow into big ones,” Sebelius said. “Most of these providers graduate with tens or even hundreds of thousands of dollars in loans, and it is very difficult to pay off while doing this important work.”

The Association of American Medical Colleges estimates that the nation will have a shortage of 91,500 physicians across all specialties just nine years from now. 

Despite the program’s recent significant growth, Wakefield said there are underserved areas of the country that qualify for National Health Service Corps members, but there is not enough money to fund providers there.  “It is a significant challenge,” Wakefield said.  “We have more sites that are designated or eligible than we have clinicians.  We also have, on the flip side, more students applying to National Health Service Corps than we have availability” to fund.

In Minnesota, for example, a state with vast wilderness areas, the federal government is providing $6.6 million in incentive dollars to doctors and nurses to increase the state’s number of primary-care providers.  According to Minnesota Public Radio, “Minnesota’s rural healthcare system is feeling new pressure.  National healthcare reform is forcing expensive record-keeping changes.  Greater reliance on Medicare and Medicaid reimbursement makes rural providers vulnerable.  Rural people tend to be older and poorer, are less likely to have insurance and suffer more chronic illness.  And the doctor shortage has gotten harder to deal with.  In response, care is changing.  Services like mental health counseling are delivered via teleconference.  Clinics and hospitals are consolidating.  ‘Mid-level’ practitioners like paramedics and dental therapists are starting to play new roles.”

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Is the Physician Shortage Easing?

Wednesday, June 29th, 2011

The current physician shortage has implications in terms of a lack of medical care for a greater number of insured patients over the next few years, physician workload, and difficulties with recruitment.  There is, however, hope on the horizon.  Enrollment in family residency programs rose in 2011, rising 11 percent from 2010.  The University of California, San Francisco (UCSF), saw a 20 to 25 percent increase in medical applicants, according to Kaiser Health News. “Primary care has always had the strongest connection with public service and a public health agenda,” said Andy Bindman, professor of medicine at UCSF and chief of general medicine at San Francisco General Hospital.

According to Kaiser Health News’ Jenny Gold, “As the shortage of primary care doctors worsens in the U.S., experts are carefully tracking the interest of today’s medical students and residents in primary care, to see if a new generation of family doctors might be emerging.  By 2020, the Association of American Medical Colleges predicts that the country will be short 45,000 primary care physicians.  Some say the focus on primary care in the federal health overhaul law, called the Affordable Care Act, deserves much of the credit for rising interest in family medicine.”

Where will future doctors come from?  Today’s teenagers show little interest in healthcare and science careers, according to an online survey by Harris Interactive for University of Sciences. Forty-nine percent of 9th to 12th graders definitely or probably would not consider a career in healthcare or science, an 8.9 percent increase from the previous year.  Sixty percent of younger teens (age 13 – 15) also said they were not interested.  The survey found that those who were interested in pursuing healthcare- and science-based careers were primarily women and minorities.  Respondents interested in healthcare careers cited reasons, including financial motivations (“earning good money”), general interest, and public service (“want to help people”).  “It is essential that the sciences remain top of mind for America’s teenagers,” said Russell J. DiGate, Ph.D, provost at University of the Sciences.

The fact that states are slashing their budgets could force medical schools to cut back on admissions in 2012 is making a bad situation worse.  Texas medical schools are facing $500 million in combined cuts in the 2012-13 academic year, making them unable to fully fund students already enrolled, reports the Texas Tribune.  These schools are poised to see state payments for medical education fall by more than $12,000 per student per year, putting future admissions on the chopping block.

Some sources are not so certain that an end to the physician shortage is at hand.  Twenty-three percent of general internists and 40 percent of subspecialists are not renewing their internal medicine board certification,  according to research from the Journal of American Physicians and Surgeons. Older physicians especially will stop practicing than recertify, faced with extensive requirements and time commitments.  According a 2009 Association of American Physicians and Surgeons (AAPS) survey, just 30 percent reported that recertification improved their performance; just 22 percent would voluntarily do it again.

“This number will most likely increase as these processes become more expensive and more time-consuming, and continue not to reflect clinical practice,” Dr. Martin Dubravec said.  “Recertification has become a cottage industry of bureaucrats and testing agencies, dragging with them a few university physicians,” said AAPS President Lee Hieb.  “Accrediting bodies increasingly require continuous physician competency, and more boards require certification.  Hesitant physicians exiting practice could pose a significant problem that would leave a vacuum for physicians during times of shortage.”

“We cannot afford to drive our most seasoned, experienced physicians into early retirement,” said AAPS executive director Jane M. Orient, M.D. “They simply cannot be replaced.”

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The Doctor Is In – But Patients Must Wait and Wait

Monday, June 6th, 2011

A shortage of primary-care physicians in Massachusetts means that some patients must wait up to 48 days for an appointment. A poll of 838 Massachusetts physicians called the “Patient Access To Health Care Study“ found that Bay State residents often have to wait weeks — in some cases as long as a month and a half — for non-urgent appointments with primary care physicians and certain specialists.  The Massachusetts Medical Society (MMS) called doctors’ offices in February and March and asked when they could come in for routine care.  They asked for a new patient appointment with internists, family practitioners, and pediatricians; an appointment for heartburn with gastroenterologists; a heart check-up with cardiologists; an appointment for knee pain with orthopedic surgeons; and a routine exam with obstetrician/gynecologists.  The typical waiting period ranged from 24 days for an appointment with a pediatrician to 48 days to see an internist.  The wait for an internist was less than the 53 days in a 2010 survey, but the waits for family doctors, gastroenterologists, orthopedists, and ob/gyns rose.

Additionally, 50 percent of Massachusetts’ primary-care physicians are not accepting new patients.  The report has serious repercussions on the cost of healthcare in the state.  Patients with no access to a primary-care physician are more likely to visit the far more costly emergency room when they are sick.  “Massachusetts has made great strides in securing insurance coverage for its citizens,” said Dr. Alice Coombs, MMS president, in reference to the state’s ground-breaking 2006 universal health insurance law.  “But insurance coverage doesn’t equal access to care.”  Dr. Lynda Young, a Worcester, MA-based physician, counters, noting that “There’s only so many patients you can see in a day.”  The situation is especially dire in rural areas.  Dr. Joseph Viadero, whose Turner Falls, MA-based four-physician, three nurse-practitioner practice includes 12,000 patients, says “We’re overwhelmed and just have difficulty taking care of our own patients.”  As a result, more people don’t get the preventative care they need.

Dr. Richard Dupee, a geriatrician, says he sees poor, sick and elderly people traveling from Boston to the suburbs, just to see a doctor.  Because relatively few Boston-area doctors are willing to see new patients who pay with government-subsidized insurance, “people are always taking the T from Boston, to get to my office.”  Although Massachusetts’ healthcare law was written to get moderately ill people out of costly hospital emergency rooms and into less expensive doctors’ offices, the report finds that difficulty accessing care is sending some people back to the emergency room.  “These people are insured, but they end up in the ER anyway, because they can’t find a doctor to treat them,” Dupee said.

The study also examined the types of insurance accepted by each specialty.  Medicare acceptance ranged from 98 percent in orthopedic surgery to 85 percent for internal medicine.  While 92 percent of cardiology practices accepted MassHealth and Medicaid, that fell to 62 percent for family medicine and 53 percent for internal medicine.  Two additional insurance types were included: Commonwealth Care, which serves low- and moderate-income adults lacking coverage and ineligible for Medicaid, and Commonwealth Choice, which is offered through an unsubsidized exchange run by the Commonwealth Connector.  Acceptance ranged from 82 percent for ob/gyn to 43 percent for internal medicine with Commonwealth Care, and from 76 percent for cardiology to 35 percent for internal medicine with Commonwealth Choice.

The Association of American Medical Colleges estimates that the nation will be short of 91,500 physicians over the next 10 years.  “Physicians are very heavily loaded with patients that have been in their practice for a long time,” said Dr. Robin Richman, executive vice president of medical affairs and chief medical officer at Fallon Clinic.  “Over time, as we all age, we develop a complexity of care issues, and those take more time and management skills for physicians.”

“We still have much work to do to reduce wait times and widen access,” Coombs said.  “This has important implications for health care cost control, as difficulty or delay with routine access to care leads people to seek other options, such as the emergency room, which is much more costly.”

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Physician Shortage vs. Aging Baby Boomers a “Perfect Storm”

Monday, April 6th, 2009

As 78 million aging baby boomers deal with more chronic conditions, the country is facing a serious shortage of physicians. Compounding the crisis is the fact that between 1985 and 2006, the percentage of physicians aged 55 and older climbed from 27 percent to 34 percent, according to statistics from the Association of American Medical Colleges (AAMC).  Approximately 250,000 active physicians are expected to retire between now and 2020.  These shortages are especially critical among surgeons and family medicine practitioners.

The doctor deficit has its roots in the 1980s and 1990s when medical schools capped their enrollments at 16,000 students per year because they believed that managed care would create a physician glut.  6a00d8341caabc53ef00e5516c58f68833-800wiThe exact opposite has happened and medical schools were “woefully wrong” in their assessment, according to Josef Fischer, chairman of surgery at Beth Israel Deaconess Medical Center in Boston.  “It’s going to be tough in this situation to make it better.”

Accordingly, medical educators have identified the problem and are finally accepting more applicants.  During 2008, nearly 17,800 students started medical school — the largest class ever.  By 2015, medical schools hope to achieve a 30 percent increase in enrollment over 2002 levels.  Still, Fischer warns of “a perfect storm” forming, because it takes three to seven years to train physicians at a time when the number of senior citizens in the United States is growing fast.  With training for surgeons often exceeding seven years and few pre-med students focused on primary care as a career, additional enrollments are only a first step in the right direction.

Many doctors would prefer a career in primary medicine, focused on prevention and health, but the reality of medicine in today’s environment is that reimbursement for physician services is decreasing.  The healthcare system itself is discouraging the very best and brightest talent from pursuing primary care.  Fixing what is broken in the system at a time when prevention should be more important than ever requires fast action if we are to meet our needs in the next decade.

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