Help Wanted...for free!

I had a chance to visit one of the free clinics in town this week and interview the Medical Director. Because I have an MA in Non-Profit Organizations, I was fascinated by the concept of "totally free" care to the uninsured provided by this 501(c)3 organization. They had a pharmacy with 60 some-odd drug types, plenty of nice, clean space, lots of volunteers and staff. They lacked only one major thing: physicians! The clinic has very limited hours--just like the other clinics in town. Remember what James Shrum said in our earlier class--add up all the hours donated by docs in town and you get the equivilent of two full-time physicians. Not good.

I have reported here about the shortage of physicians in the US as well. The problem extends "down under" too. In Australia, they are introducing a "super clinic" concept in various regions and having their own problem finding docs. This story reports amongst other things that they are providing $15,000 bonuses for certain locations. But that is the least of their health workforce problems. Another story reports about the poor credentials from foreign doctors entering the country and what Australia is doing about it.

Ah, herein lies a possible pitfall of socialized medicine and universal health care. Let's say we go to a "socialized" healthcare system here in America, and physician wages begin to fall. We have already seen in my earlier "nurses" post that Filipino doctors can make more being a nurse in America than they can as a doctor in their own country. In this scenario, there will probably be an even longer line of foreign doctors who would love to come here and practice, and some of the slots will be filled. Unfortunately, we may find out as Australia has learned that not all doctors are created equal. Note--our family has used an Indian Doctor, and we like him!

Meanwhile, in Alberta, Canada, their health workforce grew by 4% from 1996 to 2001--mainly due to relocation. "Occupational therapists, respiratory therapists and speech language pathologists were the most likely to move from one place to another, while dentists, licensed practical nurses and medical laboratory technicians were the least likely to relocate," reported a CanWest story.

Norman Wall of the New York Times asks what can be done to reverse this situation? He suggests the following:

• Create more places in American medical schools; there is not a medical school in America that cannot increase its enrollment without lowering its standards.
• Open more medical schools; there are only 125 schools for 300 million people, and with more private support, new schools geared toward training general practitioners would increase the supply of American-trained doctors at a relatively low cost.
• The United States should invest in training doctors and building hospitals overseas, particularly in Africa and Asia.
• The World Health Organization (WHO) should augment the meager pay doctors and health care workers receive in the developing nations so they have a respectable salary.

With that advice, I am glad that the University of Georgia and the Medical College of Georgia will be starting a new medicial school extension here in Athens in August, 2009.

Free Clinics

I spent a little time this weekend in a food line for the needy, and used the opportunity to find out more about the poor's perception of free clinics. For one, these clinics are not open enough. Both free clinics in Athens that I am focusing on are closed on Saturday. Even the Athens Neighborhood Clinic is closed on Saturday.

After interviewing a board member from one of the clinics today, they said that the only thing holding them back from being open ALL the time is volunteer pharmacists and physicians. We'll return to this issue in a later blog entry.

There are hundreds of these type clinics in the United States, and according to a UVA study, they are only open about 30 hours per week, and less than a third have a licensed pharmacy. So, Athens and her free clinics are on par.

Free Clinics are non-profit organizations for the most part. Being a non-profit executive, I can really appreciate the challenge that they face to raise a budget, train volunteers, make a payroll, and comply with the IRS regs. They are, however, an important part of our medical safety net.

Like many other associations, there is a National Association of Free Clinics that can help with resources, lobbying, etc.

Public Health is defined as “what we as a society do collectively to assure the conditions in which people can be healthy,” according to a 1988 Institute of Medicine report entitled The Future of Public Health. We usually think of public health as a clinic though, like the Athens Neighborhood Clinic. These are a part of our public health system and face their own set of challenges.People can use their Medicare for these clinics or pay a small co-pay. The lines are long and they have to balance their patient load between those paying with Medicare and those who can only pay a co-pay. The result is that many people do not get seen.

The problems are immense, and there is no easy answer. Alan Greenspan was on the circuit promoting his book this past week. In it, he says that the Medicare System will go bust by 2019 unless something significant is done. Wealthy Americans can expect a 100% co-pay.

Outspoken ACC Commissioner Elton Dodson told me, "It is absolutely criminal what we have allowed our health system to become in this country. No civilized western country treats their people the way we treat our people when it comes to health care.

So what is the answer? How will it impact our Health Workforce? Can we help our citizens attain quality health care without moving to a system that rations out services? Can we work within our free markets system to maintain the financial incentive doctors want after investing so many years of their life?

Everybody wants to be a...nurse

Now that I am covering health workforce as my "beat" for my 8350 class, it seems like I see "workforce" everywhere. Last week I was walking down the hall in the Grady School and saw a CNN segment on Filipino doctors leaving the Phillipines coming to America become nurses. Upon further investigation, I find out that this has been going on for quite some time. I have been to Manila, and I knew that people often left the country for greater wages, but I had no idea that medical doctors would ever consider leaving their country.

Why are they coming? It turns out that training to be a nurse is the easiest way to get a visa and work in the US. A CBS story references a research paper by former Philippine Secretary of Health Dr. Jaime-Galvez Tan who says that three years ago, around 5,000 doctors became nurses. A associated press story in USA Today in January of this year tells the story of one such doctor and how things did not turn out the way recruiters in the US told him it would.

You can see the lure though. Nurses in the US make 10 times what they do in the Phillipines, and about five times more than even a doctor make in his native homeland. Having been in the Phillipines, the cost of living is far less there.

According to Dr. Tan, the departure of health care professionals from the Phillipines is having a devastating effect on their own health care systems.

So what should the US do? Our own need is causing our elected officials to change public policy that make it easier for such people to migrate to our country. Maybe a better long term solution would be to think of ways to incentivize our own young citizens to pursue nursing and other health related fields.

No money...No Doctors

Have you ever seen the occupation reputation chart? You know, the list that shows car salesmen and lawyers at the bottom, and nuns and doctors at the top. Doctors are universally respected. Will you be disappointed to find out that they care about their income? Maybe you’ll be disturbed to know that for every $1 drop in hourly income for doctors, approximately 1.46% of the physician workforce retires within two years of the drop. The same 2001 Medical Care Research and Review article projects that an earning decline of $10 per patient-care-hour motivates 11,000 physicians to retire early. Before I totally taint your view of doctors, let me assure you that you should not lose heart. In fact, I would like to suggest that we do all can to boost the health workforce in Georgia and beyond.

For too long, we have put doctors on a pedestal thinking they can purchase their food and shelter, and an occasional Mercedes, with altruism. I’ve even heard well meaning anti-poverty activists suggest that doctors are somehow greedy because they will not give away their services. Physicians pay an extraordinary educational price to be able to practice medicine. They attend college, have to attain almost perfect grades, and then attend medical school for four years or more. We don’t expect charity from our grocer, so I am not sure why we feel doctors owe us anything but the service we are paying for—with insurance or without.

This blog was not paid for by the Medical Association of Georgia.

Welcome to Health Workforce UGA Update

Welcome to the UGA Health Workforce Update. This blog will follow developments and trends in the health workforce across Georgia and the United States.

As recently (July, 2007) reported in the Chronicle for Higher Education, the US could face a shortage of 24,000 doctors and nearly one million nurses by 2020. This study is based on a report that was produced by PricewaterhouseCoopers’ Health Research Institute. That means that if you are in high school or college now, becoming a doctor or nurse might be a good idea. Ah, but what kind of doctor should you aspire to be. David Goodman from the Medical College of Wisconsin reported that pediatricians per child will increase by 50% by 2024. On the other hand, a gal from the Rheumatology Association in Atlanta I spoke with yesterday told me that Rheumatologists were not in that situation. More are needed.

But are the medical schools ready? According to the Chronicle article, applications to nurses programs are rising, but the number of qualified students being turned away has increased even more—in some places it has grown six fold. Bottom line, the schools need to be able to increase their capacity.

Another factor that the statistics don’t accurately explain is where these doctor shortages actually will be. For example, Massachusetts currently has a surplus of doctors whereas Mississippi has a shortage. In Athens, Georgia just down the street from the University of Georgia, a doctor from California moved here to work in our Neighborhood Clinic. This blog will look at incentives that have and will be proposed to get needed doctors in out of the way places where folks may not want to go.

The shortage isn’t just limited to doctors though. Recently, the US House appropriated almost $100 million for 10,000 health care information technology grants that would be administered through the National Science Foundation.

Health Workforce is a serious concern for all us, and worthy of our time and interest.