Health Workforce Updates

Signing off of my beat....for now

2007-12-13T03:06:00.000-08:00

As I post my last blog for our 8350 class, I will never read newspapers the same again. Covering the "workforce" beat and watching my classmates cover their beat has sensitized me to the enormous amount of health-related material in the media today and the need for excellent coverage.

One thing is really clear to me after this semester--there is a worldwide shortage of healthcare professionals. Little Johnny and his sister Suzie need to be urged to consider a career in healthcare and get as much education as they possibly can. That will require a strong public awareness campaign, new scholarships and incentives, and more medical and nursing schools.

Those of us in the media can help this effort too--by writing about the need, and bringing the issue front and center before our readers. That means more journalists who know how to write about it--accurately--and editors who see the need for strong placement of these articles.

All of us who had the privilege to sit under Professor Thomas and Coach Kim Davis and our numerous guest speakers this Fall owe them a debt of gratitude for their investment in our lives and careers.

Intra-Sector Cooperation Needed

2007-12-09T19:00:00.000-08:00

Reuters reported that the Jonas Center for Nursing Excellence Executive
Director Marilyn Deluca said, "Foundations, business and academia must
work together to fund programs that get to precisely these issues, because
urses -- the unsung heroes of our health care system -- need more
champions."  Marilyn, commenting on the nursing shortage is one of many
looking for innovative ways to get more nurses into the workforce.

This partnership of sorts between the academic, business, and philanthropic
community is the kind of creative solutions I think we need in our country today.
The Academic brings the best-practices and training. Business brings the
incentive, and the philanthropic community can provide avenues for people
to use their heart. Compassion is a driving force in the health care business.

In my last post, I talked about the need for more medical schools for doctors,
but the looming shortage of nurses is even worse. 

Fortunately, we have an MCG (Medical College of Georgia) Nurses
School extension here in Athens.

In my very first post, I talked about the bird flu and the impact it would
have on our nurse work force.  We need to take action now to get this
aspect of our work force in line with the needs of our country.

Med School Wanted...apply within!

2007-12-02T17:13:00.000-08:00

The last couple of weeks have been exciting for me. My op-ed piece from the New Orleans trip was published on the front page of the Athens Banner Opinion Section as the "big idea." Then, I had an opportunity to talk more about it on a talk radio show in town.

If you did not get an chance to read it, go to the article here.

Getting the med school extension campus here would be so great for our community. Until then, we need to continue to recruit physicians and nurses to work in our three safety net clinics. Additionally, December is the best month of the year for non-profits to raise money. As their budgets grow, so will their staff and their ability to see more patients.

Dr. DeSalvo at Covenant House in New Orleans was blessed to have so many doctors doing their residencies there. Hopefully, with a powerful Ga. House member running against Congressman Paul Broun here in town, we will get the attention of the legislature and the money needed to jumpstart the program.

Where are all the psychitrists?

2007-11-19T10:53:00.000-08:00

Seeing the devastation of New Orleans certainly had a sobering affect on me. I had thought after two years things would be back to normal, but boarded-up and gutted houses was what I had been warned about.

What I didn't expect to see was a lack of mental health professionals. If ever there was a supply of people needing help, it is in post-Katrina New Orleans. Read more here including Dr. Kevin Stephens' comment that "we have a lot of post-traumatic stress. We have a lot of depression. We have a lot of suicides. We have a lot of challenges in terms of mental health. And, in fact, a lot of people self-medicate by using alcohol and other drugs."

The professionals we visited certainly validated this over and over again.

In talking with one nurse at the PACE Center, she told of how people just needed to talk--to tell their story, and what they had experienced.

Learning to listen. Taking time to listen. Maybe if all of us did a better job of listening to the needs and concerns of others around us, we might help them through the difficulties they are facing.

Eye Doctors alive and well

2007-11-12T19:34:00.000-08:00

Ophthalmologists spent the first 20 minutes of their annual meeting in New Orleans talking about politics—not eyes. Powerpoint slides outlined the group's lobbying efforts to stop the 10.1 percent fee cut in medicare legislation pending before the United States Senate.

Who can blame them though? These physicians went to college and medical school and did residencies and fellowships--all to have the federal government threaten yet another cut to services they provide for older Americans in particular: cataract surgery, AMD treatment, and Glaucoma.

They quickly moved on to the latest procedures, drugs, and experiments that will prevent blindness, and help Americans be able to see better and longer: something they would rather be doing than lobbying the US Congress.

Dentists are in the health workforce too

2007-11-04T17:15:00.000-08:00

Dental, or oral health, is often overlooked. Would it surprise you to know that tooth decay is the single most common chronic childhood disease; five times more common than asthma. Untreated tooth decay has been associated with eating, learning and speech problems and diminished self-esteem in children, a Kansas website reported Saturday.

The Mercy Clinic has a "dental day" every Friday for those who qualify. I was pleasantly surprised to see that Dentists in the Athens area have been more responsive than doctors at giving their time to the Mercy Clinic. With dental work like "fillings" and "root canals" being very expensive these days, this is a wonderful service to provide.

The American Dental Association has a ton of reports on the state of the dental workforce in America. See more at www.ada.org

Dental insurance policies are usually not a great deal, and most people do not have them. Therefore, we often wait to go to the dentist when there is problem. When is the last time you had your teeth cleaned? Maybe you should make that appointment this week.

Health Care Down Under

2007-10-28T19:13:00.000-07:00

"There is a workforce crisis, not only affecting emergency specialists but also surgeons, psychiatrists, rural doctors, nurses and other health workers. We need to know that there is a workforce plan. At present there is none because politicians don't know what sort of health service to provide," said Dr. Tony Joseph, an Australian physician on Friday.

Government-run health care is ultimately politician-run health care, and bringing this to the US is not going to solve all of our problems. We need to look carefully at what is happening in Australia, Canada and Europe before we assume that this is best for America. All of us in this great country need to work and advocate for the health and welfare of our fellow man. Our class speakers and articles continue to show us the great need out there. Saying healthcare is a "right" and then tasking the government with delivering it is one solution, but maybe not the best.

Maybe the next 8350 class can take a trip to Canada or Italy and see first hand if government run health care is all it is cracked up to be.

In other health workforce news, women doctors are on the rise in Canada. From 2002 to 2006, females in the workforce increased 13 percent compared to only one percent for males. Wow, this sounds like Public Relations here in the US. Women are taking over.

Read more about what is happening in Canada here. In fact, the study referenced shows that women in Canada make up over 48 percent of physicians under the age of 40.

Note to females in class--no hidden message here.

Everything is bigger in Texas

2007-10-21T07:54:00.001-07:00

Last week as I debuted my safety-net clinic feature story, I cited a study in Dallas, Texas comparing two geographical areas and how the safety-net clinic there is decreasing costs, stays in the hospital, and numbers of visits.

What I did not say, but have found out since, is that there is an aggressive legislative agenda in the Texas Legislature to move more of the state's uninsured into some kind of health coverage. Read more here.

One positive result is that 3100 new healthcare jobs were created in the workforce in Texas last month alone. Read more in the Star-Telegram. While the article doesn't attribute the legislation with creating the jobs, there are many lawmakers and policy leaders who are obviously working hard to bring effective solutions to the table. This is in contrast to some states who have put a lot of the "eggs" in the SCHIP basket, and now find themselves in a crisis.

Yes, this is a plug for states-rights and limited government (federal) and a reminder that local governments are most effective at serving the needs of their people. States are required to balance their budgets, but the Federal Government is not. Finding "state" solutions within current state budgets is good for the state, and good for the country.

I write this blog from Washington DC, having ridden the metro with thousands of federal employees over the last few days. The Federal Government is huge and costly and bureaucratic--and those or look to it to be their mother or nanny best realize that this task is best left to states.

My cowboy hat is off to the great state of Texas for their innovative health care solutions.

Would you hit your doctor?

2007-10-14T18:00:00.000-07:00

I went in for a check-up the other day, and declined a rectum prostrate exam. I told my doc I would await the PSA test results. But I never would have dreamed of hitting him.

Not so in Scotland. Their health workforce is getting assaulted--literally--at a rate of six incidents per day across Edinburgh and The Lothians. Last year in the same region there were 2335 incidents of physical abuse, attempted assault, or verbal abuse of staff. That was up 136 from the year before. This kind of report is not good for recruiting. Read more here.

Friends, welcome to the world of socialized med--uh, universal health care. When anyone can walk in and demand care, every doctor's office will need an armed security guard.

Here is how a blogger responded:
"These figures will be even higher over the next period. The problem is that there are too many undesirables at loose in society. Don't mock, but the problem will become so great and grave that mandatory sterilization and culling of anti-social individuals will become a reality. It's not prisons we need, it's cages."

There is no easy answer for the problems we face in our culture. Universal Health Care, I fear, will shift too much of our economy under government control.

Mental Health Care and Lab Techs

2007-10-07T19:35:00.000-07:00

Last week, our AJC guest reporter told us horror story after horror story of abuse in mental hospitals. It was really gut wrenching. Not only do we need more of a psychiatric workforce, but we need to take better care of them in order to increase their longevity. These people may have the toughest job on the planet.

This month in Psychiatric Services (58:1324-1329, Oct 2007), Dr. Edward S. Casper discusses his study with 94 mental health practitioners who were participating in continuing education. One group of them did the standard continuing education, but the other group did continuing education that applied principles of the theory of planned behavior. Guess what? The group using the theory applied what they learned in the class by a 74% versus 42% ratio. The content of the class is not important for this blog, but suffice it to say that we need to be giving mental health practitioners effective tools that can make their job easier and more productive. Lives are at stake. (You'll have to use Galileo to find the article.)

I had my semi-annual "blood drawing" the other day at the health center. I am on Lipitor and have to do that. Did you know that lab workers are an important part of our health workforce? Don't feel bad if you do not as there are a lot of folks who don't think about it. That is why a bunch of laboratory associations are coming together for an initiative called "labs are vital." "Lab Worker contributions save lives, reduce morbidity, and help control the cost of care," said the VP of the American Society for Clinical Pathology."

So the next time you get that "stick" in your arm, thank the lab tech for what they do.

Help Wanted...for free!

2007-09-30T18:06:00.000-07:00

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

2007-09-23T19:41:00.000-07:00

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

2007-09-16T15:42:00.000-07:00

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

2007-09-07T16:47:00.000-07:00

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

2007-09-01T12:55:00.000-07:00

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.