With the face of healthcare in America constantly changing, especially since we have an aging population, the shift to primary care is key in lowering healthcare costs and in improving access and quality. There is a shortage of primary care doctors in America. In addition, there is also some serious maldistribution of those doctors. The previous reform blog for our group suggested incentives for medical students to pursue primary care or family practitioner positions. This reform blog builds on that, but for the need of incentives, not only for all primary care, but also specifically for rural doctors, either to draw more healthcare workers, or to retain those employees and make sure their needs are met as professionals in those areas. There needs to be recruitment and retention of doctors in rural practice. This will require the removal of disincentives to rural practice, and the provision of incentives, which help to counteract the additional responsibility of isolated practice. Rural doctors have identified financial, work practice and professional issues that can be adapted to enhance the capacity of rural doctors to remain in rural practice. These strategies will also assist the recruitment of doctors to rural practice.
The first issue is finding strategies to enhance financial incentives. This is the part that we feel the government holds a bigger responsibility in. We feel that the government should be more of a major payer and regulator when it comes to incentives for rural doctors. Not necessarily should the government have to foot the whole bill, but there should be incentives for the facilities to help in retaining and recruiting doctors, such as grants and tax breaks. Adequate financial rewards that recognize the complexity and degree of clinical responsibility accepted by rural doctors are an important incentive.
Some strategies are:
• Funding models that provide security and flexibility for the doctor and recognize the physician as a community resource.
• Additional payments to rural practitioners in recognition of higher level of clinical responsibility, services provided and on call demands.
• Specific incentive payments for practicing in isolated/underserved areas.
• Financial assistance to maintain the economic viability of at least two doctors working together in a rural location.
• Funding for travel and other costs for the doctor to attend continuing medical education.
• Support and incentives for rural doctors' spouses and families.
As stated before, retention of rural doctors is just as important as recruiting. The retention of rural doctors is predicated on the satisfaction that they achieve in both their professional and personal life. The isolation of rural practice puts strains on both of these. There is a need to provide an adequate working environment for rural doctors to use the extended range of skills that they have required. Too often the rural doctor has to work in substandard facilities. The extended period of on-call, often single handed, is a source of stress to doctors and their families. Such conditions must be alleviated if doctors are to remain in rural areas.
The next issue in retaining and recruiting rural doctors is the fear of an unstructured career path. Many fear not being able to change their career path once in a rural setting. The opposite must be implemented.
Such as:
• Access to ongoing appropriate continuing medical education to enhance and maintain their skills.
• Development of clear and attractive career pathways for rural practitioners.
• Preferential access to specialist training for those rural doctors who choose to change career pathways.
• There should be no financial, career or regulatory barriers to doctors moving to practice in urban areas.
• Academic appointments and support for rural doctors.
These and other strategies could help with the shortage of rural doctors. Family practice, primary care, and rural care may not seem as flashy and precise as specialty medicine but it will be the key in changing America’s failing health and failing health care around. We need to instill more incentives in rural America because they deserve the same level of quality and access and also lower costs. These steps towards preventive care will be the turning point for access in this country.
Sources: (all of which are a good read too and provide more insight)
http://www.globalfamilydoctor.com/aboutWonca/working_groups/rural_training/practice/Practi07.htm
http://www.amavic.com.au/page/About_Us/AMA_Agenda/Current_Issues/Incentives_for_rural_doctors_needed
http://www.glgroup.com/News/Shortage-of-Rural-Doctors---The-U.S.-Can-Learn-From-Canada-14602.html
Tuesday, March 30, 2010
Monday, March 29, 2010
Reform Proposal #3
In order to decrease health care costs and increase access to health care in America, the United States Government needs to create incentives for future medical students to enter the primary care sector. These incentives should include reimbursement of student loans for medical school, along with a bonus for signing on for at least ten years in the primary care sector. Throughout the past 40 years there has been an overwhelming decline between the ratios of primary care physicians to specialty care physicians. Specialty physicians have increased by a whopping 118%, while primary care physicians have only increased by 18%. Specialty physicians are qualified in a specific segment of medicine. Some examples might be pediatrics, surgery of all types, and anesthesiology. Specialty trained physicians commonly require additional years of advanced residency training along with several years of practice in the specialty, and being certified by taking and passing a specialty board exam. Primary care physicians, on the other hand, provide more preventative care and treat more common illnesses like head colds and non-life threatening injuries (cuts and bruises).
The fact that our system has too many specialty physicians and not enough primary care physicians affects the ideas of cost, quality, and access for citizens throughout the United States. The increase of specialty physicians is a result of the innovation of all kinds of new technology. However, the increase of specialty physicians is causing an increase in the usage of expensive tests and procedures to treat patients, even when they are unnecessary. This is causing part of the increasing health care costs. Quality of care is also negatively affected by the increase of specialty physicians, partly because of the income gap between specialty and primary care physicians. According to primary care physician Kevin Pho, “. . . The resulting income gap between specialists and primary care providers has serious consequences. Primary care providers may resort to shorter patient visits, with adverse affects on the satisfaction and well-being of their patients.” This fact is quite startling, but it shows how a primary care physician is not viewed as a prestigious and important study of medicine. This ultimately affects the quality because of attitudes of physicians, and even patients, have toward the area. Shortage of visits may also be a result of the lower ratio of primary physicians to patients. Along with quality and cost, access is also affected. With the baby-boomer generation becoming older, there will need to be an increase in primary care physicians to carry out simple vaccinations and yearly physicals. If the rate of primary care physicians stays the way it is now, there will be a significant shortage in few years to come as the baby-boomers age.
As stated in our stance on this issue, we firmly believe that all people should have equal access to health care since we view it as a basic right; we value life and care about the disadvantaged. We believe that the government should be actively involved in health services delivery to decrease overlap and excess spending since we value effectiveness and efficiency. Therefore, by implementing an incentive program to increase primary care physicians, we would decrease costs and increase quality and access. Increasing primary care physicians would decrease costs because the use of unnecessary tests and procedures would decrease. Also, an increase in primary care physicians would increase preventative services, thus, decreasing tertiary actions to treat disease and decrease costs. Quality of care would increase because the more preventative services provided decreases the amount of disease and mortality. An increase of primary physicians will increase a value in primary care. These physicians will feel as important as specialty physicians, thus will be more likely to ‘give it their all’ to patients. An increase of primary physicians will increase access to health care by creating more time slots for appointments and even more flexible times for appointments (i.e. weekends and later hours). This will be a significant factor in the next five to ten years because of the baby-boomer generation.
By giving incentives to future medical students enter the primary care field, will only generate benefits to patients and tax payers because of the decrease of costs, increase in quality care, and more access to care.
Now that Obama’s Health Care reform bill has been passed in Congress and signed, there will be an increase of the population entering the health system because the uninsured will now be covered. The idea of increasing primary physicians is key in creating an effective and efficient health care system for all!
Sources:
Physician Kevin Pho’s ideas on the shortage of primary care physicians:
Pho, Kevin. "Primary care-specialty income gap: It’s worse than we think." KevinMD.com. N.p., 23 May 2007. Web. 29 Mar 2010. http://www.kevinmd.com/blog/2007/05/primary-care-specialty-income-gap-its.html
The American Medical News portrays the struggles between specialty and primary care physicians:
Croasdale, Myrle. "Work force study tackles specialty vs. primary care." American Medical News 11 April 2005: n. pag. Web. 29 Mar 2010. http://www.ama-assn.org/amednews/2005/04/11/prsb0411.htm
James Artvantes of AAFP interviews physicians to get their ideas on the shortage issue:
Artvantes, James. "Primary Care Physician Shortages Can Be Traced Largely to Pipeline Issues, Says FP." AAPF 23 Sep 2009: n. pag. Web. 29 Mar 2010. http://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/20090923medpac-pcps.html
Margaretann Cross of Managed Care Magazine gives more incite, along with graphs, about the shortage of primary care physicians in America:
Cross, Margaretann. "What the Primary Care Physician Shortage Means for Health Plans." Managed Care Magazine Jun 2007: n. pag. Web. 29 Mar 2010. http://www.managedcaremag.com/archives/0706/0706.shortage.html
This is an awesome, fairly recent article pertaining to the shortage of primary care givers:
Carmichael, Mary. "The Doctor Won’t See You Now." Newsweek 26 Feb 2010: n. pag. Web. 29 Mar 2010. http://www.newsweek.com/id/234218
The fact that our system has too many specialty physicians and not enough primary care physicians affects the ideas of cost, quality, and access for citizens throughout the United States. The increase of specialty physicians is a result of the innovation of all kinds of new technology. However, the increase of specialty physicians is causing an increase in the usage of expensive tests and procedures to treat patients, even when they are unnecessary. This is causing part of the increasing health care costs. Quality of care is also negatively affected by the increase of specialty physicians, partly because of the income gap between specialty and primary care physicians. According to primary care physician Kevin Pho, “. . . The resulting income gap between specialists and primary care providers has serious consequences. Primary care providers may resort to shorter patient visits, with adverse affects on the satisfaction and well-being of their patients.” This fact is quite startling, but it shows how a primary care physician is not viewed as a prestigious and important study of medicine. This ultimately affects the quality because of attitudes of physicians, and even patients, have toward the area. Shortage of visits may also be a result of the lower ratio of primary physicians to patients. Along with quality and cost, access is also affected. With the baby-boomer generation becoming older, there will need to be an increase in primary care physicians to carry out simple vaccinations and yearly physicals. If the rate of primary care physicians stays the way it is now, there will be a significant shortage in few years to come as the baby-boomers age.
As stated in our stance on this issue, we firmly believe that all people should have equal access to health care since we view it as a basic right; we value life and care about the disadvantaged. We believe that the government should be actively involved in health services delivery to decrease overlap and excess spending since we value effectiveness and efficiency. Therefore, by implementing an incentive program to increase primary care physicians, we would decrease costs and increase quality and access. Increasing primary care physicians would decrease costs because the use of unnecessary tests and procedures would decrease. Also, an increase in primary care physicians would increase preventative services, thus, decreasing tertiary actions to treat disease and decrease costs. Quality of care would increase because the more preventative services provided decreases the amount of disease and mortality. An increase of primary physicians will increase a value in primary care. These physicians will feel as important as specialty physicians, thus will be more likely to ‘give it their all’ to patients. An increase of primary physicians will increase access to health care by creating more time slots for appointments and even more flexible times for appointments (i.e. weekends and later hours). This will be a significant factor in the next five to ten years because of the baby-boomer generation.
By giving incentives to future medical students enter the primary care field, will only generate benefits to patients and tax payers because of the decrease of costs, increase in quality care, and more access to care.
Now that Obama’s Health Care reform bill has been passed in Congress and signed, there will be an increase of the population entering the health system because the uninsured will now be covered. The idea of increasing primary physicians is key in creating an effective and efficient health care system for all!
Sources:
Physician Kevin Pho’s ideas on the shortage of primary care physicians:
Pho, Kevin. "Primary care-specialty income gap: It’s worse than we think." KevinMD.com. N.p., 23 May 2007. Web. 29 Mar 2010. http://www.kevinmd.com/blog/2007/05/primary-care-specialty-income-gap-its.html
The American Medical News portrays the struggles between specialty and primary care physicians:
Croasdale, Myrle. "Work force study tackles specialty vs. primary care." American Medical News 11 April 2005: n. pag. Web. 29 Mar 2010. http://www.ama-assn.org/amednews/2005/04/11/prsb0411.htm
James Artvantes of AAFP interviews physicians to get their ideas on the shortage issue:
Artvantes, James. "Primary Care Physician Shortages Can Be Traced Largely to Pipeline Issues, Says FP." AAPF 23 Sep 2009: n. pag. Web. 29 Mar 2010. http://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/20090923medpac-pcps.html
Margaretann Cross of Managed Care Magazine gives more incite, along with graphs, about the shortage of primary care physicians in America:
Cross, Margaretann. "What the Primary Care Physician Shortage Means for Health Plans." Managed Care Magazine Jun 2007: n. pag. Web. 29 Mar 2010. http://www.managedcaremag.com/archives/0706/0706.shortage.html
This is an awesome, fairly recent article pertaining to the shortage of primary care givers:
Carmichael, Mary. "The Doctor Won’t See You Now." Newsweek 26 Feb 2010: n. pag. Web. 29 Mar 2010. http://www.newsweek.com/id/234218
Monday, March 15, 2010
Reform Proposal #2
The government should implement health sciences programs in public secondary schools so that students can prepare for careers in health professions. Programs should aim to be intriguing for students. The government should support education and training grants to meet the critical needs of Americans who require mental and behavioral care. They should also increase funding for geriatric education and training. Finally, they create scholarships and loan repayment programs for allied health professionals. Once those interested in health care have decided to pursue a career in it, they should have help with paying for the schooling. In doing so, the number of people working in the health care workforce will increase making access to care easier. There will be more workers trained in working with the elderly and mental health needs patients as well. This will decrease costs by making services more available to the public. Access and quality will increase since there will be more physicians available to spend quality time with their patients.
Supporting health care professions is important because it is an effective way to encourage students to join the health care workforce. Students and young people respond well to getting help with paying for schooling. Medical school is very expensive, but with scholarships and support for health sciences programs more people will be apt to choose a health profession. The people in the health care workforce are important to our nation’s well being so the government should support them. Although this may increase taxes, which many people fear, it will ultimately decrease overall costs and increase the number of health care workers, which are both positive things for the health of our nation. Making the health care industry attractive to young people is important at this moment in time for our nation, as there is a shortage of workers and low level of access to care.
Supporting health sciences programs in secondary schools is an important step towards health care access on a national level. Learn more about access problems and reforms at these websites. Title V’s subcategory on ‘Supporting the Next Generation of Health Professionals’ is referenced most.
Sources:
Putting Americans In Control of Their Health Care
Title V. Health Care Workforce
Supporting the Next Generation of Health Professionals
http://www.whitehouse.gov/health-care-meeting/proposal/titlev/supporting-next-generation
Increasing the Supply of Primary Care Providers in Underserved Communities
http://www.whitehouse.gov/health-care-meeting/proposal/titlev/increasing-supply
Issues: Health Reform
Benefits of Health Reform
http://www.barackobama.com/issues/healthcare/index.php
The Costs of Inaction
http://www.healthreform.gov/reports/inaction/diminishing/
Americans Speak on Health Reform: Report on Health Care Community Discussions
http://www.healthreform.gov/reports/hccd/concernsc.html
Supporting health care professions is important because it is an effective way to encourage students to join the health care workforce. Students and young people respond well to getting help with paying for schooling. Medical school is very expensive, but with scholarships and support for health sciences programs more people will be apt to choose a health profession. The people in the health care workforce are important to our nation’s well being so the government should support them. Although this may increase taxes, which many people fear, it will ultimately decrease overall costs and increase the number of health care workers, which are both positive things for the health of our nation. Making the health care industry attractive to young people is important at this moment in time for our nation, as there is a shortage of workers and low level of access to care.
Supporting health sciences programs in secondary schools is an important step towards health care access on a national level. Learn more about access problems and reforms at these websites. Title V’s subcategory on ‘Supporting the Next Generation of Health Professionals’ is referenced most.
Sources:
Putting Americans In Control of Their Health Care
Title V. Health Care Workforce
Supporting the Next Generation of Health Professionals
http://www.whitehouse.gov/health-care-meeting/proposal/titlev/supporting-next-generation
Increasing the Supply of Primary Care Providers in Underserved Communities
http://www.whitehouse.gov/health-care-meeting/proposal/titlev/increasing-supply
Issues: Health Reform
Benefits of Health Reform
http://www.barackobama.com/issues/healthcare/index.php
The Costs of Inaction
http://www.healthreform.gov/reports/inaction/diminishing/
Americans Speak on Health Reform: Report on Health Care Community Discussions
http://www.healthreform.gov/reports/hccd/concernsc.html
Monday, March 1, 2010
Reform Proposal #1
The government should fund scholarships and loan repayment programs for students going into the heath care workforce. By funding scholarships and loan repayment programs, the number of primary care physicians, nurses, physician assistants, mental health providers, and dentists will increase in the areas of the country that need them most. With a comprehensive approach focusing on retention and enhanced educational opportunities, this combats the critical nursing shortage. And through new incentives and recruitment, this proposal would increase the supply of public health professionals so that the United States is prepared for health emergencies. This proposal would require an increase in spending towards funds for these students while those paying for school would experience a decrease in their personal spending. Imagine how much differently people would view going into the health field if they knew they could receive financial assistance.
Some may feel that spending money to help pay for the cost of schooling is not as important as other areas of health care. If we don’t fix our shortages and find ways to increase the number of health providers we won’t even be able to provide basic care for those people who need it. The more expensive schooling is the fewer people there will be who are willing to pay the high costs and become educated in the medical field. By offering help with the costs more people will have the opportunity to become a public health professional.
Because doctors, nurses, and other health care providers are the backbone of the health care system, we need to make more of an effort to reverse the shortages and maintain an appropriate number of people in our workforce. Could you imagine what would happen if these shortages became more common? Lets act now and prevent the worst from happening.
If you would like to read more about the shortages of health care providers and the effects it has on people I encourage you to view this website:
http://www.who.int/mediacentre/factsheets/fs302/en/index.html
Sources in APA:
Putting Americans In Control Of Their Healthcare. Retrieved February 26, 2010, from
http://www.whitehouse.gov/health-care-meeting/proposal/titlev/increasing-supply
http://www.aacn.nche.edu/media/factsheets/nursingshortage.htm
http://bhpr.hrsa.gov/healthworkforce/reports/publichealth/default.htm
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