Sunday, January 8, 2012

Unfixed: Let's Deal with It

Suppose the nursing and primary care physician shortage is not fixed. Just suppose.
That, despite addressing the issue as we are now, despite the economic and market models and calculations, the heated negotiations in health insurance conference rooms, and the contemplative considerations of academia, we are in the same predicament twenty, thirty years from now (it could happen). What, then, must we do? (Billy Kwan's, played by Linda Hunt, repeated question, "The Year of Living Dangerously".)
While reviewing the discussion board for our class in healthcare management, you may have come across the post in which I wrote of substituting NPs for physicians in primary care, in order – my argument – to free them for the practice of geriatrics. Geriatrics is my “thing” so any time I can find a way in which to weave it into the conversation, I do so. My read of the healthcare tea leaves is we are to expect shortages of nurses, primary care physicians, and geriatricians. An accidental realist, this likely state of affairs compels me to suggest we prepare ourselves – and our children, our families, our patients – to know how the shortages will be manifested in the quest for healthcare. We might expect:
1. increased frustration scheduling a timely appointment in primary care
2. ailing parents whose multiple medical conditions are not addressed
3. anguish and regret that we did not “fix” the problem when we had the chance
I do not have “the” answer to the shortages. I do, however, practice and teach resilience to patients, families, and caregivers. We live in a privileged country where a demanding population has high expectations and relishes a good crisis. We will discover, however, no quantity of prosperity or urgency will solve personal demands involving public crises.
Nursing education programs have turned away 30,000 qualified applicants annually?

Here’s Chris Fleming, June 14, 2010 in Health Affairs blog:
“[although these projections represent a smaller shortfall than earlier estimates] the magnitude of the 2025 deficit would still be more than twice as large as any nurse shortage experienced since the introduction of Medicare and Medicaid in the mid-1960s. Avoiding this shortfall would require expanding the capacity of nursing education programs, which since 2002 have turned away 30,000 or more qualified applicants annually.”

Stats on geriatricians:

Matt Sedensky, Nov 11, 2011, The Huffington Post:
* 70 million American members of the baby-boom generation (those now 46–65) reach their senior years over the next few decades
* 2011 - one geriatrician for every 2,600 (1:2600) people 75 and older
* 2030 - one geriatrician for every 3,800 (1:3800)
* compared to pediatricians, 1: 1300 < 18 years old
* geriatricians rank among the lowest-paid medical specialties (median salary $183,523).

How are you planning to cope with the shortage when it directly affects your 1) practice, 2) family, and 3) well being?

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