This story was reported for San Diego News Network on December 9, 2009.
The public option, Medicare and insurance for undocumented residents are just some issues related to health care being debated in the U.S. Senate at the moment. But some Americans have other concerns surrounding health care legislation — like the depleted amount of workers in the industry. Does the U.S. have enough doctors and health care professionals as more Baby Boomer-doctors retire?
Though the U.S. could still be months away from revamping the nation’s health care system, other issues that haven’t been fully addressed in both the Senate and House concern the industry itself, health care workers say.
“The problem does exist in some areas – we’re not producing enough workers for the health care industry,” said Tracy Garmer, Council of Community Clinics’ director of human resources. “And based on statistics the problem could be worse with the rise in the number of patients if health care reform does go through.”
The stats
The latest statistics offered by the U.S. Centers for Disease Control, show there were 27 active physicians for every 10,000 Americans in 2006. In California, there were 25.7 physicians for every 10,000 residents. Physicians in direct patient care, however, are at 25.3 per 10,000 Americans and 24.1 per 10,000 Californians. (See Chart)
A Merritt Hawkins & Associates (a healthcare consulting firm) survey of waiting times to obtain an appointment with a physician shows some signs of optimism. The survey which was conducted from September 2008 to March 2009 and in 15 cities (including San Diego) showed the average wait time for an appointment with a cardiologist was 15.5 days. This is a drop compared to 18.8 days in 2004. Other statistics show the average wait time for a dermatologist was 22.1 days; for an obstetrician or gynecologist – 27.5 days; for an orthopedic surgeon – 16.8 days; and for a family practice physician – 20.3 days.
Moreover, in 2006, there were about 14 million jobs in the health industry, the nation’s largest. The Federal Bureau of Labor Statistics reports that health care will grow by 3 million new workers from 2006 to 2016.
Although the number of physicians has risen steadily with the population (See Chart), growth may not be fast enough if 30 million more Americans gain health care coverage under proposed health reform bills.
‘The problem does exist’
The number of physicians per American or per Californian isn’t a shocker for Sharp Healthcare’s Joyce Stewart.
“The problem does exist,” said Stewart, director of human resources for the San Diego healthcare provider. “A recent report showed the California population is expected to grow by 10.2 million people in the next 20 years and in 2030, more than one million Californians will be 65 and older. California has does an excellent job in increasing the number of registered nurses in the state but there are still not enough.”
A report by Merritt Hawkins and conducted between April 1, 2008 and March 31, 2009 showed a 23 percent increase in requests for primary care doctors.
“Virtually every hospital or large medical group in the United States would be happy to add a family physician or general internist,” said Merritt Hawkins’ president Mark Smith. “There simply are not enough primary care doctors to go around.”
Other statistics show that one out of three “practicing physicians in the United States is over the age of 55” and “U.S. medical schools have not provided for the loss of 33 percent of the nation’s physician work force,” according to Health Leaders Media.
HLM also noted, “The first of the boomers turn 65 in 2010, and the U.S. Census Bureau estimates that the nation’s population over the age of 62 will increase from about 46 million now to about 83 million by 2030. Of that population, 14 million will have diabetes and 21 million will be obese. By 2020, the American Hospital Association estimates that boomers will account for four in 10 office visits to physicians, if they can find them.”
Despite these stats, San Diego State University public health professor Rob Seidman said it’s important to note that the problem varies from type-to-type of physician.
“I think it [the problem] depends on the different types of health care professionals,” Seidman said. “We’d also have to consider supply and demand. There hasn’t been a dramatic increase in the supply [of health care workers] but that doesn’t mean it’s going to be adequate to meet the demand. I would say there are probably more needed, particularly for those who deal with technology.”
But if Obama’s wish to expand coverage to as many Americans as possible comes true the shortage of health care workers could become an even larger issue.
“A lot of political types are concerned that the demand of services could change significantly depending on what type of health care reform actually is,” Seidman said.
He’s right. Solana Beach Councilmember Dave Roberts and former candidate for Congress told SDNN previously he was concerned about health care delivery.
“I’m really concerned that we are not producing enough doctors or nurses,” Roberts said. “We don’t have enough facilities to take care of people. Our population is aging, we need to have a more intense focus on home health care so that people can stay in their homes and get the health care they need. So there is still a lot more that needs to be done after the health care bills are passed.”
But Seidman said it’s too soon to tell what the size of the problem is, considering the Senate is still debating legislation.
“There will be a shortage and there will be rationing, etc. But it’s different to predict particularly when we don’t know what the components of health care reform are,” he said.
So why does the problem exist? According to the community clinics’ Garmer, there’s a shortage of professors or trainers in the industry.
“The programs are impacted and the schools can’t take more than a certain amount,” she said. “It’s not that people do not want to enter the industry.”
Taking on the problem
The federal government has already attempted to tackle the problem.
Federal statistics show that more than 200,000 jobs could be created via the American Recovery and Reinvestment Act in the next year. Moreover, nearly $220 million in stimulus funds will be released to train workers for the industry and are available to hospitals nationwide – as announced in August by U.S. Labor Secretary Hilda Solis.
As SDNN previously reported, the federal government allocated $19 billion specifically for health care technology training and expects the employment for this sector to grow by 18 percent by 2016.
But according to Seidman, the effects of the stimulus have yet to be seen.
“Just throwing money out there won’t necessarily lead to any more workers,” he said. “We need faculty members. You couldn’t just simply double the number of students even if you had funds to support it. Will the stimulus funds improve the supply of personnel too then? Possibly. But the magnitude of that improvement is unclear at this point and it will take some years before there are significant changes.”
But some hospitals aren’t waiting for any significant changes and they are doing its part too to take on the issue. A Merritt Hawkins report says “signing bonuses were offered to physicians in 85 percent” of the hospitals surveyed from April 1, 2008 to March 31, 2009 — “up from 74 percent the previous year and up from 58 percent three years ago. ” Average size: $24,850.
California initiatives and backlogs
California has its own unique challenges. First, as noted by Stewart from Sharp, California addressed its nursing shortage in 2005. Gov. Arnold Schwarzenegger signed a $90 million plan to be used until 2010, that allows for a partnership with community colleges and hospitals to produce more nurses. According to Stewart, in 2008 alone, 10,000 nurses entered the workforce through California’s public-private partnership initiative.
“I think that the success of the state’s initiative will serve as a model for the rest of the country,” she said. “The need for the service providers encourages the state to bring forth the dollar to be able to address the problem.”
Although the state government has implemented an initiative to address the shortage, industry workers are now concerned the $20 billion-plus deficit facing California will increase the problem.
According to Gamer, physicians she knows have been delayed in becoming licensed in the state because of the furlough days implemented by Schwarzenegger.
Luis Farias, a spokesperson for the California’s Department of Consumer Affairs, said the furloughs are a necessary factor Golden State residents should accept.
“The medical board [who approves of licenses] — like any other entity under the Department of Consumer Affairs — has furloughs – furloughs are the necessary part of the budget strategy that the state is using right now…. so medical board is tightening their work load like any other board.”
There are backlogs of health care professionals waiting to be licensed, he said, but the issue existed before the budget crisis hit. The latest numbers show that 4,483 physicians are waiting to be licensed — 1,483 are waiting to be reviewed and 14 have waited longer than the 90-day-period. The current average time to be licensed is six to nine months. While there is not a backlog for California nurses at any given time, there could be up to 5,000 nurses waiting to be licensed.
Despite the conflicting problems hitting the health care industry, Seidman said one thing is certain – Americans or Californians will not know the severity of the problem until the health care bills are finally put into law.
“There is no easy solution to the problem,” he said. “The details of the eventual legislation are still unknown — we still have questions… like, what kind of incentives will be provided to health care professionals? How extensive is the increase in coverage for those currently unemployed?”
“We don’t have a clear solution yet because it’s political.”
Hoa Quach is the political editor for the San Diego News Network.