February 1, 2012

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Feeling the Pain

Medical Provider Shortage Looms Large

Tom Haraldsen

February 1, 2012

            For instance, many OB/GYN doctors are simply getting out of obstetrics altogether, due in part to the cost of liability/malpractice insurance. Gessel says an OB/GYN physician might pay as much as $100,000 a year in liability insurance premiums. Neurosurgeons face even higher premiums. So doctors and nurses in rural hospitals and clinics who choose to specialize outside of those areas can leave residents with limited choices.

            “Some [physicians] are looking at those rates and deciding to focus on other areas,” he says. “We see fewer and fewer of the old-style doctors that used to do lots of things. They are becoming more focused on specialties now.”

            McOmber says there’s been talk about turning to foreign-trained physicians, but with that come the questions of how those physicians have been trained compared to U.S. practices and standards.


A Wider Problem

The problem isn’t limited just to physicians, either. McOmber says there is a nursing shortage as well.

            “Many nurses are also tapped for certain administrative slots in their offices, so they can’t necessarily fill in to help with some of the physician’s duties or with training,” she says. “We are greatly concerned that we don’t have a training program that is sufficient to meet the needs of our growing population in Utah.”

            “When you look at the funds that have been cut by the state over the last couple of years, it has definitely affected our nursing program,” says Maureen Keefe, dean of the U’s College of Nursing. “We lost about $1 million, or 15 percent of our budget, so we’ve had to reduce our undergraduate enrollment from 144 students to 128. Because we’re unique in the state in that our college does both undergraduate and graduate programs, we’ve had to reallocate some money and thus roll back our undergrad program. Those cuts, ironically, came after a couple of years of increasing the numbers of new students into the program.”

            The nursing shortage has been mitigated a bit by the return of previously retired nurses coming back into the workforce, an abatement in the shortage due, curiously, to the same recession that in many ways has caused it.

            “But as we look to the future, those baby boomers in the workforce are planning to retire,” Keefe says. “Five to 10 years out, there will be a shortage again. And we have a strong need for more home-care and long-term care nurses. There are 3 million registered nurses in the country right now, and in the next 10 years, we estimate we’ll need 500,000 to 1 million more.”

            She adds that Utah has the lowest number of registered nurses of any state in the nation.


Short Changed

A big part of the problem, McOmber says, is limited federal funding for Medicaid overall.

            “With the huge cuts in Medicaid, the question is, ‘Where do you focus your attention?’” she says. “You have to look at different proposed areas of cuts and determine where your biggest needs are. It’s important that we have training, but it’s also important to fund ongoing medical care. We obviously need to see a restoration of funding for the medical school, as that’s in the best interest of the state.”

            Gessel says there’s a huge sense of concern in the medical industry about practitioner shortages, and there are ongoing efforts by both hospitals and medical systems to find ways to rectify it. Federal regulations have made it almost impossible to see any of that help coming from the well-heeled pharmaceutical industry, which is a large benefactor and has a huge vested interest in the future of medical practices.

            As of mid-December, Congress was still debating a possible cut of reimbursement via Medicare that would kick in January 1, 2012. That cut would result in a 27.4 percent drop in reimbursement to physicians, further adding to the industry’s woes.

            Most everyone agrees that the solutions will rely largely in healthcare reforms—what passes Congress going forward, how reimbursements are determined, and when federal funding for many programs is restored.

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