The pandemic has exacerbated many chronic challenges for the US healthcare system, including shortages, burnout, and inequitable distribution of healthcare workers. More than 230,000 health care providers left the profession in the first two years of the pandemic alone.
America is an aging country, which only compounds the problem. Our health care needs increase dramatically as we age, and the needs of our aging population have grown at a much faster rate than the supply of health care workers. As a result, the United States faces a projected shortage of 37,800 to 124,000 physicians over the next 11 years. We are already experiencing a critical shortage of providers which has resulted in reduced access to care and longer wait times for appointments.
The lack of accessible primary care fuels the cycle of this country paying far more for complex and expensive care than we do for more cost-effective prevention and early detection and intervention. The result is that we fail to manage conditions such as diabetes and high blood pressure before they lead to more serious consequences such as heart attacks and strokes.
It also diverts incentives from quality of care to profit. Some medical specialties that require fewer acts, and therefore less remuneration, are experiencing a decline in interest from trainee doctors. Last year, for example – in the shadow of a historic pandemic – nearly half of fellowship positions to train infectious disease specialists went unfilled.
In addition to growing gaps between types of providers, we also have inexcusable inequities in where health care workers are and to whom they go. Even before the pandemic, about 80% of rural America was classified by the US government as medically underserved. Communities of color often see hospital closures or other service cuts that limit their access to care.
Then there is burnout. Many experienced healthcare workers are leaving the sector or retiring, a trend expected from an aging workforce but made worse by the pandemic. Patients lose the accumulated wisdom of proven nurses and doctors. Young workers are also leaving health care due to long working hours, high stress, and compensation levels that neither match the efforts made by health care workers nor their value.
Still, there is cause for optimism about health workforce issues in the United States. For one thing, unlike many other political challenges, there is a bipartisan interest in tackling this issue.
To answer this call, we need strategic and substantial investments in expanding training opportunities for doctors, nurses and other health care providers, especially those involved in primary care. The federal government should add more Medicare-funded residency training slots as well as increase its funding for primary care residency training programs and nursing education initiatives to keep pace with our growing care needs. health.
States should also increase funding for their university systems to expand their nursing programs and medical schools and, if possible, establish new ones. Existing medical and nursing schools should partner with historically black colleges and universities as well as institutions that serve rural populations to help reduce inequities in access to health care.
Beyond strengthening training, improving the well-being of caregivers is in our collective interest. The Biden administration’s allocation of $103 million from the bipartisan U.S. bailout to initiatives to reduce burnout and provide healthcare workers with more mental health resources is a good start.
But we also need structural changes, including greater compensation for workers and higher reimbursement for non-procedure-based care. To prevent workers from leaving this sector, we need greater job mobility, in particular through training subsidies for new jobs in the healthcare sector.
Telemedicine is also part of the solution. The declaration of pandemic-related emergencies at the state and federal levels has reduced regulatory barriers to telemedicine consultations. Legislation that permanently removes many of these barriers will help make the health care system more accessible and efficient, thereby easing the burden on the workforce.
And we can reduce the labor shortage by allowing the immigration of health professionals. The Resilient Healthcare Workforce Bill – which was stalled in the Senate – would allow the government to grant 15,000 medical immigrant visas and 25,000 professional nurse visas that were available in previous fiscal years but not used. There is already bipartisan support for expanding the Conrad 30 waiver program, which allows international medical graduates doing their residency in the United States to stay in that country if they work in underserved areas, where doctors are the more needed. There is no reason to wait for either initiative.
COVID-19 emergency declarations were always going to end. An ambitious health workforce initiative will improve our lagging status quo and help ensure America is prepared for what comes next.
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