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With the passage of the Affordable Care Act (ACA), millions of previously uninsured Americans were able to become insured—at the same time the medical community is grappling with a shortage of primary care physicians caused by an aging doctor base and the allure of more lucrative and specialized medical fields attracting doctors away from generalized medicine.
Some signs of these challenges are already being seen and felt by medical professionals.
Although new patient visits to primary care providers increased only slightly from 22.6 percent in 2013 to 22.9 percent in 2014, according to a report from athenahealth, a cloud-based health IT vendor, and the Robert Wood Johnson Foundation, trips to emergency rooms have skyrocketed. According to a recent article in Modern Healthcare, which pulled data from the American Hospital Association, of the nation’s 24 busiest emergency rooms, there were 18.7 percent more visits in 2013 than 2012. Some say the emergency room increase speaks to the need for a cultural change to encourage the newly insured to start going to primary care physicians rather than the emergency room for minor medical issues.
Additionally, health care professionals are making plans to deal with the changing paradigm, including ramping up staff, putting a greater emphasis on retention and modernizing training to handle the changes coming to the industry in the foreseeable future.
“They are anticipating there should be between 30 to 40 million new patients overall going into the system over the next few years,” said Michael DiPietro, chief marketing officer for HealthcareSource, a talent management software company in Woburn, Mass., that represents roughly 2,500 hospitals as clients. “They know they will have to hire to plan for that demand. The other thing they are looking at is the type of staff that will change as well—from more critical care to more preventative care.”
DiPietro said human resource executives at hospitals are also grappling with the “retailization of health care,” a term used to describe how health care services like flu shots and health screenings—long the exclusive domain of hospitals, clinics and doctor’s offices—are now offered in large retailers like CVS and Wal-Mart, stores that HR execs suddenly have to compete with for qualified health professionals. “It makes hospital HR people nervous in terms of change,” DiPietro said. “If you think about being an HR person in health care, it for the most part has been very stable. You’re usually the biggest job in town. Now it’s becoming a very different world.”
Adding to the challenge of competing with retailers for employees are the accountability requirements of the ACA, which require health care practitioners to have certain core competencies and which measure service in core categories, like patient satisfaction, for hospitals. “What you’re seeing is a shift that is making sure that not only are they getting people on board, but people who have the right competencies—not only so they get reimbursements, but also so patients don’t go to the Minute Clinic,” DiPietro said. “It’s accountability in health care. We’re asking our employees to be accountable. That’s a hard shift for hospitals.”
Others agree all the changes will continue to be challenging.
Bruce Hamory, a physician who taught academic medicine for 22 years and who is now a partner at Oliver Wyman, a global management consulting firm in Boston, said several issues are converging in the medical space so the approach needs to be multilayered to tackle the influx of new patients, the shortage of physicians in primary care, doctor burnout, and adequate training to get medical staff up to speed on new IT skill sets.
“There has been a relative shortage of regular care physicians for a long time and it’s anticipated to get worse, with or without the ACA,” Hamory said, adding that the Association of American Medical Colleges has projected a shortage of 30,000 primary care doctors in the coming years. “Part of that is the population is getting older, and older people need more care, and the other piece is that physicians are aging. The thing I would add with the aging physician population, you also have the issue that it’s difficult for them to adjust to the new environment. It really requires a reorientation of attitude and an understanding of why they went into medicine and how it aligns. These things get wrapped in together and it’s a much more challenging environment today than it was 20 to 30 years ago.”
Another challenge is an economic one. “One of the reasons primary care does not have sufficient numbers of practitioners are primary care physicians are not paid as well as specialists,” said Tom Flannery, a partner at Mercer, a HR consulting firm in Boston. Medical staff is seeking to address the shortage by developing programs to train nurse practitioners to handle some medical procedures traditionally dealt with by general practitioners. “It’s not going to solve the issue, but it’s going to help address it,” Flannery added.
Additionally, the new health care landscape includes regulations and mandates, a move to electronic health records, and new job skill sets—all areas that medical staffing need to get acclimated to.
“There are new skill sets as part of all the changes going on, which are needed for all of the people in health care, not just physicians,” said Hamory. People need to learn certain computer skills and how to work with electronic health records, “skills that have not been routinely taught in any of the professional schools,” he said.
“There’s a huge sea change in the way health care is delivered, both at a primary care level and a specialty level,” Hamory said. “So we can’t train people the same way my grandfather was trained or even the way I trained people 20 years ago.” Hamory added that a number of medical schools are beginning to adapt their training,” thanks to grants from the American Medical Association to medical schools that accelerate their curriculums.
The shift to more preventative care is one of the basic premises behind the ACA. And, despite the challenges, this is what many people are hoping will lead to a successful transition to universal health care.
“The ACA is significant legislation,” said Flannery, who has worked in the health care field for 35 years. “Whenever you have significant legislation, you’re going to have challenges. Our society is resilient to absorb these changes. The plus side of ACA is that people who could not afford health insurance now have access and that is good. Yes, there are issues with it, but on the whole, having more people with access to health insurance potentially means a healthier society.”
Dawn S. Onley is a freelance writer based in Washington, D.C.
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