How a healthcare repeal could exacerbate the doctor shortage crisis
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Americans are living longer than ever, and what were once fatal diseases are now often considered treatable, chronic ailments — think hypertension, heart disease, and many different types of cancers.

This fact is creating an excessive healthcare demand, and it can be traced to two cultural issues: people choose to be less healthy than they could be, and they’re reluctant to face end-of-life. We now have a system of continuous and expensive treatments for chronic conditions, with some of the most intensive and expensive treatments coming in the last year of life.

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With millions of Americans lacking adequate healthcare, extended life spans and treatable diseases are straining our already burdened system, and studies show it’s only going to get worse. Already, there isn’t enough provider capacity in the system to meet the expected patient demand going into the future, and just increasing the number of providers isn’t an effective long-term solution to the problem.

 

According to a 2016 study published by the Association of American Medical Colleges (AAMC), we can expect a total shortfall of as many as 94,700 physicians by 2025. In March of this year, AAMC updated its report, citing an aging population as one of the main reasons for the physician shortfall.

“By 2030 the U.S. population under age 18 is projected to grow by only 5 percent, while the population aged 65 and over is projected to grow by 55 percent,” according to the 2017 updated report. “Because seniors have much higher per capita consumption of health care, the demand for physicians — especially specialty physicians — is projected to increase.”

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More people needing physician care and industry attrition means the supply of physicians isn’t keeping pace with the demand. The number of physicians and specialists in the U.S. is declining for the first time in 20 years, and will continue to do so, according to a recent Wall Street Journal article.

As the battle on Capitol Hill to end the Affordable Care Act (ACA) continues, Americans are facing more than just a threat to their health care coverage. The current administration’s plan to repeal and replace the ACA could end health care coverage for millions of Americans, which would worsen the provider shortage crisis.

House Speaker Paul D. Ryan (R-Wis.) in March introduced a replacement plan — the American Health Care Act (AHCA) — that never made it to a vote, but an independent study by the Congressional Budget Office estimated it would have left 24 million Americans uninsured.

A recently introduced amendment by Rep. Tom MacArthur (R-N.J.) would further slash at the ACA, and critics say it would allow insurance companies to charge patients more for premiums and reduce standards for care plans.

When we reduce insurance coverage, we make it harder for patients to address their preventative needs. According to information from the Centers for Disease Control (CDC), nearly 50 percent of American adults suffer from a chronic ailment, and that chronic diseases are responsible for seven out of 10 deaths annually. Racial and ethnic minority communities experience higher rates of obesity, cancer, diabetes, and AIDS. The CDC also notes that American children, and especially those in the African American and Hispanic communities, are also suffering greater rates of obesity, which predisposes them to chronic disease.

As part of its National Prevention Strategy, the CDC states that, “Focusing on preventing disease and illness before they occur will create healthier homes, workplaces, schools and communities so that people can live long and productive lives and reduce their healthcare costs.

Better health positively impacts our communities and our economy” by increasing the number of productive school days for children, productive workdays for adults, and the amount of time senior citizens are able to live active, independent lives.

Expanding the scope of our healthcare system to include insurance for all, preventative care and societal education will maximize disease prevention, but it costs money. That funding is possible through multiple parallel and interlocking insurance systems, but too many people are left out of those systems.

We provide emergency care for acute conditions and trauma, but the provision of continuous and lifelong preventative care to the uninsured is a major challenge for our society.

Most systemic change initiatives target cost reduction directly, and many of those initiatives make the problems in the system worse by either reducing patient access on the demand side, or reducing provider capacity on the supply side.

Reducing insurance coverage makes it harder for patients to address their preventative needs. Decreasing provider reimbursements reduces their capacity per patient as they increase appointments to make up for the financial tightening. Increasing provider paperwork further reduces their capacity to treat patients.

Privatizing healthcare financing ensures that more money will shift from providing care to providing profitability. The problems we’ve got are direct responses to the design of our system. Whether that design is intentional, organic, or both; we’ll only get different results from a different design.

Healthcare systems engineers are working to design and optimize all-inclusive care delivery methods that focus on moving parts and personal interactions. System redesign means engineers evaluate current procedures, medication delivery, patient information capture and sharing, and continuity of care to determine how to best improve healthcare organizations and service delivery methods.

We are working with providers, healthcare facilities, regulatory administrators, social services, academia, biomedical researchers and the public to focus on the whole system and bring changes that will optimize performance. Systems engineers learn from providers who best know their patients’ needs and couple that knowledge with a systems-type thinking that will correct our healthcare system and take it into the future.

Healthcare system engineers are redesigning the system from first principles. To solve the doctor crisis, we want a system where patients choose healthier lifestyles and address their end-of-life needs, while we honor and reward the work of our providers by keeping them focused on their patients without having to worry about their compensation. A system that does these things must be engineered very differently from our current system.

Some changes can be made incrementally, and many such changes have been made in recent years. Other changes require more dramatic system changes, but it’s not yet clear if we have the social, political, and economic will to see them through.

Richard Biehl, Ph.D., is an instructor and program director of Healthcare Systems Engineering at the University of Central Florida. He is an information technology and quality practitioner with 38 years of experience.


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