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Health-care shortage can be solved by increased funding for education and training

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Clinical experience is one of the essential components of a health care provider’s education including for any physician, physician assistant, pharmacist and professional in advance practice nursing.

As an investment in the health care workforce, Medicare, Medicaid and Veterans Hospital have been funding resident physicians practical training for a minimum of three years past graduation from medical school. It is the largest federal investment in the health care work force spending over $16.3 billion on graduate medical education in 2015. 

President Donald Trump last month signed H.R. 5385 into law, under the Public Health Service Act to reauthorize and extend the Children’s Hospitals Graduate Medical Education program for five years. The Congressional Budget Office estimates the cost to Medicare and Medicaid would increase federal funding by $1.5 billion over the current $16.5 billion.

While this will help physician trainings, this increase of federal funding will not stop the expected shortage of primary care providers. The shortfall is expected to reach over 100,000 by 2030. An increasing population, people living longer with more chronic diseases, an increase in enrollment of insured patients and retiring health care providers, influences the shortage. 

Over 58 million American are living in areas through the United States that are considered primary care shortage areas in both rural and urban areas with rural and remote areas the hardest hit. A shortage of health care providers has a negative impact on the health care delivery system due to lack of patient access to care. That is due to increasing the distance a patient may have to drive to be seen by a provider and the waiting time to be seen. It all affects the quality of care by limiting the time of patient interactions and increasing the use of hospital’s emergency departments non-emergent care. 

Physicians cannot meet quality health-care only. Nurses have been ranked by 82 percent of Americans as the most trusted health care profession compared to physicians at 65 percent, according to the 2017 Gallup Poll.

I’ve been a pediatric primary nurse practitioner for 22 years working in a variety of settings from the Department of Children Welfare and Federally Qualified Health Care Centers to privately owned primary care offices.  In all scenarios, families welcomed advanced practice nurses or registered nurses, delivering evidence-based patient centered care and are key members of inter-professional teams.  

The Institute of Medicine identified Advanced Practice Nurses as key providers to address the shortage of primary care physician. Nurse practitioners are registered nurses with advanced preparation and education (this includes a master of science degree and more often a doctorate of nursing practice) with the majority pf APRNs working in primary and are licensed to practice independently in 23 states, with more states removing barriers to practice.Nurse practitioners are licensed to diagnosis, order and interpret tests, treat and provide primary, acute and specialty health care services.

The American Enterprise Institute last month reaffirmed the results of nurse practitioner care as a higher-quality of care than physicians’ patients.

To fill the expected access gap in primary care in this country, recruitment and competition for top talent in health-care between the heath-care educational institutions is growing. Schools are expanding enrollment, new schools are opening and colleges have moved to an online educational format to allow working nurses to advance their careers as and fill the gap in access to health care.

Yet most health-care professionals agree the number and lack of quality preceptors — or working clinicians who provide clinical training and support professional development — has become the limiting factor of education.

Federal funding is paying for physician resident training, but who is paying the advanced practice nurses for their clinical training? Until recently, no one.

This past June, Hawaii legislators signed bill SB 2298, allocating $1.5million in tax credits for health care preceptors from $1,000 to $5,000 if they are aligned with Medicare, Medicaid and the Veterans Hospital Administration. Other states have passed similar laws, including Maryland, Georgia and Colorado, while still more states are working on it now.

The benefit of passing state tax credit laws has the potential to help fill the health care workforce and nursing faculty shortage. Sustainability of these new tax credits laws is possible without tapping Medicare or Medicaid.

Maryland added a small $15 fee onto Advanced Practice Registered Nurses licensing service fees. These bills have been passed in collaboration with physicians in mind too. They can receive these tax credits directly.

If funding for the workforce shortage is limited to physicians only, patient access to quality and effective care will be even harder than it is now. It is time to join forces, campaign for change and collaborate. This is every nurse practitioner’s call to action to contact state legislators and local chapters of the American Association of Nurse Practitioner.

Filling the gap in services by healthcare providers will allow more Americans to have access to quality care. Nurse practitioners have historically worked in rural and underserved areas more so than physicians and in the recent years the trend has increased.

Policymakers can act to improve the fate of millions of Americans seeking care by funding licensing and training for nurse practitioners.

It’s that simple.   

Janice Odiaga DNP, is an associate professor and the director of the pediatric primary care nurse practitioner program and inter-professional education at Rush University College of Nursing. She is a public voices fellow through The OpEd Project.

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