Feds try everything to fix health-care system — except what works
Here's how we can solve the doctor and nurse shortage problem
Health care today faces a clinician shortage; let that sink in a minute. We're not talking about forecasts five years out or a decade forward. Industry watchers all agree that the swelling elderly population of Baby Boomers - the so-called "silver tsunami" - already poses a major challenge to the health-care delivery system.
Older Americans consume three times the health-care as younger Americans and the growth of the health-care workforce is not keeping pace with the growth in demand. Doctors and nurses are themselves aging and retiring and not enough people are choosing the noble profession of delivering care, so our nation is struggling to meet the needs of patients. This can and will have a detrimental effect on health delivery. Already today, medical error is the third leading cause of death in the United States and the most common root cause of error is understaffing.
Staffing shortages will only become more and more dire unless we innovate. A number of remedies that come from the worlds of workforce automation (new technologies like AI), workforce multiplication (new channels like telemedicine), workforce allocation (new tools like efficient job marketplaces) and rationalization (new care settings and new provider types) have surfaced that could help combat the problem.
The full impact of these remedies is still far off, but there is one step that would serve to alleviate some of today's challenges that lawmakers should embrace right away: federal licensure for clinicians.
Today, medical licensing requirements demand that clinicians procure a separate license for each state in which they see patients. Although states have the same basic standards for clinician licensure, each of the 50 states has its own timetable for license renewal, its own continuing medical education requirements, its own often paper-based application and numerous other unique demands, making the process of acquiring a license, let alone multiple licenses, both time intensive and costly.
State-specific medical licensure was implemented as a way to ensure patient safety and to promote quality at the state level. It also represented an economic opportunity for the states, as clinicians are required to pay fees to the state to maintain licensure. Therefore, from the perspective of responsible governing, licensure is both perfectly reasonable and in fact laudable.
But today the case for state-to-state licensure no longer makes sense. National standards govern medical training and testing and accepted clinical practices have become more national in scope. A patient with pneumonia in California is much like one in Illinois and each patient and should be treated up to the same, national standard of care. What's more, the fragmented nature of a state-based licensure system may even make it more challenging to ensure quality across state lines as there are not seamless systems for sharing information about clinicians.
Not only is the quality argument less valid, today, state-by-state licensure exacerbates shortages. Clinicians who are willing and interested to go where patients need them are prevented from doing so by the frictions introduced by the cumbersome patchwork of state licensure processes.
Additionally, telemedicine, a promising, modern solution to the rapidly increasing needs of patients across the nation is severely inhibited by our archaic licensure framework, as providers must have a license in every state where their patients are. So, even though technology allows a doctor sitting in New York to see needy patients in Texas, Florida and Colorado in an hour, outdated licensing requirements prevent it.
A single national licensure system would be the best solution to this problem. We should push for that. But at a time when supply and demand is already meaningfully out of sync, reciprocity by way of compact agreements, like the Nurse Licensure Compact (NLC) for registered nurses or the Interstate Medical Licensure Compact (IMLC) for physicians, are a way to introduce a partial solve.
Medical licensure compacts are legal agreements among states to share information with each other and to work together to expedite the medical licensing process and to make it easier for clinicians to practice medicine in other states.
However, these compacts still present a barrier to entry as they require clinicians practicing in multiple states to observe a myriad of state-specific regulations. These compacts are also not national in scope - many of the more densely populated states with inherently larger patient populations, such as New York and California, have yet to enact legislation to join these compacts.
So, what are the implications of a move towards more participation in medical compacts or, even better, federal licensure? At Nomad, we work closely with both clinicians and the facilities that hire them, so we're very familiar with the burden that licensing puts on both sides of the equation.
While today's issues are more magnified in certain pockets of the country, we've been told by the tens of thousands of clinicians in our network that their interest in being more 'nomadic' would increase meaningfully with less burden and cost to that process. Relaxed state-to-state requirements would fill more empty roles across the country and bring care to those populations and health-care facilities experiencing the largest provider shortages.
Health care doesn't stop at state lines. To create better access to care and to increase the supply of clinicians at the national level, we need to promote a free market that attracts more clinicians rather than burdening them with more bureaucracy.
Let's be open-minded in introducing solutions to a challenge that exists today and will only increase considerably in the future. Remedying out-of-date legislation is a great first step.
Alexi Nazem M.D., is the founder and CEO of Nomad Health, a New York-based technology company that built a marketplace for health-care jobs.