The Looming Healthcare Shortage: Now is the Time to Invest and Innovate

BY EDWARD BRIGGS DNP MS APRN-BC

The author Rita Mae Brown (not Albert Einstein) once said “The definition of insanity is doing the same thing over and over and expecting different results!”. This quote is exquisitely appropriate when we talk about the looming healthcare provider shortage that Florida, and our nation, faces. For decades health policy leaders have repeatedly invested in increasing the numbers of physicians to provide care in our state. Policy leaders have used financial incentives, grants, tuition forgiveness, licensing revisions and liability protections to increase the numbers of physician providers. Unfortunately, these efforts have demonstrated limited benefit in bringing physicians to our state., As the healthcare provider shortage becomes more urgent, we need new, innovative, and targeted solutions to this growing crisis. 

With an aging Florida population, population growth and increasing rates of chronic illness our healthcare system will face dramatic demands. Attempts to attract, retain, and create physicians to address the problem is admirable, but will likely not be sufficient to meet Florida’s needs. It is projected that by 2030 Florida will have a physician shortage of 21,978 providers to meet the health needs of our state. A BMC study looking at physician availability has given Florida a grade of D and ranked Florida 42nd in our nation for healthcare access.1 This shortage will become more acute in specific healthcare areas such as rural care, primary care, geriatrics, psychiatry, emergency medicine and obstetrics/gynecology. 

So how do we address the looming healthcare access crisis? The evidence demonstrates that creating more physician providers will neither meet the healthcare needs, nor improve healthcare outcomes for populations at risk. 

This is where innovation and creativity play an essential role. Health policy leaders need to move away from historic solutions and consider solutions not predicated solely on increasing the numbers of medical providers.

First, we need to increase the numbers of ALL essential healthcare providers. The United States is facing significant shortages of nurses, pharmacists, physicians, physician assistants, therapists, and mental health providers. Tuition assistance programs, loan forgiveness, licensing revisions and retention incentives need to be developed for all essential professions. Such incentive programs should prioritize ensuring these healthcare providers are placed into communities with the greatest need. Such targeted interventions can include financial or loan forgiveness incentives. These must be significant incentives and must avoid the easy fix of decreasing the educational requirements for these professions. 

To increase the numbers of students moving into health-related fields we must do a better job of encouraging high school students to seek careers in these professions. The COVID pandemic resulted in marked declines in college enrollment in healthcare related fields, particularly when we need them most. Reaching out to students, particularly populations who previously saw a college education as unattainable, can increase the numbers of healthcare providers and increase diversity within the healthcare workforce.

In addition, nursing has persistently suffered a shortage of men entering the field. Approximately 12% of the nursing workforce are male. This statistic has changed little over the last 20 years. To adequately meet the nursing shortage schools, policy leaders and communities need to implement programs that attract male high school students into the profession. 

Second, we need to move away from the hierarchical healthcare system where the physician is seen as the “captain of the ship”, to a healthcare model that allows the provision of healthcare services based on the needs of the patient, or community. Nurses, Advanced Practice Nurses, Pharmacists, and therapists should be allowed to practice to the full extent of their education and training. Evidence has clearly demonstrated these professions can provide safe, and effective, care without unnecessary “physician” supervision. (We need to be honest here, current systems of “physician supervision” rarely mean actual involvement of the physician in the provision of care but more represents the financial tethering of the other professionals to the physician.)

Healthcare needs to move towards a multidisciplinary approach where each team member provides care based on their abilities to meet the unique needs of the patient at that instance.  

In states where Advanced Practice Registered Nurses were allowed to practice to the full scope of their education and training resulted in increased access to care, especially in underserved and at-risk populations, without decreasing healthcare quality. A review of available research on Advanced Practice Nurses practicing without supervision found safety, efficacy, increased access, patient satisfaction and reduced costs. 

There is also a growing body of evidence that demonstrates pharmacists can safely, and effectively, manage uncomplicated medical conditions without physician oversight. Research has demonstrated that in states where pharmacists can prescribe medications to treat conditions, adjust medication regimens, or prescribe/administer vaccines healthcare access increases and healthcare outcomes improve.,

Finally, we need to dramatically innovate our healthcare infrastructure. Currently our healthcare system operates within silos where patients have multiple healthcare providers and there is limited communication between providers. As a nation we need to develop an information infrastructure where providers can see the totality of health records for the patient they are caring for, and not just data within their silo. This would dramatically reduce cost and increase healthcare outcomes. 

To provide fast, affordable, and convenient healthcare access policy leaders need to expand proven health systems. Telehealth, mobile clinics, community-based clinics, and strong public health infrastructure has demonstrated increased access to care with improved health outcomes.,, Legislators need to target funds to incentivize the development of community-based clinics in underserved populations and remove barriers that inhibit the development of nurse led clinics. These systems need to recognize that transportation is a major barrier to care and bringing the care to the community has proven to be cost effective. ,

As policy leaders work to address healthcare provider shortfalls they need to recognize that the solution does not lie solely in increasing the numbers of medical providers. Targeted programs need to be implemented that encourage students to seek careers in all healthcare professions. Healthcare providers, in every field, must be given the authority to practice to the full extent of their education and training. And our current system of healthcare provision must shift to prioritizing convenient access to care for all populations, with attention to rural and at-risk populations. Persisting with long standing interventions will only demonstrate the same outcomes we have witnessed previously.

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