Wednesday, August 20, 2008

Combating Workforce Shortages

HRSA’s National Advisory Committee on Rural Health and Human Services just released their 2008 Report to the Secretary of HHS with a section in the report targeting healthcare workforce challenges in rural areas. Although the Committee is aware that Federal programs have been created to help reduce rural physician shortages, the Committee is very concerned that several recent trends may undermine attracting the next generation of physicians to rural areas.

Such trends as:

  • The continued cuts in the HHS title VII primary care training grants and the declining match rates for family practice residencies
  • The decline in applicants for the J-1 Visa Waiver program
  • Not having enough federal assistance to train nurses, physical therapists, and radiation technologists
  • The shortage and lack of rural dentists in rural areas. Wisconsin and North Carolina are considering opening new dental schools to focus more directly on public health dentistry and on the needs of underserved areas
  • Primary care doctors in rural areas may not have adequate training in mental healthcare, yet they are providing the majority of mental health services in these areas. There is often stigma associated with receiving help in rural areas since confidentiality can’t always be assured in close knit rural communities

According to the “Chronicle of Higher Education”, the nation will need at least 20,000 more physicians over the next decade to care for elderly patients, through fewer than 8,000 geriatricians are in practice today. High caseloads, long hours, isolation from colleagues, lack of easily accessible continuing education, limited professional opportunities for spouses, and heavy school debt deter medical students and residents from practicing in rural areas.

The Committee’s report argues that solutions will require long range planning. The Committee suggests that not only must HHS play a major role in addressing the workforce challenges, but also other cabinet-level departments need to play key roles. The Department of Education with links to community colleges, and the Department of Labor through the Workforce Investment Act program needs to become more involved.

Massachusetts is also addressing healthcare workforce shortages. According to AAFP News, the state has just enacted a sweeping healthcare measure to address primary care workforce shortages. The legislation calls for creating a robust primary care workforce particularly in rural areas, and calls for the establishment of the patient-centered medical home.

The state now has the authority to establish a medical home demonstration project. However, certain provisions of the law still need to be flushed out. For example, the legislation authorizes MassHealth to develop a medical home pilot project in conjunction with the state’s Health Care Workforce and the Massachusetts AFP, but it is not clear how the medical home pilot will be structured, how many practices it will involve, or how long it will last. Most importantly, the project itself is subject to appropriations.

State Senator Richard Moore a sponsor of the legislation, said “the pilot will go forward and the focus will be on the medical home particularly for chronic illnesses where it will be used to better manage a patient’s care.”

Most importantly, the legislation establishes a statewide goal of adopting electronic health records by 2015. Hospitals will be required to use an interoperable health record system after 2015 to receive their license. The legislation authorizes $25 million for the new Massachusetts e-Health Institute to facilitate the financing and deployment of a statewide compatible system of EHRs. The institute which is part of the state’s technology collaborative will award grants to physician practices to help facilitate the adoption of EHRs.