So - Physician shortages worsening, who's surpirsed raise your hands

**Alundil** · 07-30-12, 10:27 AM

As has been mentioned more than once (by me at least, though I know several others have made similar statements) the nation is already facing a shortage of trained healthcare providers. The shortage was already predicted to worsen over the next decade +.

Why, oh why, was this not highlighted in the rush to jam as many bodies into "care" programs as possible? This was glossed over, or ignored, by many. Can't fathom why (ok I can but I'll leave it there)...

http://www.nytimes.com/2012/07/29/he...=MYWAY&ei=5065

Community example (not my community obviously) but this is hardly unique around the country.

**CivilWars** · 07-30-12, 10:30 AM

Your obvious right wing propaganda is obvious, just look at your source.

**AetheLove** · 07-30-12, 11:21 AM

Originally Posted by Alundil

As has been mentioned more than once (by me at least, though I know several others have made similar statements) the nation is already facing a shortage of trained healthcare providers. The shortage was already predicted to worsen over the next decade +.

Why, oh why, was this not highlighted in the rush to jam as many bodies into "care" programs as possible? This was glossed over, or ignored, by many. Can't fathom why (ok I can but I'll leave it there)...

http://www.nytimes.com/2012/07/29/he...=MYWAY&ei=5065

Community example (not my community obviously) but this is hardly unique around the country.

No one should be surprised that no one is surprised at this.

There has been a shortage for decades.

Nurses have been in heavy demand for a long time. Why hasn't the labour market fixed it? One could argue that it's because the job requires additional training, is particularly stressful and demanding, but doesn't carry very much status (social compensation), or pay well enough (monetary compensation).

So maybe that's the story of nurses, or maybe not.

But how about this story: our society/country wants more medical care.

Our population is ageing - the mean and median age is older, and older people use more healthcare.
Our population is growing. Not fast, but more than zero. More people means more demand.
Our technology is improving. There are many new healthcare "products" (though I hate to reduce it to that word).
Some people who enter the field do so to provide elective care (eg: cosmetic health care).
Our society has been under-providing health care for a long time. Lots of people have been getting less than they want.
Probably other stuff too (add to my list, Alundil?)

It's been predicted for a long time that the US would be spending an increasing proportion of its GDP on health care. That's because we want more. That shift has been underway for a while. Changes to the law are just about to become another factor affecting demand, but that isn't news either.

I'll bet that for a while in the early 20th century there was a persistent shortage of good auto mechanics. That's because the auto industry was growing. We - as a nation - wanted more cars.

When our nation's growing wealth, shifting demographics, healthy banking system (post Glass-Steagall) and shifting tax laws, set off a huge surge in home ownership - well, what happened? The home building industry grew. We got suburbs. Where did all those people live before? Did it happen one day that all of a sudden there were 20 million extra homeless people? Nope. Demand shifted, and the economy responded.

So I totally agree with you. Anyone who didn't see this coming simply hasn't been paying attention.

Cheers,

AetheLove

**Alundil** · 07-30-12, 11:38 AM

Right - and that's what's very frustrating about the impending scenario (or the continuance if you prefer). There has been no (or none that I can see) focus placed on how to care for "the masses" (ever aging as you pointed out) or to acquire and retain people charged with caring for said masses on a large national scale. Period. Only the directive that the care "must" be given. Regardless of reality provider to patient levels.

And your point about cars and mechanics, while good as nuts to bolts ratios and the problems of imbalance, isn't as easy as a comparison from a "doing" perspective as people <> cars and mechanics <> doctors/nurses if only in the sense that people are several orders of magnitude more complex that autos (but I also know your were not being literal).

**Alundil** · 07-30-12, 11:43 AM

Originally Posted by AetheLove

Nurses have been in heavy demand for a long time. Why hasn't the labour market fixed it? One could argue that it's because the job requires additional training, is particularly stressful and demanding, but doesn't carry very much status (social compensation), or pay well enough (monetary compensation).

In the Houston market at least, nursing pays pretty well, imo. Signing bonuses for leaving a place to go to another are routine and pretty nice. Yearly cost of living increases are the norm. Stipends and things for CEU (Continuing Education) are as well. So with that said, I think that their compensation is pretty good. Could it be better? For some, certainly. Specialization is also a factor as well like in almost all (all?) other fields. The more specialized one becomes the more compensation one receives (as long as the industry/market desires that specialization of course >>> specialized leeching is probably not worth as much as it was once upon a time).

**AetheLove** · 07-30-12, 12:26 PM

Originally Posted by Alundil

In the Houston market at least, nursing pays pretty well, imo. Signing bonuses for leaving a place to go to another are routine and pretty nice. [...]

That's fine, and I might even agree. But the point is that our judgement from outside isn't particularly relevant. The base-line is that people go where they are attracted, and one of the primary motivators is salary. If it pays so well, why don't you go be a nurse?

Why don't I? Why don't enough people?

The health care industry (in this case, mostly hospitals) has gone out of its way to try every enticement it can think of - short of simply offering attractive wages. They are willing to cover all sorts of one-time expenses, because that's cheap. I don't blame them for that, but in the industry the relative power of nurses is low, and that means the profession has a harder time in the bargaining process. I'm not saying that's good or bad (it may or may not be), just that it is.

Nursing can be a very hard job. For example, in a hospital, a lot of doctoring can be scheduled to happen when doctors want - week days between breakfast and dinner. Not all, but quite a bit. Nursing is much less that way. The hours nurses have to work are harder. They also have significantly less social and professional status. It doesn't matter if that's "true", or "deserved", if that's the perception of nurses then the effect is real.

... wait, why am I even telling you this? You know it. Better than I do, for sure.

But if the nursing shortage is real, then there are two primary solutions. First, informational. Make sure people know that they can have a career as a nurse; help them find and follow that path. Second, compensation (money, and maybe status). If people know about nursing and are still choosing something else, then that might be the only fix.

Cheers,

AetheLove

**Alundil** · 07-30-12, 02:39 PM

At issue though is that the shortage is not merely in nursing. Primary Care Physicians are another major area of shortage. That is expected to get worse as time goes. So while I understand, and agree with, some of your points as they apply to nursing, many of those points do not apply to "doctors". So the question then becomes what is causing this shortage of doctors and what do we do about it (note: that question applies to just about all types of healthcare workers beyond the entry level "patient care specialists" (basically clerks) and medical assistants (less qualified/licenses than nurses and takes < 1 yr to attain cert)).

There's a very obvious decline in trained and licensed medical professionals. Why? It can be argued that some might not be compensated as well as possible. Or that some might not receive the recognition or respect they should, but that's a tough argument to make in regards to most doctors and highly specialized mid level providers (CRNA, Physician Assistant, Adv Prac Nurse, etc).

Increasing nurse staffing levels would most certainly help. But they (nurses) can't legally diagnose anything per their license. Most of them can't prescribe anything and the mid levels, while some of them can diagnose and prescribe many things, can't generally prescribe and controlled substances.

This means that the providers that we do have, that can't keep up with the patient loads already, will fall further behind under the additional increased patient loads if the current trend continues (and it looks to be continuing).

**CivilWars** · 07-30-12, 02:44 PM

I don't think it is solely due to "low pay", but the combination of high cost of entry coupled with low pay. Obviously low pay is a VERY relative term, but if you look at going to college for 8-10 years, then entering the workforce with a hundred thousand in debt then you need to obviously make more than someone who just gets a BS in poli sci or some such.

**Hocus Pocus** · 07-30-12, 03:00 PM

Low pay?? RNs are making close to 100k here in South Texas. The shortage is due to the baby boomers. They live longer and get checkups far more frequently than people use to. Small copays and government assistance makes most visits cheap. Why don't I go to healthcare? Because its not my cup of tea. You may make some money but there's no longevity if you don't enjoy it. Also, just like the banks there's going to be stiff regulations coming up in healthcare. Plus working for a dr. Would blow. Most are very full of themselves yet suck at everything besides being a Dr. Their check goes out the window because they like to leverage themselves up in investments that never pan out.

Rant over

**deathgodusmc** · 07-30-12, 03:03 PM

Originally Posted by Alundil

Right - and that's what's very frustrating about the impending scenario (or the continuance if you prefer). There has been no (or none that I can see) focus placed on how to care for "the masses" (ever aging as you pointed out) or to acquire and retain people charged with caring for said masses on a large national scale. Period. Only the directive that the care "must" be given. Regardless of reality provider to patient levels.

And your point about cars and mechanics, while good as nuts to bolts ratios and the problems of imbalance, isn't as easy as a comparison from a "doing" perspective as people <> cars and mechanics <> doctors/nurses if only in the sense that people are several orders of magnitude more complex that autos (but I also know your were not being literal).

Both autos and humans are hard in their own right. One could simply replacing a kidney to anesthetize, cut old one out and stitch new one in. Our equipment and techniques got better but lets not forget you can amputate with a dull ass hack saw.

I think his example was spot on. Autos use to be as simple as take out bolt replace part. In both cases we have gone WAY past that. They you have to look at it as every doctor i've seen looks at people. Its a diagnostic service on a customer. The personal touch has been gone a long time now.