What’s Next in America’s Healthcare? (Part 1 of 2)

In last month’s column I talked about healthy families. That topic led me to thinking about the “health of our nation.” What health issues are you concerned about? Although there are specific public health issues such as chronic diseases, infections, and obesity, I would like to discuss the big-picture items (which indirectly impact our health) such as our doctor shortages, the cost of healthcare, aging, and hospital errors.

As a healthcare consultant, I frequently hear about these concerns from my clients because they create barriers to accessing and obtaining good healthcare. By developing a clearer understanding of the process, we can learn to advocate for ourselves, as well as become more informed citizens who will back measures that truly lead to improved healthcare for our nation.
 
Here are some of the nation’s health issues that we face:
 
1. We have a shortage of physicians, but why? Sadly to say, our young people are not being encouraged to go into practice. In addition to the changes and frustrations that we all know about with our healthcare system, there are financial issues. Medical students can easily walk away with at least $300,000 in loans (and that doesn’t count undergraduate costs). It takes 10 years to complete the basics of a physician’s education and the two-year residency program. The government is increasing interest rates on federal school loans, and we could possibly see a phasing out of the Federal Perkins School Loan Program. Also, the number of medical schools and residency programs are limited, so the competition to get into medical school is rigorous – for example, med schools with 15,000 applicants and only 260 slots; this is common. If that isn’t enough discouragement, hospital administrators (on average) make more money than the average physician and yet the education of a hospital administrator may include only a bachelor’s degree, or a master’s degree for a CEO. The average salaries in the U.S. are as follows:

• Hospital insurance chief executive officer = $584,000
• Hospital C.E.O. = $386,000
• Hospital administrator =  $237,000

Compare that to the salary of a:

• Surgeon = $306,000
• Pediatrician = $190,000
• General physician = $185,000

 
According to Healthline, the American Association of Medical Colleges predicts that we will be short by as many as 90,000 physicians by 2025, with one-third of the shortfall being in primary care. Due to exorbitant school loans and disparate salary ranges, it is obvious why young physicians are choosing specialty areas rather than pediatrics or general medicine. This means for our primary care we will be relying on other providers such as nurse practitioners, clinical nurse specialists, and physician assistants. As a result of this demand, predictions include shortages of these providers as well. A scarcity of health providers is not only a U.S. problem; globally there is a shortage of 7.2 million doctors, nurses & midwives, according to the World Health Organization.

If you find this frustrating, do something about it. Become informed and get involved in America’s educational system. Ask your representatives what educational policies and federal loan programs they support.
 
2. Physician office settings look different.
We know that fewer and fewer physicians operate their own practices. Three reasons include:
1. Medicine is now a complex business
2. Medical schools are not training physicians to run a business (Although more medical students are choosing to get their MBAs as well as their medical degrees)
3. The technology and electronic records are too complex and cumbersome for a solo practitioner to manage
 
So what will the offices look like? The actual physician offices will be bigger because there will be fewer and fewer solo practices. Instead of an office setting, certain forms of your care will take place in a retail center. Even now millions of patients go to such retail centers as Walmart, Walgreens, or CVS for their flu shots, and some of these centers have clinics that provide various forms of healthcare. More people will be going to urgent care centers or hospital-owned facilities.
(http://www.healthline.com/health-news/this-is-what-your-doctors-office-will-look-like-in-five-years-042715#6).

If you have concerns about this, see my previous articles (I archive them on my website) about how to establish a good doctor-patient relationship, improve communication and become your own advocate, and get the most out of your visit with your physician.
 
3. Patients are getting care via apps and other technology.
People can track their symptoms online, research self-help techniques, and calculate their health conditions with various apps. Many home devices can monitor blood pressure, pulse, glucose levels and more.
 
Telemedicine is also changing the field of medicine. More and more, patients will be able to video chat with doctors and/or take photos of their rash, pink eye, or bruise on their mobile devices and send them to the clinic or doctor. Patients won’t have to leave their homes, work settings or vacation spots. Parents can care for their children from home. Nurses in assisted living facilities or nursing homes can avoid hospitalizations of their residents by Skyping with the physicians. Throughout the country telemedicine is already in place and its growth will be considerable, especially since telemedicine costs less and is much more convenient. It doesn’t work for every setting, and there are certainly times that physicians need to have “eyes on the patients,” but telemedicine will serve the purpose for some types of healthcare.
 
4. Hospital errors are the third leading causes of death in the U.S.
 
We are now facing approximately 1,200 deaths per day (440,000/year) in our hospitals in this country due to medically induced errors, accidents and infections (http://www.hospitalsafetygrade.org/newsroom/display/hospitalerrors-thirdleading-causeofdeathinus-improvementstooslow). Prescription drug errors are top on the problem list. Nationwide, people are simply taking too many prescription drugs. In addition to consumers needing to become savvier by participating in their care, hospital administrators must be held accountable. As consumers, we must demand better systems and policy-making by our hospitals.

The causes of these errors are complex and go beyond the responsibility of physicians and other healthcare providers. Hospital administrators have gotten into the business of directing the medical practices in the hospital and yet no medical degree is required of them to practice. As previously discussed, their education is as little as a bachelor’s or master’s degree. The care of patients must be given back to the healthcare providers, and a system of collaboration between administrators and providers is necessary for good quality of hospital care. For the consumers who are active in efforts for promoting life in this country, this is a worthy cause for taking action. Information can be found in the Journal of Patient Safety
(http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx).
 
5. Poor work-life balance impacts our health.
Americans are stressed out! Unlike other countries, we are prone to answering our work emails and phone calls during nonworking hours. Some companies in other countries have mandates against this. Many American employees work nights and weekends, and we tend not to take the vacation time that we are entitled to. American companies provide less vacation time and have feeble parental leaves of absence – if any at all. And then we wonder why we have broken family lives in America. We can take measures to protect ourselves by setting boundaries on our work-life and spending more time on our leisure life and with our families. We can also incorporate healthy approaches in our lives to de-stress (see previous articles about this on my website) – but what about being informed regarding worker protection plans? One sample measure is called Total Worker Health. The CDC defines this as “policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being” (https://www.cdc.gov/niosh/twh/totalhealth.html).
 
This column is Part I of II.   Next month, Part II will include:

• If You are Rich, You Will Get Better Health Care and More Likely Live Longer
• Food Deserts Do Exist in Our Country
• Aging: Caregiver and Alzheimer’s Challenges and Costs
• As the Climate Changes So Does Our Health