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Does President Obama’s Job Plan Include Health Care?

Posted Sep 12 2011 10:04pm

Posted on | September 12, 2011 |

President Obama just completed announcing his Jobs Plan in the Rose Garden at the White House. It’s already on its way to Congress and focuses on a cut in payroll taxes and “rebuilding schools and blighted neighborhoods, helping local governments pay teachers and firefighters, setting up an ‘infrastructure bank’ to leverage federal loans for roads, water systems and other public works projects.” (1,2)

Surrounding our President were teachers, firefighters, police officers and small business people. Health care workers? Not so much. Why?  Well, one reason may be that jobs in health care continue to expand even in down times. Another reason may be that health care – workforce wise – is caught in the cross-winds of transformation. The demographic changes in America and our move to universal coverage may demand more health care workers – but probably not the same types of workers we’ve utilized in the past.

Workforce Issues in health care have become a health policy career track over the past two decades. The issue has been studied and re-studied, usually as an addendem to the status-quo. The most recent study, from the Alliance for Health Reform with the support of the Robert Wood Johnson Foundation goes a bit farther but still tip toes around the real issues.(3)

You should read  the report yourself. It’s based on two blue ribbon meetings in the fall of 2010, and the input of a range of career workforce experts. It boldly lays out part of the story:

1. 40% of physicians are over 55 and 33% of nurses are over 50.
2. Medical school debt averages $145,000 for public and $180,000 for private medical schools.
3. We are an aging society and the Affordable Care Act will soon add 32 million to our insured population.
4. Some estimates say we will have a 25% shortage of physicians by 2025 – if they continue to do the same work they have done for the past century.
5. The number of direct care workers (not physicians or nurses) is expected to increase by 2018 by 35%.
6. Doctors groups have blocked independent nursing practice in all but 11 states in the Union.
7. The current workforce is largely non-mobile (meaning a patient has to go to someone’s brick and mortar to access care). 40% of the workers are in hospitals; 21% in extended care facilities; and 16% in ambulatory offices.
8. Health care doesn’t need a stimulus package. Since the financial crisis hit in December, 2007, the nation lost 8.4 million workers – while health care employment expanded by 732,000.

The report also suggests quietly that the world is changing. The report sites one advisor, Ed Salsberg, director of the National Center for Health Workforce Analysis, who says, “increasing the supply alone will not be sufficient to assure access. Redesigning the delivery system to make more effective use of our health workforce is critical.” The report also notes that “Some analysts question whether physicians being trained today are learning the right skill set. Are they being trained to practice evidence-based medicine, team-based care, care coordination, and shared decision making?” (3)

The report tees up critical questions, but leaves them unanswered. Questions like: Are we training for the right skills? Are those with skills using them to the full potential? Where do nurses and unlicensed allied health professionals fit into the picture? Are the physician shortages absolute or distributional? How will new technology change the workforce picture? What choices are medical students, nursing students, and others making with regard to area of practice and why? Which health professional categories are growing jobs? What role will nurses play in the redesign of health care delivery?

Teeing up questions without answers sometimes reflects a desire to gather additional knowledge and other times reveals the absense of a preferred vision for the future. So let me throw one out, the concept of a home-centered health care system which advantages the power of health consumerism, information technology advances, and aging complexity.(4) Such a system focused on customized and personalized health planning and prevention in the home would require a different kind of workforce including:

1. A home health manager, previously the informal family caregiver, designated for each extended family.
2. Physician-led, nurse-directed virtual health teams with home health managers fully invested members of the team.
3. Basic diagnostics, including blood work, imaging, vital signs, and therapeutics performed by the home health manager and transmitted electronically to the physician-led, nurse-directed educational network, which provides feedback, coaching, and treatment options as necessary.
4. Sophisticated behavioral modification tools, age adjusted for each generation, present and utilized, and funded in part by diagnostic and therapeutic companies that have benefited from expansion of insurance coverage and health markets as early diagnosis and prevention takes hold.
5. Team reimbursement tied to patient health. Patients incentivized by lower insurance rates for healthy outcomes.

Which means:

1. Physician office capacity sees growth as most care does not require a visit. Physician surpluses allow redistribution to underserved areas.

2. Nursing school enrollment goes up as the critical role as educational director of home health manager networks becomes a major magnet for the profession.

3. Family nutrition is carefully planned and executed; activity levels of all five generations rise; weight goes down; cognition goes up; mental and physical well being are also up.

4. Hospitals continue to right size – they’re more specialized and safer, with better outcomes. And scientific advances have allowed early diagnosis and more effective treatment, making the need for hospitalization increasingly rare.

So my advice to those who choose Health Workforce Policy as a career – if you believe as I do that America deserves a personalized, prospective, and participatory health care system 1. Start with a vision of what you want to create.
2. Define the type of workforce necessary to support such a vision.
3. Examine all current job descriptions – including physicians – to establish your current bank of human capital.
4. Subtract #3 from #2, and the result will be your future workforce requirements.

For Health Commentary, I’m Mike Magee

References:

1. Job Deal Likely To Get A ‘Yes’ On Tax Cuts And Trade, A ‘No’ On More Spending. Washington Post. 9/12/11. http://bit.ly/r0HQUy

2. Runninghen R, Goldman J. Oboma Says Congress Should Act On $447 Billion Jobs Plan With No Delaya. 9/12/11. http://bloom.bg/ppa2ZH

3. Okrent D. Healthcare Workforce Supply vs. Demand. 2010. www.allhealth.org/publications/Medicare/Health_Care_Workforce_104.pdf

4. Magee M. Visions. 2011.  http://positivemedicine.info/?page_id=54

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