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The Doctor Shortage and Nurses’ Role in Filling the Gaps

Posted Oct 18 2012 12:00am
By Kathryn Norcutt

Doctor shortage could be intensified by the Affordable Care Act
Despite how one may feel about the Affordable Care Act, it is going to change the face of American medicine forever. For better or for worse, once it is up and running in 2014 an estimated 30 million newly insured people will have access to the health care system outside of the emergency room. This is great news for anyone who works in or has been forced to visit one of the thousands of overcrowded emergency rooms across the US, however, the looming doctor shortage will loom even larger once those patients have access to specialists in other parts of the hospital. 
Getting by the Fed cap It’s easy to blame the government for just about every problem, but since health care and the government are so deeply intertwined, it’s difficult to sneeze without having to get approval from one federal organization or another first. That having been said, the reality is that the government holds the health care purse strings. Those strings have been especially constricted when it comes to creating new doctors, let alone doling out payments for Medicare and Medicaid, but that’s another story.
For the last 15 years, the government, who pays for a large part of all of the residency programs through Medicare spending, has capped the total number of new residents it pays for at 85,000 students. According to the US Department of Health and Human Services, we are lacking around 16,000 primary care doctors across the US, and that number is projected to be closer to 63,000 by 2015, unless we can find a way to either remove the cap or fund more doctors as soon as humanly possible. Even if the cap was lifted today and raised to 200,000 residency programs, we wouldn’t see its effects for another five years or more. By then, we will have over 30 million new patients, with nowhere close the number of doctors able to see them.
Where do we fill the gap? Unless we can either import enough doctors magically from around the world, or export our patients by 2014, someone is going to have to provide medical care to our nation’s sick. Who will fill this gap varies from hospital to hospital, but it is in large part being filled by nurses of all types. Training a nurse is about 25 times less expensive and time consuming than the $145,000 it takes to get the average doctor through residency. For the cost of one fully trained general physician, we could have 25 or more fully trained nurses and in much less time too.
As Angela K. Golden, President of the American Academy of Nurse Practitioners puts it, “Four Decades of research show that nurse practitioners provide high-quality, cost-effective, comprehensive, patient-centered primary health care with excellent outcomes. In a growing number of states, a nurse practitioner can own and operate an autonomous, independent practice, not requiring any physician involvement.” In short, nurses are more than qualified to provide care for general practice cases both in and out of the hospital. Honestly, for the average patient, they’re not going to care whether or not they are being treated by a nurse or a doctor, as long as they are getting treated at all.
The road ahead Nurses everywhere have been stepping into more and more diverse roles as doctors seem to be rarer and rarer. It’s not uncommon to be admitted to a hospital and receive excellent care without ever meeting a doctor. The doctor shortage may have changed the playing field for medical care forever, but it doesn’t mean that there isn’t a silver lining for nurses. We could be seeing the dawn of the Golden Age of nursing which will hopefully provide coverage for the staggeringly wide gap between the upcoming number of patients and care providers. The medical field, just like all fields, must yield to the laws of supply and demand. As Daniel P. Moen, President and CEO of Sisters of Providence Health System explains, “there’s got to be a leveling out or equalization of supply and demand at some point.”   





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