Multiple Solutions Needed for Health Workforce Shortage, Senators Told

WASHINGTON — The healthcare workforce shortage can be improved with some creative thinking, said James Herbert, PhD, at a Senate hearing Thursday.

“We must fundamentally change the prevailing educational model,” noted Herbert, president of the University of New England (UNE), at the hearing called by the Senate Committee on Health, Education, Labor & Pensions’ Subcommittee on Primary Health and Retirement Security. Rather than having trainees work in specialized silos, “a new educational model has emerged in which students from diverse disciplines are explicitly trained to work together across traditional boundaries in multidisciplinary teams … And this model has been shown to improve clinical outcomes, to reduce medical errors, to increase patient satisfaction, and to decrease provider burnout.”

Geriatrics is a good area in which to use this kind of model, said Herbert, because geriatrics “often encompasses a broad scope of conditions — heart disease and diabetes treated by primary care practitioners, isolation [treated] by social workers, oral health by dentists and hygienists, and so on. At UNE, rather than just merely training more geriatricians, we’re weaving training in geriatrics and in behavioral health across all of our healthcare professionals in this team-based approach.”

Problems Are Well-Known

Senators from both sides of the aisle agreed on what the problems were with the healthcare workforce. “Our nation simply does not have enough doctors, nurses, dentists, and other medical professionals, and why that is so, I’m not sure,” Subcommittee Chairman Sen. Bernie Sanders (I-Vt.) said in his opening remarks. “According to the Association of American Medical Colleges [AAMC], by 2033 the United States will have a shortage of up to 139,000 physicians … Primary care alone will be facing a shortage of up to 55,000 physicians, and this does not take into account what COVID-19 has done to the health profession” in terms of people burning out and leaving.

Sanders noted the federal government’s large role in funding graduate medical education (GME). “In 2015, the most recent data available indicates we spent about $16 billion on graduate medical education, providing roughly 31,000 residency slots a year,” he said. “Last year, Congress added 1,000 additional slots — that’s a step forward, but it was nowhere near enough.”

AAMC President and CEO David Skorton, MD, suggested a few reasons for the coming shortage. “Not surprisingly, the nation’s growing aging population continues to be the main driver of increasing demand for physicians over the next 15 years, on top of current stressors, including behavioral health needs, substance use disorders, and, of course, COVID-19,” he said. “Our physician workforce also is aging and a large proportion are nearing the traditional age of retirement, thus affecting supply, as do physician well-being and work hour patterns.”

Rural Areas Hard-Hit

Ranking member Susan Collins (R-Maine) emphasized the toll that the shortage was taking on rural areas. “In many areas of the country, there is a fierce competition for nurses, nursing assistants, other medical professionals, and physicians, and for those of us who represent rural states, the competition is particularly steep,” she said. “It is frustrating to watch, year after year, tens of thousands of qualified nursing school applicants who are turned away each year due to a lack of a sufficient number of faculty and a shortage of clinical sites. We need to break that cycle.”

Shelley Spires, CEO of Albany Area Primary Health Care in rural Albany, Georgia, also mentioned the recruiting problems. “Recruiting staff to work in underserved areas is, in a word, tough,” she said. “This goes for all staff, in particular focusing on clinical staff. The good news is we have existing programs that help with these challenges, but these systems could always have some additional investment.” Spires singled out the National Health Service Corps and the Nurse Corps as programs that could use additional funding.

Sen. Jacky Rosen (D-Nev.) noted that even though Congress increased the number of GME residency slots available, there are still some medical school graduates who won’t match to any slot. “How can we utilize these [graduates] — while they may be perhaps in a gap year waiting for a residency — potentially in some of our rural and underserved areas?” she asked. Skorton said medical schools were working on ways that the graduates could volunteer during that “gap year,” while they’re waiting to try again for a residency.

Lack of Diversity Still a Problem

Skorton also expressed concern about the lack of diversity among healthcare professionals. “When I began my first faculty appointment, Black men made up 3.4% of entering U.S. medical students; today, Black males are 3.6% of all U.S. medical students,” he said. “It’s inexcusable that we haven’t moved the numbers in 40 years.”

Collins asked for ideas on recruiting more people of color to the health professions. “We need to go to elementary schools, pre-K through 12th graders” to get students interested early on in healthcare careers, said Leon McDougle, MD, MPH, president of the National Medical Association. “We have a program at the Ohio State University called Health Sciences Academies where there’s a cascading mentorship model involved with partnering with the teachers and parents of students who are at feeder schools into Columbus East High School, which is right across the street from Ohio State East Hospital … That’s one example.”

Salaries are another issue, especially when it comes to recruiting behavioral health professionals, said Spires. “Most FQHCs [federally qualified health centers] and RHCs [rural health centers] are not positioned financially to take on large salaries; this salary is very hard to offset when you are serving an uninsured or underinsured population,” she said. “I happen to have had at least four psychiatrists interview and decline based on salary. The interest is there because of the mission of what we do, but the salary is the barrier.”

Sanders wondered about the low pay for primary care physicians. “Explain to me why, when primary care physicians often work so hard — crazy hours — why are they paid substantially less than other specialists?” he asked. “Does that make any sense at all?”

“It has to do with the way our payment systems are set up, and it’s not directly linked to the quality or the importance of care,” Skorton responded. Herbert elaborated further. “Our payment system is based on procedure and visit codes, and that’s what you get paid for,” he said. “If a primary care physician spends 15 minutes counseling a patient on their diet, lifestyle, exercise, this sort of thing — a patient with chronic disease — they’ll get paid one-tenth to half of what they would get paid if they did an EKG, maybe a catheterization, and gave them some medications. The payment system is flawed and it incentivizes the wrong things.”

Last Updated May 20, 2021