Medicine
Expansions of clinicians are out of control. There appear to be no obstacles to accelerating numbers of clinicians. This is the result of more sources of clinicians plus expansions in US MD, US DO, Caribbean, non-citizen international, nurse practitioner, and physician assistant training.
Graphics indicate the most rapid increases in nurse practitioner workforce, rapidly leaving US population growth behind. The total number of physician assistants who could practice is much higher as only 60% are clinically active.
The US Population will increase only 29% from 2010 to 2040 but the active clinician workforce is set to increase by 100%.
There might be some decline in the growth of annual graduates for any source, but the last doubling of NP graduates from 8000 to 16000 in less than a decade indicates that high numbers are not a limitation. The ten times expansion since 1980 does not appear to be facing limitations. Nursing school graduates have also increased substantially, allowing more expansion of NP graduates.
Physician assistant programs are increasing and some programs are being expanded.
US MD schools were slower to the expansion, but have clearly moved into expansion phase as well.
Osteopathic and Caribbean school expansions are also continuing. An expected decline in non-citizen international graduates has not occurred.
These expansive changes will not recover primary care or workforce where needed - because health spending is still limited for these areas. Coordination of specific workforce and specific payments are required and the US fails in workforce and in payment designs. The expansions are not without impact. Clearly the expansions result predominantly in non-primary care workforce for Too Many and the Wrong Clinicians
Shortages of physicians have grabbed headlines for over a decade. Numerous health professional associations have used this to lobby for more funding to train more graduates. New sources of clinicians have been added. The question remains. Will Americans be able to access the clinicians that they need when they need them?
More clinicians may well add to problems without helping areas such as primary care or workforce where needed. My assertions:
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Medicine
Too Many and the Wrong Clinicians
Expansions of clinicians are out of control. There appear to be no obstacles to accelerating numbers of clinicians. This is the result of more sources of clinicians plus expansions in US MD, US DO, Caribbean, non-citizen international, nurse practitioner, and physician assistant training.
Graphics indicate the most rapid increases in nurse practitioner workforce, rapidly leaving US population growth behind. The total number of physician assistants who could practice is much higher as only 60% are clinically active.
The US Population will increase only 29% from 2010 to 2040 but the active clinician workforce is set to increase by 100%.
There might be some decline in the growth of annual graduates for any source, but the last doubling of NP graduates from 8000 to 16000 in less than a decade indicates that high numbers are not a limitation. The ten times expansion since 1980 does not appear to be facing limitations. Nursing school graduates have also increased substantially, allowing more expansion of NP graduates.
Physician assistant programs are increasing and some programs are being expanded.
US MD schools were slower to the expansion, but have clearly moved into expansion phase as well.
Osteopathic and Caribbean school expansions are also continuing. An expected decline in non-citizen international graduates has not occurred.
These expansive changes will not recover primary care or workforce where needed - because health spending is still limited for these areas. Coordination of specific workforce and specific payments are required and the US fails in workforce and in payment designs. The expansions are not without impact. Clearly the expansions result predominantly in non-primary care workforce for Too Many and the Wrong Clinicians
Shortages of physicians have grabbed headlines for over a decade. Numerous health professional associations have used this to lobby for more funding to train more graduates. New sources of clinicians have been added. The question remains. Will Americans be able to access the clinicians that they need when they need them?
More clinicians may well add to problems without helping areas such as primary care or workforce where needed. My assertions:
- America will have too many clinicians. This is a bad situation for clinicians and for the ability of clinicians to require the care needed for patients.
- About 40% of Americans will still have deficits of clinicians in their county and in adjacent counties.
- Primary care clinicians will continue to be too few, particularly where primary care demand is most rapidly increasing.
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Blogs indicate that primary care can be recovered and should be recovered.
Robert C. Bowman, M.D. [email protected]
Basic Health Access Web Basic Health Access Blog World of Rural Medical Education
Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.
- Medicare And Medicaid At 50 And Beyond
When did M and M design change from support for health access to against health access and why? Government and Foundations are currently celebrating the accomplishments of Medicare at Age 50 - but which Medicare? Claims of improving the cost of care are...
- Distribution Failures Behind By Many Designs
The 3138 US Counties can be coded by physicians, by types of physicians such as active family physicians seen here, by population and by other demographics, including those age 65 that are increasing rapidly and even more in health care demand. As previously...
- More Reasons For Lesser Performance For Small Health
America is aging. With increases in age, Americans become more dependent and have more care needs in areas such as health, activities of daily living, finances, and more. Aging in America is not equitably distributed. States like Alaska and many of the...
- Damn The Reality Of Small Practices - Full Speed Ahead
The Graham Center has released a study indicating that 45% of primary care physicians are found in small practices with 5 or fewer physicians. Studies by county and by zip code indicate substantial portions of the American population dependent upon small...
- Health Access Blogs In Order Of Viewing
Most Recent Posts All True GME Reforms Point to Family MedicineFamily Medicine Needs a New Beginning - Current Preparation, Admission, and Medical School Plus Health Policy Interact To Prevent Family Medicine Choice - and Health Access ResultToo Many...