Solving Workforce Woes: 4 practical reforms providers should consider

Nurse Leader Insider, March 1, 2018

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In the face of a worsening nationwide physician shortage, health providers should look to developing more avenues for doctors to join the workforce, according to a new study from the Mercatus Center at George Mason University.

Jeffrey Flier, MD, of Harvard Medical School, and Jared Rhoads, MPH, MS, of Dartmouth Institute for Health Policy and Clinical Practice, released a working paper Tuesday entitled “The US Health Provider Workforce: Determinants and Potential Paths to Enhancement.”

The authors argue that over-regulation for medical practitioner credentialing by state government organizations has resulted in significant protections from local and international competition for members. This creates a challenge to instituting reforms, though the study suggests four steps can affect change outside of the regulatory system. 

The study includes several recommendations to address the core issues surrounding the severe physician shortage facing providers. These include a call to remove barriers to create more medical schools in the U.S., hire more foreign-trained physicians, utilize nonphysician providers, and embrace innovative technological options.

Below are four recommendations for health providers to consider as practical reforms to improve quality and reduce cost.

1. Minimize barriers to license doctors

The authors argue that problems persist with the accreditation process conducted by the Liaison Committee on Medical Education (LCME), which is in charge of accrediting U.S. medical schools. While accreditation is voluntary for schools, individuals are not able to obtain a physician’s license without taking the United States Medical Licensing Examination, which requires an LCME-accredited school graduation, the authors state.

U.S. medical schools, however, lack available openings for applicants, charge high prices for attendance, and are unlikely to pursue meaningful medical experimentation and innovation due to the high-stakes nature of the accreditation process.

The authors suggest the answer to these problems might be the development of future medical schools that are attached to integrated health systems (IHS) rather than universities. Mirroring what Kaiser Permanente has pursued, the study states that such an approach has the potential to provide better efficiencies, education and delivery of healthcare.

Though the study admits that critics believe future medical schools attached to IHSs could create a two-tiered medical school system, the authors argue the current system is no better.

2. Hire foreign-trained physicians

A commitment to recruiting international medical graduates (IMGs) is another recommendation for staffing issues faced by providers.

Currently, IMGs make up 25% of the physician workforce, providing care “as good as or better” than that of U.S. medical graduates, according to the study. IMGs are more likely to work in rural, low-income communities and are overrepresented as primary care physicians, which helps address the physician shortage, the authors state.

The study offers suggestions for the Educational Commission for Foreign Medical Graduates (ECFMG), which oversees foreign medical school graduates entering the U.S. healthcare workforce, to revise its policies.

Most importantly, the authors argue that ECFMG should reduce retraining licenses for IMGs, which are often times repetitive to foreign programs. The study highlights a program developed by the Minnesota Department of Health, which implemented “new approaches for IMGs to be licensed to practice, especially in primary care and in rural areas, without current barriers to licensure.”

3. Hire more nonphysician providers

Though nurse practitioners (NPs) and physician assistants (PAs) may operate under “reduced practice” or “restricted practice” limits, the study states both professions offer an opportunity to deliver quality care to consumers at a reduced cost.

The authors said NPs and PAs are inexpensive investments for providers seeking to mitigate shortage issues, adding that they are proven to be just as safe and effective as physicians in similar services.

They also acknowledge the challenges to scope-of-practice decisions for NPs by medical societies across the country, though they note that NPs have certification procedures in place through the American Association of Nurse Practitioners while PAs are usually licensed by state boards.

And while they do not have the same range of available services as physicians, NPs currently operate without physician oversight in 21 states, and can write prescriptions in all 50 states.

4. Look to transformative technology

Noting the growth of medical technology options in recent years, the authors suggest that providers embrace new opportunities in telemedicine, physiologic sensors, and mobile health apps.

The potential impact of technological opportunities in healthcare range from clinical applications to revised payment options for consumers, all with the goal of increasing access and lowering costs.

However, the study acknowledges that governmental regulations and industry hesitation toward innovative technologies could suppress potential medical advancements.

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