The Health Care Shortage: Causes and Solutions

As the baby-boom generation ages and retires or moves into other positions, replacements will be needed. As technology creates new diagnostics and treatments, new positions may be created as well. As the demand for more services grows, so will the need for larger staffs.

There is a shortage of health care professionals in many fields today. Physicians are still scarce in rural areas and lower socioeconomic sections of the country despite efforts to recruit them with tuition forgiveness and other package deals of benefits and incentives. Nurses are in short supply all across the country. Not long ago when women sought to join the health care team they were limited to becoming nurses. Now women are members of all health care professions. Low salaries and poor benefits in the field of nursing have long been ignored, resulting in a lack of incentive for anyone to pursue a career as a nurse. Creative solutions are way behind in filling the growing need for nurses.

Critical shortages of nurses have encouraged creative recruiting efforts and financial incentives that are enticing many into the field. However, the shortage of nurse educators will be a major factor in keeping this shortage at critical levels for years to come.

Tighter immigration laws will affect the health care profession as a whole. As fewer immigrants are available to step in and fill the openings, the need for new health care professionals will also grow.

Cost containment issues have forced a shift in the health care industry as well, which has led to a shortage of home health care workers. There has been a major shift from inpatient to outpatient care. Patients no longer spend a week to ten days in the hospital recovering from surgery. They go home in two to three days and are expected to care for themselves, or have family members or hired help assist them. When necessary, home health care agencies address these needs. But even then, the ultimate responsibility for the care rests upon the patient and family or caregivers, as the home health care is not unlimited. Medicare and insurance companies restrict the number of visits allowed, and in most instances expect the patient or caregiver to learn to perform the care needed.

Many times diagnostics and treatment are provided as outpatient services rather than as inpatient services. The series of tests a patient may have been hospitalized for in the past is now performed over several days in outpatient diagnostic centers.

Managed-care systems imposed by insurance companies dictate inpatient versus outpatient care and have resulted in waiting periods for authorization for procedures and treatment as well.

All of these scenarios have influenced staffing issues and roles within the field of health care. For instance, where nurses and therapists once treated patients in the hospital until they no longer required care and went home, now they are expected to do much more teaching so that patients can go home and care for themselves.

Fact

Registered nurses top the list of most-needed workers in the United States, and indeed there is a critical shortage of nurses that is only expected to worsen. Nursing is one of the most physically and emotionally demanding jobs, and the workforce of nurses is aging. One of the challenges that nurses have faced in this crisis is that there are so many other health care career choices available now.

Those who work in outpatient and home care environments now deal with patients who are much sicker and weaker and require more care and instruction than ever before. This shift has created tremendous growth in the need for home health aides as well as personal and home care aides. Home health aides visit patients on an intermittent short-term basis to assist with bathing and personal care under the supervision of skilled nurses or therapists. Personal and home care aides are hired privately to assist patients with personal as well as custodial care in their homes.

Roles change, but staffing levels, pay, and benefits don't always keep pace. This can cause severe retention and recruitment issues for employers and lead to shortages.

ssential

Efficiency and cost-effectiveness have forced role changes. Nurses, physicians' assistants, pharmacy techs, and veterinary technologists now handle a larger portion of the examination and patient teaching process. The practitioner's time is too costly for them to spend it taking temperatures, asking questions, and instructing in care and prescriptions.

Solutions will come from thinking outside the box as well as examining the usual issues such as salaries, benefits, and work conditions. Flexibility is going to be a key issue.

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