Is There a Doctor In the House? Part I
Over the past few months, we’ve spoken a lot about what the Affordable Care Act does for uninsured and underinsured Americans, but what does it do for the health care practitioners who are expected to care for them? Now that more than 7 million Americans have registered for health insurance through various national and state health insurance exchanges, a healthy and stable workforce is expected to meet this increased demand. Unfortunately, the health care workforce is facing a critical shortfall of health professionals over the next decade. This leaves many to wonder what this means for the quality of care that patients will receive.
Is there a relationship between quality of care and staff levels? While some may debate this topic, the answer should be a resounding, yes! Unfortunately, despite studies that have shown a positive correlation between quality of care and staff levels, the problem of understaffing still exists. Budget constraints, increasing numbers of qualified, retiring clinicians, and lengthy degree programs have contributed to this staffing shortage. The first step in stopping the “bleeding” is understanding that a correlation does exist. This will help guide policy interventions in order to improve quality of care and maintain cost efficiency.
The past decade has seen an increase in calls to mandate minimum staffing requirements as a policy instrument to help solve the problem of quality deterioration in health care facilities nationwide. By 2010, 41 states, including Washington D.C., had implemented minimum staffing mandates. Many of these states have been able to replicate the success that California had since it enacted a nurse-patient ratio cap in 2008. This legislation not only implemented limits on the numbers of patients assigned to nurses, but also aims to help reduce errors caused by fatigue and overwork by prohibiting mandatory overtime.
Despite this progress, an eventual system overload is inevitable. Without more graduates from nursing and medical schools and increased innovation in shared roles and responsibilities among doctors, nurses, and other medical professionals, individuals and families will continue facing longer wait times, greater difficulty accessing providers, shortened time with providers, increased costs, and new frustrations with care delivery.
Of course, doctors, nurses, and other medical professionals want to help people in need, but the sheer logistics of expanded care delivery, the current and growing shortage of personnel, and limited resources will certainly undercut the good intentions of the policymakers who crafted the national health law. Without a strong and growing workforce operating under better working conditions, the quality of patient care will not improve. Health professionals worry about the ACA’s impact on their workforces, and many are considering alternative careers and opportunities. The ACA increases stress on individual workers, organizations, and systems. Part of the problem is the overwhelming complexity of implementing the massive law, requiring them to meet new legal requirements while fulfilling professional obligations and meeting professional expectations for high performance in delivering patient care. Rather than ease these problems, the ACA aggravates them.
In part II of this series, we will examine some potential solutions as well as look at what Nevada has done in terms of easing the clinician shortage. I invite all of you to stay tuned.