It’s no secret that the United States is facing a serious shortage of health care professionals. We have an aging population, and we’re simply not training enough health care workers to meet growing demand.
The shortfall in the US is indicative of a global trend of alarming scope. In their most recent, comprehensive global study the World Health Organization (WHO) estimates a global shortfall of 12.9 million healthcare workers by 2035.
In order to understand how to fix the shortfall, we have to consider both the factors causing a rise in demand for health care and those limiting the supply of health care workers.
Not by Doctors Alone
Complex chronic diseases are the leading determinants of demand for healthcare workers.
According to the CDC, as of 2012 half of all adults in the US — 117 million people — had one or more chronic health conditions. One in four adults had two or more chronic health conditions. Eighty-six percent of annual health care spending is for patients with one or more chronic conditions.
The US has one of the best health care systems in the world and is home to leading medical schools like Stanford, Harvard and John Hopkins. Even so, our MDs simply can’t solve this problem on their own.
Licensed medical doctors are highly capable of treating Type II diabetes, hypertension, depression and obesity once these conditions have progressed into full-fledged diseases. They are not nearly as equipped to provide the much less expensive care required to prevent these diseases or reverse their earliest symptoms.
This is through no real fault of their own. The current fee-for-service system incentivizes quick-turn doctor visits (the average PCP visit includes about 8–12 minutes of face time). HIPAA regulations are complex and opaque; the perceived threat of unintentionally violating these regulations makes phone and online communication between office visits an obstacle.
We need to invest in training more health care workers who can provide compassionate preventative care.
The type of care that someone with a chronic disease like diabetes needs to reverse his or her condition is often behavioral in nature and can be administered successfully by a qualified health coach or a nurse.
We Need More Generalists
From a supply side, we’re producing too many specialists and not enough generalists. Of course, we’ll always need brilliant surgeons and anesthesiologists, but most of the world is severely underserved when it comes to basic, general care.
As Allen Frances, MD and Professor Emeritus of Psychiatry and former Chair at Duke University argues in Huffington Post:
“The most powerful departments in any medical school became the ones that attract the most research dollars and produce the most clinical revenue by doing highly reimbursed medical and surgical procedures. Primary care teaching and practice has always been deeply devalued by medical centers because it does neither.”
I agree that a greater emphasis on primary care would fix a myriad problems we face in our healthcare system, but I would go one step further. I argue that we need to devote more energy to training competent health workers outside of medical universities. Nurses, pharmacists, and other health sciences professionals are all generalists by nature, and we should be encouraging these professions now more than ever.
We also must remove the taboo of choosing a “less prestigious” route. The men and women who choose to become nurses, health coaches, and social workers are vitally important to the health of their local communities. They have the needed level of cultural competency and bedside manner that not only improve patients’ experiences but also meaningfully contribute to better outcomes.
It starts with education. At the highest level, we need to train more students in health care professions — including general medicine — without sacrificing quality. I’ve spent my entire career dedicated to this cause. While any global solution will be necessarily complex, we can make a measurable impact right now.
Experimenting with new models of health sciences education
Healthcare delivery has changed, but the way we train our professionals has not. Most health sciences and medical schools still operate under a model pioneered in the early 1900s by Abraham Flexner. Much of our health science and medical education is dour, based on rote memorization; yet, most medical knowledge can be learned outside of the classroom. We should be pushing the “flipped classroom” in more schools around the world. Teachers and professors will never be replaced by technology, but their role can become more additive in nature– they can spend more time guiding hands-on learning, moderating dynamic discussions, and sharing knowledge unique to cultural, linguistic, and socio-economic circumstances.
Giving Students More Tailored Options
Not every student is cut out to be a neurosurgeon. That’s okay. We don’t need more highly trained specialists; we need more general practitioners, nurses, caretakers, social workers, and compassionate health coaches.
We can build smarter pathways by leveraging student data to match individuals with the careers for which they’re best suited. The data-driven pathways we’ve implemented in all our programs at Ponce Health Sciences University — from nursing to health sciences to our MD degree — have improved test scores and match rates. They’ve also helped us graduate more students and aid them in choosing fulfilling, decades-long careers.
Empowering Students To Rethink The System
What if every health insurance plan came with a personal health coach responsible for helping you achieve your health goals or help you maintain a healthy lifestyle in between doctor’s visits?
What if success were measured by a patient’s quality of life improvements, not just whether or not the pills we subscribe treat the condition?
What if health sciences and medical students were graded on bedside manner, cultural competency, and compassion just as seriously as they are graded on anatomy and biochemistry today?
Our current path is unsustainable. We need to be teaching the next-generation of healthcare workers not just how to take blood and read lab results but also how to redesign the system in a way that improves patient lives and ensures that individuals everywhere have access to exceptional care.
David Lenihan, PhD is the President of Ponce Health Sciences University and the CEO of Tiber Health.