This report originally appeared in the August 2010 issue of DOTmed Business News

For the 32 million Americans who will receive health care coverage in the upcoming years as a result of the Patient Protection and Affordable Care Act, finding a primary care physician won’t necessarily be easy. A workforce shortage, most prominent among primary care physicians and nurses, is already affecting hospitals now, but that problem only promises to increase in the coming years.

“As millions of Americans obtain health insurance for the first time and can now access ongoing health care, it’s critical that our nation ensures a strong and viable physician workforce,” said Cecil Wilson, president of the American Medical Association (AMA), in prepared remarks. “Even more physicians may be needed to care for the influx of newly insured Americans.”

However, it’s not only the newly insured that will strain the workforce. According to the AHA, it’s expected that the 78 million baby boomers will begin to retire this year. In order to accommodate this aging group, the Bureau of Labor Statistics estimates health care will generate 3.2 million jobs between 2008 and 2018. But the question remains, will that be enough?

The numbers say no. The American Medical Association predicts a shortage of 85,000 physicians by 2020, and the U.S. Bureau of Health Professions projects a shortage of 109,600 by the same year. Already, at least 22 states and 16 medical specialty societies report an inadequate physician workforce.

It’s not only primary care physicians the country will be lacking. The Department of Health and Human Services estimates that by 2020, the country will need 2.8 million nurses — 1 million more than the expected supply.

Dr. Peter Buerhaus of Vanderbilt University School of Nursing offers a different estimate. He predicts there will be a shortage of 260,000 nurses by 2025, which are “conservative” estimates, says Robert Rosseter, chief communications officer for the American Association of Colleges of Nursing.

Health care reform: a catch-22
When it comes to primary care physicians, money is tight, making it a hard profession to draw medical students into. But as the population ages and people live longer as a result of advancing medical practices, changes need to be made to increase the workforce pool, explains Edward Salsberg, director for the Association of American Medical Colleges’ Center for Workforce Studies.

“People are living longer…increasing survivorship rate,” he says. “We have the ability to do procedures that didn’t even exist 10 or 20 years ago. It’s leading us to conclude that the demand for service is rising rapidly.”

HHS stepped in to try to make the primary care atmosphere a more attractive place to be for existing physicians as well as those studying medicine. In June, the department allocated $250 million to increase and strengthen the primary care workforce, which is expected to have a shortage of 21,000 physicians in 2015, according to AAMC.

The funds are expected to support training and development of more than 16,000 new primary care providers over the next five years.

“This critical investment will help alleviate the current shortage of primary health care providers including physicians, physician assistants and nurses," said Rep. Lois Capps (D-Calif.) in a statement. “Increasing the number of primary care professionals will allow us to place an increased emphasis on preventive care and wellness.”

Salsberg points out that there isn’t a quick fix to the problem, but government programs and funding can help the situation in the short term. He says there is legislation to increase Medicare fees for primary care physicians. This would be welcomed with open arms, especially because once the baby boomer population hits retirement, it will turn to Medicare for health care coverage.

Dangling the carrot
Not only do doctors-in-training have to dedicate nearly a decade to post-grad studies, it costs a pretty penny as well. According to AAMC, the average education debt of 2009 graduates is $156,456.

In order to make the thought of applying to med school less intimidating, there are programs in place to dull the financial blow and to attract a diverse group of applicants. A section of the health care law provides grants to offer, among other things, financial assistance to trainees and faculty. Funding for 2010 is set at $125 million, and this amount may be needed for 2011 to 2014.

“Students and residents need help identifying funding sources and managing financial issues,” said AMA’s Wilson. “Congress must lift the cap on government-funded medical residency training slots so that all future medical students can finish their training and become full-fledged physicians.”

And in an effort to attract nurses to the scene, the law increases the total loan amount for clinic nursing programs to $17,000.

The AHA, in a letter to Congress, asked for an increase in funding for Nursing Workforce Development Programs — the primary source of federal funding for nursing education. The programs are currently funded at $244 million, and the nursing organization has requested to receive $267.3 million.

“If we got anywhere near the funding physicians got, we wouldn’t have a shortage,” says Cheryl Peterson, director of the American Nurses Association’s Department of Nursing Practice and Policy.

A teaching shortage
When it comes to the inadequate number of nurses in the workforce, it’s not a sign of a lack of interest in the profession. It’s actually the opposite.

“There is not enough faculty to teach people who want to be nurses,” says Rosseter. “It’s not that folks aren’t interested in becoming nurses — schools can’t handle the capacity.”

AACN reported that in 2008, U.S. nursing schools turned away nearly 50,000 nursing applicants due to a lack of faculty, clinical sites, classroom space and budget constraints. Nearly two-thirds of the nursing schools surveyed for the report cited faculty shortages as a reason for not accepting all qualified applicants.

Peterson calls the faculty shortage and the lack of funding for nursing programs a “big barrier” to increasing the workforce pool.

“We’re trying to ramp-up capacity, but we have these limitations of funding, faculty, sites,” she says. “We have the students...we don’t have the capacity to educate [them].”

“It takes awhile to produce faculty,” says Rosseter.

It takes nurses at least six years to complete their masters and eight years for a doctoral, not far behind physicians, making it impossible to address the shortage in the workforce immediately.

With educators still being educated, it’s not likely the nursing shortage will abate. According to a 2008 report from the Council on Physician and Nursing Supply, 30,000 additional nurses should graduate annually to meet the nation’s health care needs — an increase of 30 percent over the current number of annual graduates.

Nurses are baby boomers too
According to numbers from a 2006 Nursing Management Aging Workforce survey, 55 percent of nurses reported they plan to retire between 2011 and 2020.

Despite a slight easing of the shortage due to older nurses delaying retirement because of the recession, a 2009 article by Buerhaus in Health Affairs cited a rapidly aging workforce as a key contributor to the projected shortage.

“How do we retain [older nurses]?” asks ANA’s Peterson. “How do we keep an engaged older workforce?”

She offers suggestions, including better pension programs, better wages and a phased retirement plan, which would allow nurses to move from full-time to part-time before retiring completely.

In 2008, Peterson says, the average age of an employed registered nurse was 45.5, and generally, nurses retire around 55.

Spread too thin
Lacking adequate hospital staff can affect the health of employees and patients. Overworked nurses will be stressed nurses. Stress and fatigue contribute to sickness as well as potential errors in judgment and attentiveness.

“My license could be at risk if I made an error,” says Peterson, pointing out a major concern of overworked staff.

Earlier this year, nurses in Minnesota spent months fighting Twin Cities hospitals to adjust the nurse-to-patient ratio language in their new contract, arguing that the current ratio was not safe.

“Our nurses feel like with the recent layoffs and cutbacks through the recession, [hospitals] are asking the remaining nurses to do more with less,” Minnesota Nurses Association spokesman John Nemo told DOTmed News in May. “It’s getting to the point where nurses think [hospitals] are dangerously understaffed, where patients’ lives are at risk.”

“Increasingly, hospital management pushes nurses to take more patients or to continue with patient loads that compromise quality or even result in complications,” said MNA member and nurse Nellie Munn, in an e-mail interview with DOTmed News. “When mistakes are made or care and treatments are delayed or missed, the focus is on the competence of the nurse, rather than the conditions of the work environment, especially staffing levels.”

In July, the nurses and 14 hospitals finally agreed on a contract that calls for “renewed commitment” to looking at the staffing issues presented by both the nurses and the hospital employers.

“Nurses who work on units that are understaffed definitely feel the pressure,” says AACN’s Rosseter. “It impacts their productivity and ability to give the care they know they should be giving. Frustration leads to bad patient outcomes.”

Recruitment: Health care wants YOU
When it comes to recruitment for the health care workforce, education programs and organizations work to attract potentials from all backgrounds and socioeconomic status. Tapping into different communities would bring about more interest and thus, more nurses.

Peterson believes education plays an important role in shedding light on the value of the profession, in hopes of attracting minorities.

The health care law has provisions to increase the nursing workforce pool by including a youth public health program to expose and recruit high school students into health care with a career focus on public health; promoting training of a diverse workforce; and providing grants to increase minority representation with loan opportunities and scholarships.

Salsberg of AAMC recognizes that primary care recruitment is a public responsibility, and it’s important to encourage people to view medicine as a viable career.

Where nurses have a shortage across the board, for doctors, the issue is a little more focused.

“It’s generally not an issue of recruiting students,” he says. “[We have to] issue strategies to recruit non-traditional students, that’s both diverse economically and ethnically.”

A surviving sector
Not currently faced with a significant job crunch is the radiology sector. A 2008 survey from the American Society of Radiologic Technologists, found that recruiting for radiography, computed tomography (CT) and nuclear medicine technologists has become substantially less difficult. Employment for radiologic technologists and technicians is expected to grow faster than average, according to the Bureau of Labor Statistics (BLS).

Employment among this group is expected to increase by about 17 percent from 2008 to 2018, according to BLS. Growth can be attributed, in part, to an increased demand for diagnostic imaging.

While there isn’t a personnel shortage, radiography is still experiencing a shortage . . . of job openings. A 2010 ASRT survey published in August, found that there aren’t enough jobs for radiologic technologists, or radiographers. The numbers indicate that the vacancy rate in this field has been declining, and right now, sits at a low 2.1 percent. That means for every 100 budgeted full-time positions, an estimated 2.1 are unfilled, according to ASRT. The survey also showed that among those polled, 54.4 percent are not currently recruiting techs for their radiology departments.

BLS also predicts that while hospitals will remain the main employer of radiologic technologists, a number of new jobs will be available in physicians’ offices and diagnostic imaging centers.

And the workforce for radiation therapists — those who deliver radiation treatment to cancer patients — is expected to increase by 27 percent between 2008 and 2018, also due to an aging population. Rapid growth is expected across all practice settings, according to BLS.

When it comes to the radiologist workforce the supply and demand is stable, says Dr. C. Douglas Maynard, professor emeritus of radiology at Wake Forest University. Maynard has also been conducting an annual survey of the radiologist workforce for the past decade.

“The workforce tends to go up and down,” Maynard says. “It depends on what’s happening in the marketplace. In the late 90s [with managed care] there was basically a surplus of radiologists. Then there was a shortage of radiologists. Now, we have about an even balance.”

Maynard attributes this stability to two main factors: the uncertainty of the new health care legislation and a poor economy, which is driving people to remain in the workforce.

Because of the four-to five-year educational and training tracks in radiology, when the workforce inevitably faces a shortage, it will take several years to satisfy the growing demand.

“I’ve done surveys before, and measuring the workforce and its needs is extremely difficult,” Maynard says.