Physician and Nursing Shortages

Healthcare reforms including Obama Care, formally named the Patient Protection and Affordable Care Act greatly impacts physicians and nursing shortages. There are several provisions which could direct impact physicians and nurses through incentives for potential recruitment, grants, training and retention. Through potential initiatives, the act may indirect effects that may question or present new reimbursement alternatives and models of health care delivery options. Healthcare reforms will allow millions of additional working as well as no working Americans to obtain healthcare coverage and this may challenge and highly impact physicians and nurses workforces across the United States.

Many healthcare facilities have already reported high vacancy rates for technicians, pharmacists, maintenance staff, housekeeping staff and radiology technicians and laboratory technologists. Today, fair percentage of the American population, roughly 20%, lack proper access to needed primary care because there is an ongoing shortage of physicians. Some doctors, almost 30% are declining to accept new patients whom are insured with Medicaid.

The changing demographics of the United States today and perverse reimbursements are direct impacts from the physician shortage.

The looming physician and nursing shortages will inevitably hinder the health care system that is already being tax as well as alter the way patients and their physicians interact because the doctor-to-patient ratio will continue to be raised which will hurt patient outcomes. All workers within the healthcare arena play a vital part in making the healthcare system successful. Physicians and nursing shortages definitely create problems for every department and for all other workers within their system. Worldwide shortages that the United States are currently experiencing may create dangerous and unacceptable care to patients.

Shortages additional enable work environments that do the foster retention of highly experienced and qualified healthcare professionals, resulting in high turnover and revolving worker pool. Physicians and nursing shortages present challenges that do not help the workforce in healthcare organizations worldwide.

These challenges include inadequate incentives which may attract students to join the profession, understaffing in various medical professions, as well as inadequate training facilities, and primary care being undervalued. Obama Care relies on primary care providers to coordinate care in the hopes of lowering costs and improving outcomes. “If the population growth, aging and demand for care created by the newly insured, it is estimated that by 2025, the U.S. will face a shortage of 30,000 primary care physicians, nearly 5,000 of which are attributable to the expansion of insurance under Obama Care.” (Howard, 2013) The health care system involves a network that is a combination of hospitals, employers, insurers, physicians, patients and various other stakeholders. A significant change impacting one component will reshape the entire system. Stakeholders are greatly concerned because the qualities of health care as well as the cost of care. Health care reforms will need to address changes that are missing in policy outlines which should make primary health care more rewarding and appealing to potential new nursing and physician staff and which will also help to maintain the nursing and physicians that are already practicing.

Additional the current supply of primary health care physicians will continue to fall behind the increasing patient demands. This will also result in stakeholders presented with the problems of increasing shortfall during the next decade within the primary care physicians. The availability of primary care is consistently and positively targeted to continued improvement with patient outcomes, raising health costs, lower utilization of health and reduced mortality rates. The Affordable Care Act set forth millions of dollars to address the problems and concerns that are associated with existing physicians shortages. The Affordable Care Act also has provisions that are aimed to improve the education, ongoing training as well as to help with the recruitment of nursing, physicians, doctors as well as other health care personnel. In addition, there are provisions in place that help to increase workforces’ cultural competency, enhance faculty training of healthcare professionals, and diversity. The provisions also play a vital role because of the fact they are put into place to examine innovative reimbursement and care delivery models that highlight primary care services value and offer in improvement in the patient care coordination.

On an average, primary physician groups may see about four or five patients within an hour, probably about one patient every fifteen minutes. Because of increase productivity and cost restraints and pressures, this number could increase dramatically. This trend, unfortunately, will be matching the burden of physicians declining incomes and job market. A lessor number of physicians earn what physicians earned many years ago. Primary health has been affected more as compared to services rendered. Additionally, the shift to a bundled fee for performance from the fee for service reimbursement system for force solo practicing physicians and small group practices into forming or partnering into larger practices. Physicians and nursing staff are not surprised by many of the findings. The Doctors Company, the largest physician-owned medical malpractice insurer in the nation in 2012, released results from a survey in which more than 5,000 physicians participated in across the nation commented on the future of health care reform.

A result of the survey concluded that 60% of the respondents concluded that the pressures of trying to increase patient numbers will probably have a negative effect on the level of care physicians whom have the opportunity to provide services. The study concluded that 51% of the physicians thought that their ability to successfully keep positive relationships with their patients and grow patient relationships would be negatively affected. Lastly, the study concluded that out of 10 physicians, nine are disillusioned by the concerns with the shortages so that several of the physicians actively discourage family and friends from pursuing careers in medicine. Unfortunately, this is a shocking reality of what many of us already know, and statistics presented from the study would be even higher if the exact survey questionnaire was conducted today. While the many projected newly insured patients that will enter the health care system may obtain their insurance coverage through available state ran exchanges, many new patients may still find themselves unable to afford potential discounted policies.

This will cause many to look for coverage from Medicaid out of urgency and because they may feel as though they have no choice. Primary care physician payments have been reduced in the past and we can look for them to be continually reduced maybe even more in the future. Many physicians are unhappy with the fact that they may owe over 160,000 when they finish medical school. Many potential physicians do not find this attractive because many will have salaries that are likely to be less than the cost of their education. Many physicians in this case will find it more attractive and enticing to become specials which again will attribute to the physicians and nursing shortages. Physician assistants and nurse practitioners may have to step up in fill in. Physician assistants are qualified personnel that have been license and qualified to provide needed preventive care options.

Physician assistants have an important role in the management of chronic disease prevention and management, administering blood sugars testing and interpreting blood sugar levels. When physicians have only a short time, less than 10 minutes or so to see a patient, sometimes they encounter issues which may leave no choice but to pass responsibilities to their , who are able, to practice with the supervision of the physician in most states. “Under the proposals, issued with a view to impending physician shortages, it would be easier for hospitals to use advanced practice nurse practitioners and physician assistants in lieu of higher-paid physicians.”(Pear, 2011) Because these change, hospitals could benefit by seeing savings which would be immediate. Legislation within several states at this time is seeking to extend the physician assistant’s autonomy by enabling the assistance to independently practice without of physicians, but under certain guidelines and protocols.

Many Americans may find this legislation to be filled with controversy, but many may feel that the legislation is needed to increase productivity of physician assistants, nurse practitioners and primary-care physicians whom will ultimately have responsibilities because of the growing shortages. Doctor-patient relationship will definitely change because of the shortages. In the past, patients were granted appointment times that could last up to 60 minutes, these days are gone because patients are rushed out because of people waiting to be seen in addition. This doesn’t mean service will go down or the quality of medical care will not be like it was. Even though many people have doubts and are not optimistic, I feel the quality of medical care and health service will improve. Research also indicates the quality of patient care will improve performance measurements will prove this in the future. The Patient Protection and Affordable Care Act will impose changes that may be disruptive in the delivery of primary care.

The act allows expansion of primary care access to physicians, millions of new patients, and policymakers will be faced with increase pressure to resolve primary care practitioner’s shortages. Even though controversy surrounds the Affordable Care Act enactment, the government should do more to drive motivation among physicians, nurses and professional medical associations. They can also embrace medical societies that may offer strategy initiatives suggestions that will help to meet the nation’s primary care needs. Physicians have experience some success to this date with embracing the changes to primary care, such as supporting laws that allows primary care practice to be perform by non-physician practitioners including assistants and nurse practitioners. Some physicians have realized that they may benefit from the integration of primary care practice from population health needs. Many physicians have realized that the environment now created is beneficial, it helps them.

Many physicians have chosen to stop being against non-physician practitioners and are welcoming them to work with them. Physicians can also offer problem solving and physicians should take initiatives to foster policies and develop solutions which addresses primary care shortages. Initiatives can involve no more opposition of non-physician practitioners with primary care providers (in the past medical organizations as well as physicians did show opposition to this). Additionally, physicians should embrace changes with the delivery of primary health care including the shifting of some responsibilities to the practitioners. Lastly, because of the Affordable Care Act focuses with prevention and wellness, physicians should realize that opportunities exist to the integration of the primary care practice with population health. Many Americans will have coverage with the expansion of health insurance coverage.

With the nation’s continued growth and new covered Americans the drive the demand for primary care to levels will definitely exceed existing capacity levels. The millions of newly insured Americans who may not had access to primary care will definitely be looking for primary care now with the enactment of the act. Because of this, there will more than likely be disruptive and unwelcome changes in the delivery of primary care. Important ethical issues are presented with health care reform. The recently 2010 enacted Patient Protection and Affordable Care Act have ignited ethical debates over some minor and major controversial topics. Why do many feel as though reform within the health care system such a controversial issue? Politicians seek to gain advantages over their worthy opponents which fuel the policy debate. Differences which are important to us all, with values and moral beliefs are the underlying issues of political differences. To help comprehend the moral parameters of debate within health care reform, it may be beneficial to start by analyzing the primary goals of the nation’s health care system. Individuals and as the society want and have high expectations with our health care system.

The United States health care system has been shaped by fundamental desires and goals. The American people will accept nothing less those exceptional, high levels of quality care which provides excellent health benefits. Americans expects the United States to continue being the frontiers of medicine and expects the United States to continue improving the quality of health care. The American people also want and welcome having a freedom of choice which means they make their own decisions about their care. These decisions can include deciding where to receive care, if and when they do, what kind of care they get, and from which health care provider in which they seek care. Basically, Americans including myself would like to maintain our on control over our health care needs, choices and providers. We also want affordability with healthcare, we don’t want to spend all our hard earned money on health care costs and not have enough money to cover our other needs.

In addition, most Americans feel as though our fellow Americans can share in the costs of providing health care benefits to us all and Americans Americans as well as the government wants to make sure that medical care costs are controlled. This is an important attribute of the cost of medical care and it’s a vital element of the health care reform enactment. Extending care access to everyone without appropriate cost control measures will be unsustainable. “The number of emergency room visits continues to rise at a rate greater than that of population growth, exemplified by an increase in emergency room visit rates from 352.8 to 390.5 per 1000 persons from 1997-2007.” (Tang, 2010) Today, the United States spends the most on health care per capita, more than any other country. Americans generally would prefer cost containment that does not reduce quality or services. Cost containment approaches are not design to interfere with the value of health care.

The PPACA have address cost containment strategies which include patient care that is accountable, patient-centered medical homes, and programs to reduce patients being readmitted and patients acquiring new conditions while admitted as well as bundled payments. The Patient Protection and Affordable Care Act have some provisions that may be negative for doctors, however in some instances patients can suffer more. However examining the positives, On a positive side, provisions as well programs can help many of us. The Affordable Care Act seeks to provide additional access to coverage, lowering health care spending and improving the quality of health care delivered services. Initiatives of the ACA aid health care organizations; doctors and providers work together to coordinate health care of patient’s beneficiaries to ensure the quality of health care continues to improve while spending and costs are lowered.

Many of the elderly have begun receiving the benefits of the provisions of the law. Some of these benefits include lower payments and preventive service care. They also are seeing the benefits of Medicare prescriptions at lower drug cost. The Affordable Care Act is helping seniors by allowing annual wellness visits and preventive services in which they have no upfront or out of pocket costs, offering coverage to individuals that may have pre-existing conditions and it allows for no one to be denied coverage because of pre-existing condition and huge savings on prescription drug costs. Though the health reform law includes measurement which may address the presented and growing shortage, other provisions in the law most likely will raise the demand of primary care. For example, the law is expected to extend coverage to millions of uninsured people by 2019, which will definitely increase the demand for primary care services. “The PPACA coverage expansions are predicted to increase the shortage of primary care physicians from approximately 25,000 to 45,000 by 2020.” (Carrier, 2012)

There are several measurements that can be implemented to help improve access to primary care providers and services. Because the U.S. has a high percentage of Americans without adequate healthcare a Mobile Health Clinic or a Nursed Managed Centers can be used to attract a lot of people such as the homeless people who do not have the means to be able to go to the doctor (Whelan, et al, 2010). This will allow them to be able to see a doctor and get the proper medical attention they need to have healthier lives. One possible approach to alleviating pressures on the primary care workforce is greater use of nurse practitioners, which could both increase the number of primary care providers and potentially free up physicians to care for more complex patients. Improving access to primary care services and having more effective public health measures are critical to ensuring that individuals have access to high-quality services at the place and time that best meets their needs. Physician assistants can we be a part of the answer as well.

They are well trained, have the clinical skills, with a high level knowledge base, and be a part of the solution. The skills they bring to the table can help address the impending avalanche of patients. Not only are they cost effective with overall labor costs less than a physician, but can take the stress off of a physician needing to see a certain amount of patients per day, as to keep the productive practice (Bahrych 2011). Finally, a scholarship program for students committed to providing primary care in communities with doctor shortages should be implemented; the program can allow open residency slots to be utilized in areas with shortages. Grants and incentives should be established.

Also initiatives should be in place to forgive student loan debt. I would also make the following recommendations for improvements that will increase the availability of specialty care through tele-health, bringing specialists to primary care sites, and using physician assistants to deliver specialty services; and also expand the role of primary care providers, physicians and nurse practitioners to handle more specialized health issues through consultations and ongoing training.


Howard, Paul. (2013, July). Get Obama Care While Supplies Last. Retrieved from Tang N, Stein J, Hsia RY et al: Trends and characteristics and US emergency department visits, 1997 – 2007. JAMA 2010; 304: 664-670 Pear, Robert. US Moves to Cut Back Regulations on Hospitals, October 2011. Retrieved from Bahrych, Sharon. Let Physician Assistances be Part of the Primary Care Answer, December 2011, Retrieved from

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