Recently, I have had the opportunity to guide three close friends through the intricacies of the American healthcare system. Other than some apparent substandard care in all three cases (conditions and illnesses not addressed, misdiagnoses and inattentive staff) one factor appeared common to all of my friends: shortages.
Whether it was from a doctor or nursing shortage, a lack of hospital beds or a shortage of medication and intravenous fluid supplies, I found it surprising that the allegedly “best” medical care in the world should suffer from such shortcomings. But on reflection, I can see why. I’ve addressed drug and fluid shortages in a prior blog, so I will only deal with the other issues mentioned.
First the doctors. It is apparent that the number of doctors available to treat patients is falling, and this will likely only get worse. According to data from the American Association of Medical Colleges (AAMC), “if all Americans had utilization patterns similar to non-Hispanic white populations with insurance in metropolitan areas, the U.S. would need an additional 95,100 doctors immediately.” The same AAMC report projects that by 2030 (only about a decade away!), the doctor shortage is estimated to be as high as 121,300. In the next 10 years, the US population is expected to increase by 11% and the number of Americans over age 65 years will grow by 50%. Since older people account for the most medical care, this surely will be a problem.
So too with nursing staff. Recently, a survey of Chief Nursing Officers showed that 72% surveyed said that they’ve been affected by at least “moderate” nursing shortages, and 40% of said that shortages were having a “considerable” or “great” impact on patient satisfaction.
As well, there is a phenomenon in hospitals call Emergency Department diversion, where that department essentially has to operate as a hospital ward, sometimes for days at a time, for lack of available regular hospital beds. My friend here in Washington, DC had to transfer his care to The National Institutes of Health from a university hospital because the latter wanted to treat him for two days or more in the Emergency Department.
All three of my friends recently seeking care have experienced at least one and sometimes two of the above challenges. Combine that with potential future drug and other essential therapy supply shortages and it is easy to see why, in the coming years, there will be a real “crisis” in health care.
The reasons for shortages are complicated. Certainly, an aging, older and increasingly chronically sick population is a primary cause. So is an unwillingness of potential medical students to take on the long, hard years of training only to be saddled with enormous debt at the end of their schooling. Also, with over a trillion dollars allocated to health care in the federal budget, it is easy to see why the massive expenses required to administer to the health of Americans (who, as I pointed out in last month’s blog, are apparently uneager to take better care of themselves) strain the country’s finances. The shortcomings of the system have been nowhere more apparent than in our own Veterans Administration healthcare, where, at least until recently, veterans had to wait months, even years, to get the care they’ve earned by serving our country.
What’s the answer to all this? Sadly, I don’t see one. “Medicare for all” surely isn’t a solution, as it would probably worsen the doctor shortage. (What young person would go into all that debt to be reimbursed, compared to private insurance, at Medicare‘s measly rates?) Will people start taking better care of themselves? Knowing human nature and the trends in health, I think not. Perhaps the growing trend in telemedicine will pick up some of the slack, as will possible “breakthrough” therapies.
But until then, be prepared for shortages to worsen and patient care and morbidity and mortality to suffer.
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