Heathcare, the Economy and Jobs - Physician and Nurse Shortages In Wake of Obamacare and the 2012 US Elections
A related HubPages Forum Post asked about the impact that 40% of American physicians acting to close their practices will have on Obamacare efficacy from 2010 into the future. This information originated from Investors.com News and Analysis on December 9, 2010.
However, I saw some related adjustments in private medical practices beginning in the 1990s with physicians closing or streamlining their practices. In addition, senior citizens overall experienced related changes even before that decade. Some now rely on community sponsored health clinic says, free clinics (if there are indeed any located in their cities), and the growing ranks of nurse practitioners in private practice that are proving invaluable.
Some physicians retire early, because of increased malpractice insurance fees, along with the complexities of paperwork associated with some types of patient insurances that include Medicare, Medicaid, SSI, SSDI, and children's government sponsored coverage. Other physicians more simply begin to reject new patients among Medicare recipients and the self-insured (those who pay out of their own pockets). Increasing numbers of such older individuals cannot find a doctor in private practice to be their family physician.
In Central Ohio for example, dozens - even hundreds - of physicians have 1) already closed their practices before their originally expected retirement ages or 2) streamlined their practices by eliminating new patients among:
- Medicare and Medicaid patients (although, some continue to see Medicaid patients and like the Medicaid system and speed of payments),
- All patients without health and/or major medical insurance. This particularly includes many "self-pay" patients. Some of these cannot afford to pay all of their healthcare costs, but their lack of insurance may interfere with some necessary medical testing, because of high prices.
Some physicians have retired and joined the staffs of Veteran Administration Hospitals. Others have closed their own practices and joined others. Still others went overseas to attend to US soldiers and the civilians in Middle Eastern countries at war and on the edge of conflict not epidemics, like Ira, Afghanistan, Somalia, and several more.
Fortunately, top physicians, surgeons, nurses and other medical professionals in Central Ohio volunteer at a group of free health clinics any of 4 nights per week and some weekend afternoons. These clinics are seeing longer and longer lines of patients lining up for help. To stand in the gap, health fairs and special day-long treatment clinics are sponsored by private practices in increasing frequency around the Greater Columbus Area at churches and recreation centers and these includes dentistry services. Further, we are seeing the advent of free day-long veterinary clinics for yearly vaccinations, examinations, and minor treatment for pets as well.
Case In Point
In Ohio, especially Central Ohio, healthcare costs were driven up in the second half of the 20th Century by a prominent family that owned newspapers and other important businesses, along with having many physicians among their members. Health insurance through the workplace became popular after WWII. These particular local physicians began increasing prices, while the insurance companies responded by reducing approved payments. This spread throughout related systems until in 1986, it was general practice for the Bureau of Workers Compensation to routinely allow only 2% disability on a serious-disability claim, while the claimant's personal physician would insist on 98% ot 100%. Thereby, claims for total disability took 15 years to settle, until legislation was passed to require a 10-year time limit.
Now, many people blame insurance companies for high healthcare costs. I think it is the continued struggle for power between physicians and insurance companies, along with those few professionals that have defrauded public and private insurances.
In the 1990s, the physicians mentioned above lobbied against the field of Nurse Practitioner, because it would presumably drain away the business of doctors. Healthcare costs rose further. By the mid-2000s, however, many Nurse Practitioners were in business in Ohio, one of them from the family of physicians that lobbied against the whole field.
In the 21st Century, the field of Nurse Practitioner is joined by Physician Assistant (or Physician's Assistant), both of which are taking up some of the slack - at lower costs - of physicians that are leaving the healthcare business around the country. I look for this trend to continue.
The rise of Alternative Health Care, supported by its own arm of the National Institutes of Health (NIH), is providing additional options for the death of American physicians. On a curious related note, it seems the news is full of the discovery of people practicing medicine without a license (only a misdemeanor in Ohio), some with much success. How many in poor neighborhoods are doing similar, with less success? I think it is becoming part of the Underground Economy.
The nature of healthcare in America may have begun changing to accommodate "Obamacare" many decades before it was conceptualized or proposed.
What are Doctors Doing?
Some retired physicians are going to work for the Veterans Admiinstration in their clinics. Others go to work for pharmaceutical companies or to university research. One group here is still speaking of forming an association for moving patients with controllable high blood pressure to a Lunar Colony. At the same time, there is talk of moving volunteer senior citizens to Mars to comprise the first manned colony, never to return to Earth. Some doctors will go with them, some undoubtedly tired of trying to earn a living on Earth.
Down here, I think we will see more work for Nurse Practitioners, Physician Assistants, Medical Assistants, others on this level, and also for the Allied Medical Field overall. New positions for individuals with less than an MD or DO certification may well be invented and developed, with lower salaries to reduce overall healthcare costs. Fewer doctors will have more NPs and assistant-types under their practice umbrella.
It happened to Dentistry. Our grandparents saw one dentist for all related needs. Today, some practices support several professionals under the supervision of the dentist as he checks their work and handles major cases. I look for the same to occur in the Physician's Office by 2015, along with the emergence of additional free-standing Nurse Practitioner Clinics. The IF in this case is if we can persuade enough people to take up the education and work.
American Healthcare Job Market on 12/28/2010, incuding about 5 Million jobs:
- Openings for Physicians on Indeed.com and SimplyHired.com : ~ 360,000
- Openings for Nurse Practitioners - 43,000+
- Openings for Physician ('s) Assistants - 60,000
- Openings for Medical Assistants - 146,500+
The first three occupations each have experienced a decrease in job listings in 2010. Medical Assistant has experienced an 18% increase. Future trends will be interesting.
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