Heathcare, the Economy and Jobs - Physician and Nurse Shortages In Wake of Obamacare and the 2012 US Elections

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Medical Shortages

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:

  1. Medicare and Medicaid patients (although, some continue to see Medicaid patients and like the Medicaid system and speed of payments),
  2. 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.

Propaganda

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.

For Comparison

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.

Employment In the Growing Healthcare Field

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Comments 21 comments

ecoggins profile image

ecoggins 5 years ago from Corona, California

This is a fascinating forecast of the medical industry in the coming years. I admit that although you may not have intended it this way, I laughed hysterically when reading the part about doctors talking about opening practices in a Lunar or Martian Colony.


Patty Inglish, MS profile image

Patty Inglish, MS 5 years ago from North America Author

Yes, that can seem really funny! Everyone's thinking about space, it seems. Good for sci-fi stories, anyway, if the actual projects don't fly.

Fortunately, the free health care clinics are very good here and whenever possible, they refer patients for longer-term follow-up to doctors that do accept Medicare/Medicaid/self pay. Personally, I think medical should be free.


Patty Inglish, MS profile image

Patty Inglish, MS 5 years ago from North America Author

Could be, nightbear. My gripe is the complexity of the healthcare bill and trying to manage 300,000,000+ people, and the National DNA Database - all that. Hope it works out.


samsons1 profile image

samsons1 5 years ago from Tennessee

voted up and beautiful! Well written, timely and poignant.


Patty Inglish, MS profile image

Patty Inglish, MS 5 years ago from North America Author

Thanks very much, samson1. I'm glad to have a good nurse practitioner these days.


BobbiRant profile image

BobbiRant 5 years ago from New York

I have worked nursing homes for many years and one nursing home was recruiting doctors from the Philippines to work as nurses because they were making more in America as nurses. There is always a shortage of OT's and PT's as well for many years now. My mom always talked about doctors who even made house calls. New age of pay more, get less.


Patty Inglish, MS profile image

Patty Inglish, MS 5 years ago from North America Author

Doctors working as nurses. Interesting turn of events - Thanks, Bobbi.


schoolmarm profile image

schoolmarm 5 years ago from Florida

Hopefully we will soon have some new healthcare educators so that we can enroll some of these students that are being turned away from medical school. If so, we can fill a lot of these positions and also have some very happy graduates that can look forward to a secure future.


brandrocker profile image

brandrocker 5 years ago

Dreadful scenario! Thanks for your insight!


bettybarnesb profile image

bettybarnesb 5 years ago from Bartlett, TN

I have worked as in Medical Billing and Collections for many years. A lot of the problems consist of employees who really don't know how to bill and collect, therefore many claims are written off for timely filing. Billing takes time to learn and the laws changes constantly. Physicians only recieves a portion of what is honestly due them and claims were filed probably and followup performed in a timely manner.


susannah42 profile image

susannah42 5 years ago from Florida

In the meantime, there are theives out there who are submitting false claims and stealing millions from the healthcare system.


okmom23 profile image

okmom23 5 years ago from Midwest, U.S.A.

Patty,

Your insight is presented well. As a former Nurse, I am especially interested in how the public perceives the current and future of healthcare. Thank you for sharing! Voted up!


Hello, hello, profile image

Hello, hello, 5 years ago from London, UK

Your hub is down to earth, truthful information and is an eye opener. Thank you for such an interesting read. In view of all your facts I can't understand, even less now, that America stops the health care being introduced. I know the top, who makes the money, don't want to but the majority who is the man in the street surely want to. Already Hilary Clinton tried to when Chlinton was in power.


L.L. Woodard profile image

L.L. Woodard 5 years ago from Oklahoma City

In Oklahoma, the doctor/patient ratio is out of sight. Thankfully, there are nurse practitioners here and there who help take up the slack. I agree with your predictions, Patty. I see no other alternative to the constantly rising health care costs.


KoffeeKlatch Gals profile image

KoffeeKlatch Gals 5 years ago from Sunny Florida

Patty. how scary it all is. I can see the future of healthcare bill being uncertain. Great information, it really makes you think.


frogyfish profile image

frogyfish 5 years ago from Central United States of America

This is scary truth you have portrayed here - and I believe it will worsen before it gets better. We all need to become more familiar with how to take care of our bodies and not just swallow all the 'hype' out there. Believe you are right when you say - fewer doctors, but more 'cheaper practitioners'. Thanks for sharing your many facts!


TahoeDoc profile image

TahoeDoc 5 years ago from Lake Tahoe, California

I grew up VERY poor with no health insurance and, especially as a young adult, the fear of what would happen to me if I got sick. I busted my butt to put myself through medical school. I have been out of school for a dozen years and still have over $150,000 in medical school loans. Half of my salary goes to taxes. Of the half I "keep" a substantial portion goes to malpractice insurance and another big chunk goes to pay my loans. I only have a comfortable lifestyle because I still put in 60 to 80 hour weeks sometimes, to the detriment of my children. I have been working less this last year after having some health problems of my own,so now I just make enough to pay my bills but it's discouraging to give up your youth and sacrifice precious time with your family...holidays, weekends and so on and feel like you don't have much to show for it, especially when there is no end in sight.

I hope that things do change. I'd be happy to work less and get paid less. But, for that to happen, the whole system has to change. You can't pay back 200K+ in loans and tens of thousands of dollars a year in malpractice insurance if you aren't making a decent income, especially if you already pay half in taxes.


NicktheNurse profile image

NicktheNurse 4 years ago from Huntington Beach, CA

Thank you for the article. I agree with TahoeDoc. I am a nurse who went to law school and the legal industry is shot for new practitioners now, so I am trying to make money opening my own business to pay back nearly 150K in student loans. It is very frustrating. I am considering becoming an NP, but I am worried about working too many hours and paying too much in taxes and not having any left over to pay my student loans. Well written article. Going to vote it up!


Patty Inglish, MS profile image

Patty Inglish, MS 4 years ago from North America Author

If you can travel, you can become a Travel Nurse with higher pay and additional benefits, like rent and mortgage payments for up to a year at each assignment.


Healthexplorer 3 years ago

This above hub represents some beneficial point of view on medical care professions; most probably due to Obamacare we have noticed the lack of medical professionals but in order to save these kinds of shortages we used to promote the current condition of health care system.


Patty Inglish, MS profile image

Patty Inglish, MS 3 years ago from North America Author

Hey there. A lot of people do not major in healthcare professions in college, because of the expense and the extended time involved to become educated and licensed. But then, the 4-year majors are turning into 5 and 6 years of work anyway. Medical schools perhaps need to do more recruiting.

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