TEDMED #GreatChallenges: Rethinking the Healthcare Workforce
For years, various government agencies, healthcare advisors and nonprofit entities have been warning us about gaps in the healthcare workforce. Many healthcare systems are responding to the changing workforce landscape by relying on non-physician staff such as nurse practitioners and physician assistants as well as non-medical staff such as medical assistants, pharmacists, care coordinators, social workers and community health workers to provide patient-centered care.
Recently, TEDMED’s Whitney Zatzkin hosted a Great Challenges Program, “Shifting Work: Can Rethinking the Healthcare Workforce Drive Down Medical Costs?” This session, as the name suggests, explored long-standing challenges and potential solutions regarding the nation’s healthcare workforce. Here’s an overview of the panel discussion and its key takeaways. Watch TEDMED Great Challenges: Shifting Work: Can rethinking the healthcare workforce drive down medical... here.
Audrey Lum is chief clinical officer at Union Health Center in New York City. She oversees quality improvement and innovation projects, such as a continuing education medical assistant curriculum and a program to train health coaches. The center, thanks in part to these courses, has had great success in building a team-based care delivery system.
Edward Salsberg teaches health policy at the George Washington University School of Medicine & Health Sciences and was the founding director of the Center for Workforce Studies at the Association of American Medical Colleges (AAMC). He also was director of the National Center for Health Workforce Analysis established by the Patient Protection and Affordable Care Act of 2010 (ACA).
Troy Trygstad is the vice president of pharmacy programs for Community Care of North Carolina, overseeing 14 regional networks that provide support to nearly 1,700 medical homes, bringing together medical practices, county health departments, hospital systems and mental health providers in a medical neighborhood model. Trygstad also serves on advisory panels addressing medication non-adherence and has developed several programs around the topic.
Key Workforce Challenges
The shortage of primary care physicians has been well documented in several reports and studies. The call to improve these numbers has been heeded by educational entities but, as detailed by Salsberg, the real challenge is in the distribution of primary care physicians. Rural and low-socioeconomic status areas suffer the most from uneven distribution, as physicians flock to more affluent or urban locales.
Another challenge lies in training physician and non-physician medical workers in areas that support the growing trend toward patient-centered care, medical homes and coordinated care. In turn, these models of patient-centered care and centralized coordinated care assist in solving the challenges of primary care shortages, as they rely heavily on non-physician health workers. There are challenges facing the implementation of these symbiotic initiatives in terms of workforce, mostly having to do with competencies that are slightly beyond the scope of the education required for the certain positions. For example, Lum’s Union Health Center had to create a curriculum for their medical assistants to improve communication skills and knowledge of disease processes beyond what they had learned in schools. For all medical personnel working in a medical team environment, support and training is necessary to teach them how to manage patients outside of medical visits, prepare patients for medical encountersand follow up after encounters efficiently — this way patients are part of the medical care team, and not outsiders.
What is the point of all these changes? Hopefully, better health outcomes and reduced costs. Investing in team-based care and non-medical personnel can reduce costs. For example, Trygstad’s Community Care of North Carolina found that investments in one area could improve care as their model saw increases in drug and primary care utilization, but 20 percent less in inpatient admissions. Disease prevention and early treatment meant fewer patients had serious health issues down the road. Lum’s Union Health Center found the costs associated with training benefited their payees. In 2007, Union Health studied one small self-funded business and found it spent 17 percent less per member per month overall, and emergency room costs were 50 percent less for those participants in their program, which utilized medical assistants who went through communication and disease process training and training in self-management for patients. Lum cited the success of this program in ensuring that everyone involved, including the patient, was “on the same page.”
- Pressure to provide services in a cost-efficient manner is driving innovation and different delivery systems. But there is no hard data about what combination of professionals and para-professionals works best for costs and patient outcomes.
- Going forward, it will be important to reach a consensus as to what certain job titles should be for non-traditional medical staff like community health workers.
- Turf wars among clinicians, teams and patients are inevitable as things change. It will be essential to develop a culture in which clinicians, team members and patients all strive to be helpful, develop meaningful relationships and adhere to a joint set of key performance indicators.
The bottom line? There is no one solution to addressing the changing needs of patients and the fluctuating composition of the healthcare workforce in the age of evolving care delivery models. Patient and stakeholder involvement will be key in developing solutions that work. What changes have you seen as a patient or in your professional work related to the healthcare workforce? What do you think the right mix of medical staff would look like at your organization?
MHA@GW is proud to support the Great Challenges Program at TEDMED, funded by the Robert Wood Johnson Foundation. Through weekly dialogues with TEDMED’s intellectually diverse community, we move toward a more meaningful understanding of the great challenges of health and medicine. Click here to learn more about the Great Challenges Program. To share your ideas, join in the discussion at #GreatChallenges.