On Sept. 23, the six-month anniversary of health reform, several key insurance changes went into effect, including expanded coverage for adult dependents until age 26, coverage for children with pre-existing conditions and free preventive care. David Alexander, president of healthcare staffing firm Soliant, and Paul Willoughby, MD, president of the New York State Society of Anesthesiologists, predict five ways insurance changes will affect medical staffing.
1. Patients seeking free preventive care will flood the offices of family practitioners. Prior to the implementation of free preventive care, uninsured patients would not have the option of visiting a physician or hospital for a procedure like a colonoscopy or mammogram, Mr. Alexander says. As historically uninsured patients receive health insurance for — in some cases — the first time, he predicts family practitioner offices will be overrun by people seeking basic health care. "The [use of PCPs] is only going to increase, especially with the new opportunity for people to get a truly free physical," he says. "We're going to see a lot of people taking advantage of that towards the end of this year and the beginning of next year."
Recent changes to health coverage regulations also extended coverage for children under 26, meaning as many as 1 million children and young adults will be covered by their parents' health insurance policy. "We might see more physicals, and we might see those kids with lingering health problems that are back on their parents' insurance," he says. "I think the sickest kids will rise to the top."
He says the pool of children going back on their parents' coverage may be exacerbated by the slow employment opportunities for recent college graduates.
The problem, Mr. Alexander says, is that the United States is not producing primary care physicians fast enough. A solution that involves training new physicians will take at least a few years to implement, so staffing companies and hospitals have to find ways to get more use out of physician extenders — nurse practitioners and physician assistants, for example — to "take the heat off family practitioners."
2. The use of hospitalists will rise as family practitioners spend more time in the office. Because family practitioners will be forced by the influx of new patients to spend more time treating patients in their offices, hospitals will turn to hospitalists to staff overburdened hospital floors, Mr. Alexander predicts. "The family practitioner is really not going to leave the office," he says. "That's where we see the advent of the specialized hospitalist. When we use those hospitalists, the market becomes more efficient." He says hospitalists will benefit hospitals with their intimate knowledge of the hospital setting. Unlike a family practitioner, who would likely alternate his or her time in the hospital with his office hours, a hospitalist is staffed on the hospital floor every day, tracking patients, interacting with nurses and becoming familiar with hospital procedures.
He says this trend should cut down on patient wait time and increase satisfaction, because the hospitalist will become an easily recognizable face. Cohesion among hospital staff members may also increase, as nurses and hospitalists develop a strong bond that would be more difficult with a practitioner who only spent a few hours in the hospital every day.
3. Retired physicians could work shorter office hours to handle increased patient volume. Mr. Alexander says there may be a subtle silver lining to the tough economy: the likelihood that physicians, dissatisfied with their retirement savings, will return to work. "We have some physicians who have seen no retirement gross, as well as heavier taxation on the wealthiest Americans, many of whom are physicians," Mr. Alexander says. "They're feeling poor, and many of them are living in a house that's a fraction of what they paid for it or what they thought it would be worth."
As the healthcare industry experiences an influx of newly insured patients, previously retired physicians — or those approaching retirement — may consider taking on shorter office hours instead of retiring completely. "A lot of our [older] physicians and pharmacists say they want to start working 10 or 15 hours a week, and that's a money play for a lot of folks," he says. "Our job is to figure out how to take a full-time physician, nurse practitioner or pharmacist and turn that into a 15- or 20-hour-a-week position."
He says that could mean shorter office hours or the presence of more physicians in drug store clinics. If the healthcare industry can hold on to the large population of older physicians, Mr. Alexander says it might be easier to handle increased patient loads and staff providers during off-peak hours.
4. Physicians and nurses may become more concerned about medical liability. One of the challenges of increased coverage is that many incoming patients have been deprived of medical care for many years, Mr. Alexander says. "As these people who haven't had medical care pour into the system, medicine will become more about reducing your liability as a physician or nurse," he says. "You might see physicians thinking, 'I didn't think that test was necessary, but I thought it was necessary to protect our interests.'" Because of the high financial penalties that come with a medical malpractice lawsuit, physicians and nurses may be more likely to cover themselves with unnecessary tests that will put extra financial strain on the healthcare system.
5. Medical training will eventually have to undergo major reform. Mr. Alexander says in order to tackle the provider shortage, the medical training industry will have to change. He says in 2009, nursing schools turned down 50,000 potential nursing students because of a lack of lab space and educators. "I was in a medical science building in a big university here in Atlanta taking a tour, and I was looking at the size of the classes. They were educating physical therapists and there were 12 people in the class," he says. "I can tell you there were about 160 people in my accounting class at college." He says medical and nursing schools also spend a lot of money on state-of-the-art technology, sometimes forcing the institutions to choose between better equipment and more students.
Paul Willoughby, president of the New York State Society of Anesthesiologists, agrees that the medical education industry needs a significant overhaul. He says while health reform addressed many of the costs of patient care, it failed to consider the massive finances needed to fund a medical education. "They didn't look at the whole system," he says. "The cost of medical education and nursing education is skyrocketing compared to the price of inflation. In other countries, future physicians go to medical school for free, so they're not making that large financial investment. People will always pursue what they love, but when you have a financial investment, you have to get a return on that investment or the banks will get a little upset with you." He says the healthcare system will struggle to incent physicians to provide care at a low cost if those physicians are still burdened by massive financial debt.
Learn more about Soliant.
Learn more about the New York State Society of Anesthesiologists.
1. Patients seeking free preventive care will flood the offices of family practitioners. Prior to the implementation of free preventive care, uninsured patients would not have the option of visiting a physician or hospital for a procedure like a colonoscopy or mammogram, Mr. Alexander says. As historically uninsured patients receive health insurance for — in some cases — the first time, he predicts family practitioner offices will be overrun by people seeking basic health care. "The [use of PCPs] is only going to increase, especially with the new opportunity for people to get a truly free physical," he says. "We're going to see a lot of people taking advantage of that towards the end of this year and the beginning of next year."
Recent changes to health coverage regulations also extended coverage for children under 26, meaning as many as 1 million children and young adults will be covered by their parents' health insurance policy. "We might see more physicals, and we might see those kids with lingering health problems that are back on their parents' insurance," he says. "I think the sickest kids will rise to the top."
He says the pool of children going back on their parents' coverage may be exacerbated by the slow employment opportunities for recent college graduates.
The problem, Mr. Alexander says, is that the United States is not producing primary care physicians fast enough. A solution that involves training new physicians will take at least a few years to implement, so staffing companies and hospitals have to find ways to get more use out of physician extenders — nurse practitioners and physician assistants, for example — to "take the heat off family practitioners."
2. The use of hospitalists will rise as family practitioners spend more time in the office. Because family practitioners will be forced by the influx of new patients to spend more time treating patients in their offices, hospitals will turn to hospitalists to staff overburdened hospital floors, Mr. Alexander predicts. "The family practitioner is really not going to leave the office," he says. "That's where we see the advent of the specialized hospitalist. When we use those hospitalists, the market becomes more efficient." He says hospitalists will benefit hospitals with their intimate knowledge of the hospital setting. Unlike a family practitioner, who would likely alternate his or her time in the hospital with his office hours, a hospitalist is staffed on the hospital floor every day, tracking patients, interacting with nurses and becoming familiar with hospital procedures.
He says this trend should cut down on patient wait time and increase satisfaction, because the hospitalist will become an easily recognizable face. Cohesion among hospital staff members may also increase, as nurses and hospitalists develop a strong bond that would be more difficult with a practitioner who only spent a few hours in the hospital every day.
3. Retired physicians could work shorter office hours to handle increased patient volume. Mr. Alexander says there may be a subtle silver lining to the tough economy: the likelihood that physicians, dissatisfied with their retirement savings, will return to work. "We have some physicians who have seen no retirement gross, as well as heavier taxation on the wealthiest Americans, many of whom are physicians," Mr. Alexander says. "They're feeling poor, and many of them are living in a house that's a fraction of what they paid for it or what they thought it would be worth."
As the healthcare industry experiences an influx of newly insured patients, previously retired physicians — or those approaching retirement — may consider taking on shorter office hours instead of retiring completely. "A lot of our [older] physicians and pharmacists say they want to start working 10 or 15 hours a week, and that's a money play for a lot of folks," he says. "Our job is to figure out how to take a full-time physician, nurse practitioner or pharmacist and turn that into a 15- or 20-hour-a-week position."
He says that could mean shorter office hours or the presence of more physicians in drug store clinics. If the healthcare industry can hold on to the large population of older physicians, Mr. Alexander says it might be easier to handle increased patient loads and staff providers during off-peak hours.
4. Physicians and nurses may become more concerned about medical liability. One of the challenges of increased coverage is that many incoming patients have been deprived of medical care for many years, Mr. Alexander says. "As these people who haven't had medical care pour into the system, medicine will become more about reducing your liability as a physician or nurse," he says. "You might see physicians thinking, 'I didn't think that test was necessary, but I thought it was necessary to protect our interests.'" Because of the high financial penalties that come with a medical malpractice lawsuit, physicians and nurses may be more likely to cover themselves with unnecessary tests that will put extra financial strain on the healthcare system.
5. Medical training will eventually have to undergo major reform. Mr. Alexander says in order to tackle the provider shortage, the medical training industry will have to change. He says in 2009, nursing schools turned down 50,000 potential nursing students because of a lack of lab space and educators. "I was in a medical science building in a big university here in Atlanta taking a tour, and I was looking at the size of the classes. They were educating physical therapists and there were 12 people in the class," he says. "I can tell you there were about 160 people in my accounting class at college." He says medical and nursing schools also spend a lot of money on state-of-the-art technology, sometimes forcing the institutions to choose between better equipment and more students.
Paul Willoughby, president of the New York State Society of Anesthesiologists, agrees that the medical education industry needs a significant overhaul. He says while health reform addressed many of the costs of patient care, it failed to consider the massive finances needed to fund a medical education. "They didn't look at the whole system," he says. "The cost of medical education and nursing education is skyrocketing compared to the price of inflation. In other countries, future physicians go to medical school for free, so they're not making that large financial investment. People will always pursue what they love, but when you have a financial investment, you have to get a return on that investment or the banks will get a little upset with you." He says the healthcare system will struggle to incent physicians to provide care at a low cost if those physicians are still burdened by massive financial debt.
Learn more about Soliant.
Learn more about the New York State Society of Anesthesiologists.