Filling the void of health care workers a priority

The Pennsylvania Medical Society is looking for ways to help fill the void of health care workers which it says is creating long wait times for patients.

Dr. William Jackson, president, said the society has been advocating for physicians and good patient care for 175 years and the latest crisis is the shortage of health care workers across the board.

“The doctor shortage is real,” Jackson said pointing to physician burnout. “The problem is complex.”

Jackson explained that more than half of physicians practicing are older and with the pandemic, many retired or are planning to retire earlier than they had originally planned.

The pandemic isn’t the only thing contributing to burnout. Jackson said there is a lot more paperwork required, mostly linked to prior authorization for testing.

“The non-clinical workload has increased a lot over the past several years,” he said.

That “paperwork” includes the conversion to electronic health records. ‘

“A lot of these physicians didn’t grow up with a computer on their hip,” Jackson said. “So, it has been challenging to make sure all the documentation is there.”

Jackson said Medicare has strict rules about how documentation is done before authorizing treatment, so doctors have to be precise and thorough. Most commercial insurers, while not subject to federal rules, generally follow the Medicare protocols, he said.

“There is a lot more clicking to meet the criteria,” he said.

And while the state has expanded the number of medical school spots, the number of residency programs remain slim.

Jackson said residency programs are mostly funded through Medicare, so expanding the program comes from the federal level.

Couple that with the number of Baby Boomers who seek more medical care as they age, the demand for practitioners has increased.

The medical society, which recently celebrated its 175th anniversary in Harrisburg, has created a task force to look at ways to relieve overcrowding in hospital emergency departments which has reached a “critical mass,” he said.

The long wait times harms patient care and Jackson said the Medical Society is working with the state Department of Health and legislators to find a solution.

Part of the problem, he said, is that many people use the emergency department as their primary care facility. Even with the growth of urgent care facilities, Jackson said, often times, people don’t know when it is appropriate to use them or if they need hospital care.

The nursing shortage continues as well, and Jackson said he thinks it will be at least two years before any improvement will be seen. Even with the relatively new UPMC Shadyside School of Nursing at UPMC Harrisburg, a partnership between UPMC and Harrisburg University, and a variety of new programs to train nurses throughout the region, Jackson said it takes time to get trained.

“A year ago, we saw traveling nurses who commanded competitive salaries filling in,” he said. “I personally am not seeing as many now and there is still a shortage, which creates problems.”

Jackson said he thinks one solution would be to look for nurses trained in other countries and extend them visas.

“Of course, we’d have to make sure they are properly trained and qualified to practice here.”

Some systems are looking at nursing teams so nurses can work at their highest level of training. Jackson said there are a lot of team members in a hospital setting so with the wide range of skill sets, they can create a team approach.

In fact, Lehigh Valley Health Network created the team nursing model which put together experienced registered nurses (RN), new registered nurses and eventually, licensed practical nurses (LPN) during the pandemic. That program worked well and is still in use.

Jackson said Pennsylvania and insurers also need to improve the process of credentialing physicians.

“The system is slow and there are unnecessary delays to get physicians into the system. It could take up to six months,” he said.

One program that is helpful for Pennsylvania’s rural communities is the Pennsylvania Primary Care Loan Repayment Program through the state Department of Health.

The Department of Health provides loan repayment opportunities as an incentive to recruit and retain primary care practitioners willing to serve underserved Pennsylvania residents and to make a commitment to practicing in federally designated Health Professional Shortage Areas (HPSAs).

Qualifying doctors can receive up to $80,000 for full-time work or up to $40,000 for half-time work, according to the Department of Health.

“The hope is that once the doctor is in practice, he will stay in the area,” Jackson said.

The current health care professional shortage is just the latest “crisis” the state Medical Society has worked through. Jackson said the 175th celebration on May 3 will showcase the work the society, one of the oldest in the country, has tackled.

“This is pretty notable,” Jackson said. “There have been huge changes and progress in medical care. When we started, smallpox was the big thing and that has been irradicated.

“Dysentery was big too and now we can diagnose and treat it quickly.”

In the 1950s, the Medical Society started the Safeguard Your Health campaign to increase awareness. And then there was the HMO revolution in the 1980s and 1990s, he said.

More recently, the prior authorization act was passed by former Gov. Tom Wolf, which made getting routine testing easier and faster.

“We’re not where we want to be, but we’re moving in the right direction,” Jackson said.