Doctor shortage threatens U.S.

In 1977, Congress feared there would be a glut of doctors, so they froze the number of residencies at 110,000 nationwide. This is another incidence of the government interfering with our economic natural selection process and creating a cure that is becoming worse than the bite. Unintended consequences? Who knows what our government intends anymore?

Excerpt: Dr. Atul Grover, chief advocacy officer of the medical colleges association, pointed to several reasons for the current and anticipated problem:

• There has been a cap on slots in medical schools and residency training programs for the last 34 years as the U.S. population grew by 31 percent. Federal money now helping to pay for graduate medical education could be slashed by Congress.

• The elderly population nationwide is expected to double in the next decade. Adults in this age group use health services more than twice as much as younger folks.

• One-third of physicians now in practice nationwide are expected to retire in the next 10 years. About 21 percent of Ohio's doctors are now 60 years or older.

• As many as 30 million people currently without insurance are expected to be pulled into the system as federal health care reform rolls out in 2014.

Grover emphasized that the nation is in need of doctors in every specialty from family medicine to heart surgery.

Doctors won't be the only solution to keeping up with patient demand and more accessible care, Ohio State's Lucey said. "We need to think creatively and work with our colleagues in nursing, pharmacy and business."

Cleveland Clinic CEO Dr. Toby Cosgrove said he sees more midlevel practitioners, such as physician assistants and surgical technicians, used to improve efficiency in hospitals.
Changes already are occurring in Northeast Ohio.

Some doctors are using a group approach in which they direct care and focus on complicated cases while their team -- consisting of nurse practitioners, physician assistants, dietitians, social workers and pharmacists -- covers preliminary exams, patient counseling and follow-up care.

Another approach is corporate health care. University Hospitals, for example, has been expanding its program by working with companies like Lincoln Electric to provide employees with on-site nurse practitioners to provide easy access to care for minor illnesses and to manage chronic conditions such as high blood pressure and diabetes.

Both the Cleveland Clinic and UH are staffing health clinics in grocery stores and drugstores with nurse practitioners in an effort to make primary care more accessible to the public.

The Clinic, MetroHealth and UH have established medical homes and community centers that blend services of doctors, nurse practitioners, nurse educators and case managers.

Such wellness efforts -- growing in Ohio and across the country -- reduce the burden on doctors and the need for expensive care down the road.

"If you get someone in a state of good maintenance," Connors said, "then they are less likely to get severely sick and less likely to end up in the emergency room."

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