Research Paper (undergraduate), 2017
11 Pages, Grade: B+
Statement of Need
Plan 1: Altering the undergraduate medical education (UME) pathway in the two medical schools in the state
Plan 2: Increasing visa-waivers and improving loan-forgiveness and direct incentive programs
Plan 3: Increase residency funding
PRIMARY CARE PROVIDER SHORTAGE PROPOSAL
We are proposing the following solutions to the challenge of primary healthcare provider shortages in rural Washington: that undergraduate medical education (UME) pathway in the two medical schools in the state be altered; visa-waivers, loan-forgiveness and direct incentive programs expanded; and residency funding be increased. These are workable with the right support and resources.
We understand that primary healthcare physician shortages will worsen more and more over the next decade if nothing is done now; and there is no doubt that communities have been feeling the impacts of shortages. Since none of the plans proposed here can work to reduce the expected decrease, the right combination of strategies will results in an increase in the number of primary healthcare physicians per population in rural Washington, which is the main aim of this proposal.
This proposal reflects the opinions of Neon Healthcare Research, a major research division of Neon Inc. We are a non-profit organization that aims at improving public health policies through the use of scientific research methods and solutions. We are focused on improving health and healthcare delivery in the United States and around the world. We have a broad research portfolio which ranges from newer challenges in the delivery of healthcare to emerging issues in non-communicable disease management and population health. Alongside this broad focus, we are particularly interested in a few key areas of health: organizing patient care, payment for health care, quality of care, health research tools, and healthy communities.
The recipient organization is the Washington State legislature who needs research and empirical support to make necessary policy changes in order to address the present shortage of primary care health care personnel in rural areas of the state.
Primary healthcare has been the cornerstone on which strong healthcare systems have been built over the years as it ensures that communities experience positive health outcomes and health equity (Leiyu, 2012). There is presently a shift from disease-oriented etiologies to finding out what environmental, cultural, individual, and family factors are responsible for disease. This shift has led to a transition towards the provision of individual/family-oriented and community-focused healthcare services in a coordinated and sustainable manner so as to meet the health needs of the population. However, despite the understanding that primary health care is very vital to any healthcare system, many locations globally are experiencing imbalances between primary and secondary healthcare – including the United States. This has been referred to as primary healthcare provider shortage.
Primary healthcare provider shortage refers to the situation in which there is a reduction in the amount of local primary healthcare provider/physicians per capita below a particular threshold (Friedberg et al, 2016). According to the Health Resources and Services Administration (HRSA), primary care provider shortage areas are those locations in which the ratio of the primary care physician to the rest of the population is less than 1/3,500 (Friedberg et al, 2016). In the United States, the total number of primary healthcare physicians have been placed at 6,000 for a population of about 60 million people (Health Resources and Services Administration, 2015). Despite these glaring figures, the existence of primary healthcare physician shortages has not been completely accepted by the relevant stakeholders. A recent report from the Institute of Medicine showed that there was “no credible evidence” to support the claims that there were looming shortages in primary healthcare deliver (Pauly, Naylor, & Weiner, 2014).
It is understood that the fraction of primary care physicians who practice in the rural areas is very low compared to the urban centers. The presence of constant migration has negatively influenced the supply of skilled providers to these rural centers in which the rural primary care physicians are the older, and most probably, male, physicians who have been born in those locations (McGrail, 2015; Fordyce, Doescher, & Skillman, 2013). In Washington State, the total physician workforce was about 19,260 in strength as at 2014 (approximately 275 per 100,000 people), out of which 15,421 were into direct patient care (at 220/100,000 population) (Friedberg et al, 2016). From figures obtained at the end of 2015, 154 primary healthcare shortage areas were discovered within which a population of about 1,291,074 lived. These areas needed up to 229 additional primary healthcare physicians to meet the minimum requirements, even though this shortage has been predicted to increase to about 1695 physicians needed by 2030 in rural Washington.
The present bulk of primary healthcare physicians in Washington State are fed mainly by a pipeline of graduates from the University Of Washington School Of Medicine, and the Pacific Northwest University of Health Sciences (PNWU). The former, being an allopathic medical school produces about 200 medical graduates per year, focusing on general medical practice, while the latter is an osteopathic medical school which graduates about 140 students per year (Skillman & Stover, 2014; Greer et al, 2016).
In 2014, the state of Washington had about 1900 residents who vied for the Accreditation Council for Graduate Medical Education (ACGME)-sponsored training programs during which these residents experience rural rotations and contribute to the rural primary healthcare physician workforce (Friedberg et al, 2016). This is equivalent to about 27 physicians per 100,000 population, lower than the general state median of 27.4 resident trainees per 100,000 population. According to Friedberg et al (2016), the University of Washington’s Family Medicine Residency Network and its allied rural medicine training programs have been able to retain residents in rural medical practice after the completion of training. However, these programs have experienced significant funding and other logistical challenges (Lesko, Fitch, & Pauwels, 2011).
In addition to the state-produced graduates of medicine, a survey of medical practitioners who received J-1 visa waivers between 1993 and 2003 showed that 84 percent of these people stayed longer than the required 3- to 5-year commitment with employers, 57 percent stayed back in Washington to continue their practice, and 91 percent practiced in urban areas (Kahn, Hagopian & Johnson, 2010).
In this section, present the results of your research into the issue based on the perspective/organization(s) you have selected. Determine the scope of your focus, for example a geographic area, economic level, and/or ethnic group. Discuss problems faced in addressing the identified needs and any previous actions taken to deal with this need. Identify potential opportunities for implementing change.
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