An ounce of prevention is worth a pound of cure; our healthcare system is showing a shift that recognizes the wisdom of this old adage as we move from an acute care or cure focus to a focus on health prevention. Prevention is being proactive; avoiding or limiting negative effects of disease on a population or an individual. However, there is one area where the future harms and risks are acknowledged, but little work on prevention is being accomplished – the predicted severe shortage of healthcare providers. Within the next eight years, primary care is estimated to have a 14,900 to 35,600 shortfall; add in specialty providers and it predicted the U.S. will be short nearly 100,000 providers (Association of American Medical Colleges, 2016; Clabo et al., 2012; Levin & Bateman, 2012; U.S. Department of Health & Human Services, 2013). Further complicating this issue is the distribution pattern of providers, with approximately 44% of rural areas already experiencing shortages that are negatively impacting the population’s health (Association of American Medical Colleges, 2012; Levin & Bateman, 2012). Patients without providers, or severely overworked providers will certainly place our patients in harm’s way. This is a violation of one of the core ethical principles of healthcare – non-maleficence – to do no harm. What are we doing to prevent this harm or at the very least minimize the looming deficit? Click here to see a 2 minute video on the shortage and primary care.
Medical schools have great difficulty increasing their enrollments due to caps placed on the number of sponsored residencies allotted through the Centers for Medicare & Medicaid (CMS). Nursing schools dramatically increased their nurse practitioner (NP) programs, but were also limited by available faculty and clinical preceptors (Clabo et al., 2012; Levin & Bateman, 2012). While physicians and healthcare organizations are offered direct pay and tax benefits for training future physicians, NPs have mainly relied on exchange of benefits and professional duties/passion to secure preceptorships. The value of precepting NP students must be acknowledged and rewarded if we are to have enough quality preceptors to meet the needs of increased enrollments; which are absolutely necessary to prevent catastrophic provider shortages. To expect NPs to be trained on almost only altruistic means, while paying for physician training, but then demanding the same quality of outcomes for either healthcare provider violates the ethical principles of justness and fairness. NPs are cost-efficient providers, so the fact that CMS reimburses them 85% of what physicians can bill may be equitable; but there is nothing equitable about paying for one provider’s training but not another’s.
Beneficence is another core principle of ethical patient care. It states that plans, actions, and treatments should be driven by what is in the best interest of the patient (Bickley, 2012). It is definitely in the patients’ best interest to have an adequate supply of accessible healthcare providers. It is also in the patients’ best interest that these providers be both competent and confident. High-caliber preceptors are needed to ensure that NP students preparing to practice independently have the knowledge, skills, and self-assurance necessary to provide quality healthcare. Failing to properly train our future providers not only violates the principles of non-maleficence, justness and fairness, and beneficence; but also, a utilitarian principle that if healthcare students are not trained, there will be no future healthcare providers (Bickley, 2012). Solutions to address the healthcare provider shortage are available, we need to make sure these solutions are equitable as well to keep the teachers, students, providers, and patients healthy.
Association of American Medical Colleges, Center for Workforce Studies. (2012). Recent studies and reports on physician shortages in the US. Retrieved from https://www.aamc.org/download/100598/data/
Association of American Medical Colleges. (2016, April 5). New research confirms looming physician shortage. (News Releases). Retrieved from https://www.aamc.org/newsroom/newsreleases/458074/2016_workforce_projections_04052016.html
Bickley. L. (2012). Bates’ guide to physical examination and history taking (11th ed.). [VitalSource Bookshelf version]. Retrieved from https://bookshelf.vitalsource.com/books/9781469825106
Clabo, L.L., Giddens, J., Jeffries, P., McQuade-Jones, B., Morton, P., & Ryan, S. (2012). A perfect storm: A window of opportunity for revolution in nurse practitioner education. Journal of Nursing Education, 51, 539-541. doi:10-3928/01484834-20120920-01
Levin, P.J., & Bateman, R. (2012). Organizing and investing to expand primary care availability with nurse practitioners. Journal of Community Health, 37. 265-269. doi:10.1007/s10900-011-9537-5
U.S. Department of Health & Human Services, Health Resources & Services Administration, National Center for Health Workforce Analysis. (2013). Projecting the supply and demand for primary care practitioners through 2020. Retrieved from https://bhw.hrsa.gov/health-workforce-analysis/primary-care-2020