Lawmakers address nurse and primary care physician shortages

Jun 22 2009

A pending House bill would aim to address the nursing shortage by allowing "20,000 additional nurses to enter the U.S. each year for the next three years as a temporary measure to fill the gap," Business Week reports.

The bill was introduced by Representative Robert Wexler, D-Fla., in May. If it doesn't "pass on its own, lawmakers may include it in a comprehensive immigration reform package." Hospital administrators in some areas that face nursing shortages support the bill as "temporary relief," but "Wexler's bill is opposed by labor unions, whose leaders say it would undermine efforts to produce a steady domestic workforce while sapping other nations' nurses. [President Barack] Obama has also expressed skepticism about the idea that the U.S. needs to import nurses, in particular because the U.S. unemployment rate continues to rise." Instead, Obama has said, the focus should be on improving the resources to fund education for new American-born nurses. "The $787 billion economic stimulus bill included $500 million to address shortages of health workers in the U.S., with about $100 million to promote nursing and increase capacity at U.S. nurse-training schools."

The percentage of foreign-born nurses in the U.S. is on the rise: "In 1994, 9 percent of the total registered nurse workforce was composed of foreign-born RNs; by 2008 that percentage had risen to 16.3 percent, or about 400,000 RNs." The data "worries leaders of nurses' unions, who say importing workers can lower incentives to improve working conditions." With poor working conditions including "understaffing, mandatory overtime, and physically demanding work, such as lifting and bathing patients," along with flattening wages overall, about "one-fifth of the current RN workforce of 2.5 million" are "choosing not to practice their profession" (Herbst, 6/21).

Meanwhile, the shortage of primary care physicians nationwide "may undermine reform efforts," The Washington Post reports. "There are not enough primary-care doctors to meet current needs, and providing health insurance to 46 million more people would threaten to overwhelm the system. Fixing the problem will require fundamental changes in medical education and compensation to lure more doctors into primary-care offices, which already receive 215 million visits each year." According to the American Academy of Family Physicians, the shortage could "reach 40,000 in a little more than 10 years, as medical schools send about half the needed number of graduates into primary medicine."

"Many of the measures needed to compensate for shortages -- such as easing the debt incurred by medical students and expanding the role of community health centers -- are included in the provisions being put forth by lawmakers, but there is no quick or easy fix within the grasp of Congress or the Obama administration." Many patients across the country struggle to find a new doctor, "wait weeks or months for an appointment, spend more time in the waiting room than in the examining room, encounter physicians who refuse to take any form of insurance, and discover emergency rooms packed with sick people who cannot find a doctor anywhere." In a speech to the American Medical Association, Obama said "We need to rethink the cost of medical education and do more to reward medical students who choose a career as a primary-care physician." With heavy debts, many medical students choose to enter more lucrative specialties. The disparity in pay "results from Medicare-driven compensation that pays more to doctors who do procedures than to those who diagnose illness and dispense prescriptions," and "changes in Medicare reimbursement alluded to by Obama… could be the carrot that makes primary care more attractive. But proposals to change that funding scheme to favor primary care have encountered resistance from lobbyists for specialists" (Hasley III, 6/20).