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Here’s How We Can Rebuild Health Care Post-Pandemic

Discussion in 'Hospital' started by The Good Doctor, Jun 7, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

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    More than 36,000 aspiring physicians recently matched into residencies across the United States.

    More than 7,500 earned their degrees at international medical schools. These newly minted doctors, many of whom are U.S. citizens who chose to study abroad, will play an outsized role in treating the underserved communities hit hardest by the pandemic.

    It’s well known that the United States faces a massive — and worsening — shortage of doctors. The country will be short up to 139,000 physicians by 2033.

    The pandemic only exacerbated the shortfall by compelling a number of doctors to leave the profession. Nearly half of U.S. physicians are over the age of 55 and thus were at risk of complications if they contracted COVID-19. For them, going to work was suddenly a high-risk activity.

    Further, stay-at-home orders and the need to focus public health resources on the pandemic kept people out of doctors’ offices. The average practice saw revenues drop more than 30 percent last year. For many doctors, retiring early was a wise financial move, too.

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    Rural areas and minority communities face especially severe shortages. Of more than 7,200 health professional shortage areas across the country, 60 percent are rural. Patients living in majority-Black zip codes are nearly 70 percent more likely to live in a primary care shortage area than people outside these zip codes.

    Without ready access to care, the people who live in these areas experience worse health outcomes. Rural Americans are at higher risk of all five leading causes of death, including heart and respiratory disease, than urban Americans. Rural death rates from COVID-19 have long exceeded the mortality rate in more developed areas.

    Meanwhile, Hispanic Americans are 50 percent more likely to die of diabetes than their white counterparts. Black and Hispanic Americans have been about twice as likely to die of COVID-19 as white Americans.

    International medical graduates, or IMGs, are uniquely suited to address these disparities.

    Nearly 70 percent of IMGs who practice outside city centers work in primary care shortage areas, according to research from the Centers for Disease Control and Prevention. Only 40 percent of U.S.-trained doctors in non-urban areas do the same.

    Internationally trained doctors are also more likely to treat people from historically marginalized groups. In areas where the population is 75 percent non-white, IMGs account for nearly 40 percent of the physician workforce. And according to a study published in the Journal of General Internal Medicine, IMGs often care for Medicare beneficiaries with more complicated needs than their domestically trained counterparts.

    That trend is evident at the international medical school I lead, which is the largest source of physicians for the United States. This year, more than 1,000 of our students matched into residencies nationwide. Nearly three-quarters matched into primary care specialties, where the need for doctors is greatest.

    After the pandemic subsides, expanding access to primary care will be crucial to erasing the health disparities that have plagued rural and historically marginalized communities. That will require educating more doctors and providing enough residencies they need to complete their training.

    Securing a residency is the key to transitioning from a student to a doctor. Yet, the number of residency positions hasn’t been keeping up with demand. Medicare is the largest source of funds for residency programs, but until recently, spending had been capped at 1997 levels. As a result, the number of available residencies has only increased 1 percent each year since 2002.

    Congress finally lifted this spending freeze this past December as part of a COVID-19 relief measure. Lawmakers allocated funds for 1,000 more residency positions over the next five years. New legislation introduced in March would add 14,000 more Medicare-funded residencies over the next seven years.

    These are great starts. But we can’t wait until the next pandemic to expand opportunities for future doctors. Opening up more residencies would help a new crop of physicians — especially those trained abroad — to don their scrubs and help the communities most affected by COVID-19.

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