This week I attended two meetings, -the Federal Laws committee met on Tuesday, April 22, and the Oregon Health Fund Board met on Thursday, April 24th. I'd like to give a few snippets of information from each meeting that caught my attention.
At our Federal Laws meeting we heard presentations on health care providers/ workforce shortages and on the Indian Health System.
Based on current trends, Oregon needs approximately 322 new physicians each year. Yet only approx. 200 residents complete their training each year in Oregon. Those who elect to stay in Oregon, along with physicians moving into the state, result in a new provider shortfall that is mirrored in nursing and other health care provider professions. It was pointed out that part of the difficulty Massachusetts is now facing with its universal coverage plan stems from giving 340,000 uninsured residents coverage, but having no increase in care providers, causing corresponding doubling of wait times for care.
The Indian Health System demonstrates the unique position that the Indian tribes hold in relationship to the Federal government. The relationship of the federal government with the Indian tribes is referred to as "Federal Trust Responsibility" and has its origin in the Constitution and in early court cases and treaties. Part of its origin is acknowledgement of the cession of over 400 million acres of Indian tribal land in this country. Because of the supremacy of federal law over state law when it comes to providing Indian health services, our Federal Laws committee must be aware of "Federal Trust Responsibility" guidelines pertaining to Oregon's Indian population.
On Thursday, April 24th, the Oregon Health Fund Board met in Portland. Among other topics, they received updated progress reports from each of the six committees, and from the exchange work group. (I encourage anyone who has the time to attend one of the committee meetings to try to do so. As the committees get close to wrapping up their work, it is very interesting to observe the final discussions of their recommendations.)
Part of the OHFB meeting was spent learning about the community meetings developed for the Board by NW Health Foundation, Oregon Health Decisions, and Oregon Health Forum. Not intended to be educational meetings, they are designed to elicit the values that Oregonians hold regarding health care. There are 13 of these meetings scheduled around the state beginning on May 1st, and the Portland meeting will be held on Tuesday, June 10th at Ainsworth United Church of Christ at 7 pm. Visit www.healthforum.org for more information and to view a 30 second video made by two members of the Board, encouraging the public to attend.
Catalyst1 I think it is important to examine the current corporate mythology of “shortages” of healthcare employees. I am intimately familiar with one of the great myths—the nursing “shortage.” Folks, there is NO NURSING SHORTAGE. Let’s look at Portland as an example. In Portland, the local schools graduate 400 new RN’s EVERY YEAR. That is just RN’s. That isn’t counting the new LPN’s who also graduate. Because Portland is also a desirable place to live, there are nurses flocking to Portland from other areas of the country. As a new nurse, it will be difficult to find a hospital job. If you do, you will work 12-hour shifts overnight (7:00 p.m. to 7:00 a.m.) on your feet, without a break most nights. It will take a day of sleeping to recover from one of those nights. The liability for making any kind of error is high, while the pay is low for this kind of risk to one’s career and health. Working at night is correlated with the development of cancer. Often the nurses are understaffed, i.e. too many acutely ill patients per nurse and they put up with disrespectful behavior from doctors. It is true that there is a shortage of people who wish to continue working under those conditions. If you wonder how to prevent med errors and do away with the “shortage” it means that the hospitals have to increase the number of nurses working at any given time and do away with the 12-hour overnight shifts. The REASON that health care corporations perpetuate the MYTH of the “nursing shortage” is because they wish to continue to burn through applicants for those positions. They do not want to make staffing adjustments and treat their employees as valued resources instead of as replaceable parts of a revenue-generating machine. Just think how many more nurses these places could afford to hire if they would do away with the million dollar executives that most hospitals have! I am certain that there is some mythology around the physician “shortage” also. I remember that a physician friend of mine told me that paradoxically, when there are too many physicians in a given area, the price of medical care goes up. That was from a study done in the 1980’s. The schools are so prohibitively expensive, that it surely gives some would-be doctors pause when they think about entering. I personally know of a doctor who graduated with a $300,000 debt from OHSU. Are there really enough resident positions to accommodate all the doctors who will need those positions when they graduate? Or do they have to overcome barrier after barrier to gain entrance into the profession? Let’s look at making it easier to get into these professional positions instead of whining about the “shortage.”