Health care professionals convening at the June 12 Louisiana Health Care Quality Forum’s Spring Summit, Looking Ahead: The Future Health Care Work Force in Louisiana,
anticipated workforce needs and solutions. Cindy Munn, Forum Executive Director, called the Summit in keeping with the Forum’s mission to improve the health of Louisiana residents.
Opening keynote speaker Mike Magee, MD, presented, Home-Centered Health Care: The Healthy Home Movement. Magee, a health care futurist widely recognized as a visionary leader of the home-centered health care movement and lifespan planning records, has advised the Institute of Medicine on these topics. Magee is president of Positive Medicine, Inc. and serves as Senior Fellow for Health Policy at the Center for Aging Services Technologies in Washington, D.C. He is also editor of HealthCommentary.org, and author of the book, Home-Centered Health Care.
For three decades Magee has been following trends of aging, Internet and consumerism in America that he said are defining our health care future. “These trends are leading to more engaged and empowered health care consumers. Today, 50 percent of 60-year-olds have a parent alive. All of these factors point toward the home, because the home is the setting where most behavioral change and most good health occurs. I define health as being full human potential. To reach full human potential you have to have a healthy home. All health care leads to the home. That is where the action is.”
According to Magee, by leveraging these trends a preventive health care system can be built. “In terms of the workforce challenge – here it is. You have to do two things at once because chronic disease doesn’t go away. People are going to need hospitals, technology, interventions, but at the same time they need to be building a preventive health care system.”
The Internet and other new health technologies are useful because they ignore geography. “That means you can target information, data and support and connectivity to the individuals who need it the most and to get to them right at the right time,” noted Magee. “In the past, when someone needed help you had to put them in the car and bring them to the (physician’s) office. This is a great inconvenience for people who are managing a lot of complexity today. We have moved to a four-generation family and by 2050, there will be more than a million people over the age of 100. That means we are going to be five generations deep, so we have to figure out a way to be in the home and manage the five generation complexity in a way that is both high touch and high tech.”
Dr. Ben Sachs, MB, BS, DPH, Senior Vice President and Dean at Tulane University School of Medicine, and Charles W. Hilton, MD, Associate Dean for Academic Affairs at Louisiana State University School of Medicine, examined Future Health Care Workforce Needs for Louisiana Relating to Medical Education, Rural Health, and Graduate Medical Education for Primary Care. Sachs takes a futurist role and believes technological changes will help ease a looming physician shortage in the United States.
“Technology provides an incredible opportunity to change how we appropriate care,” he said. “First, we move patients out of hospitals into nursing homes and into home care. Patients will need less admission, less hospitalization. Second, it will empower patients to control their access to care, the kind of information they have and their outcome.
“Many of us are in the hospital business which has been the center of clinical activity, but also the center of medical costs. I suggest that the site of care is going to radically change and needs to change in order to affect outcomes.”
Sachs calls the New Orleans area the center of change in the United States for health care delivery. Last year, 175,000 people in the area received care through community-based clinics. “Tulane is building neighborhood health centers because of access to high quality care, lower costs, preventive care and the role of medical education,” he explained. “Most trained physicians spend the majority of their time in hospitals. It makes no sense because the lengths of stay in hospitals are so short and all they are seeing is an episode of care. Most physicians are going to take care of chronic diseases – diabetes, heart disease, chronic obstructive pulmonary disease. You can’t learn that kind of care in a hospital setting. You have to get out into the community and understand how to sustain a patient who has cancer and was treated for cancer, or a patient who has diabetes, because if we don’t do that we are not training the right workforce.”
Robert Baye, PA, Academic Coordinator of the Physician Assistant (PA) LSU (Shreveport) Health Sciences Center School of Allied Health, and Karen Sue Zoeller, Vice President of Policy Development for the Louisiana Hospital Association, were panelists for the session, Future Health Needs of Allied Health Professionals.
Baye said PAs in Louisiana are addressing how they can bridge a gap created by lack of physicians. Projections as early as 2020 are for an estimated national deficit of 100,000 specialists and primary care physicians. “Because PA training covers these areas, we feel we are especially tailored to bridge that gap of health care and the patient needs here in Louisiana,” said Baye. “We can provide services to those who are underserved in rural areas as well as assist physicians in those areas where additional demand is increased at the present time.”
Zoeller called for a closer look at allied health professionals, “our front-line workers who are not getting paid very much, but who are absolutely essential to providing good health care.” She advocated educating the industry about what front-line work involves and understanding its importance. “They often just take them for granted. These health care professionals need to know there are promotional opportunities available to them if they increase their education, and they need to be given the opportunity to attain that education.”
Nursing is the largest component of the health care workforce in the country and in Louisiana. It is one of the fastest growing segments of the health care profession with more than 3.1 million registered nurses in the U.S., noted Cynthia Bienemy, PhD, RN. In Louisiana, registered nurses, nurse practitioners and licensed practical nurses are among the top demand health care occupations.
The current health system has high costs, fragmentation, health care disparity, aging, sicker populations and a primary care shortage noted Bienemy, who has been director of the Louisiana Center for Nursing since its establishment in 2009 as a division of the Louisiana State Board of Nursing. The director monitors registered nurse education capacity in Louisiana and works closely with nursing stakeholders in developing strategies to increase educational access, retention and mobility for registered nurses in the state.
According to the American Association of Colleges of Nurses’ report on 2011-2012 Enrollment and Graduate Programs in Nursing, U.S. nursing schools turned away 75,587 qualified applicants from baccalaureate and graduate nursing programs in 2011 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors and budget constraints.
In her closing address, Louisiana’s Nursing Workforce: Past, Present and Future, Bienemy outlined how nursing can alleviate and address those issues.
“There is going to have to be some transformation in our health care system, and it is going to be important that nurses are at the decision making table in terms of policy, practice, workforce and education. A system that does not allow that cannot be successful. It is not about nursing. Because we are the largest component of the health care workforce, it is about how can we truly contribute to change and improve the face of our health care system and improve the health care outcomes of our state.”