Thursday, September 5, 2002
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STUDIES SHOW HEALTH CARE PROFESSIONS IN SHORT SUPPLY,
PUTTING PATIENT CARE AND SAFETY AT RISK
Health Affairs Details Shortages of Nurses, Physicians, Pharmacists and Nurse Practitioners
Washington, D.C. Serious shortages of nurses, pharmacists and physicians pose a significant threat to patient safety and access to care, according to several studies released today in the journal Health Affairs.
The September/October 2002 issue examines a wide range of trends in the health professions, detailing the severity of the shortages, the characteristics of the people leaving these critical professions, and what can be done to stop the continued losses.
"We are seeing a mass exodus just as the baby boomer generation is aging and requiring more from the health care system," said John K. Iglehart, founding editor of Health Affairs. "Their health care needs far outstrip the care and services our health practitioners can safely supply."
In 2000, the country experienced a shortfall of 110,700 registered nurses. At the same time, there was a dramatic shortage of pharmacists, leading to vacancies in community pharmacies, public and private hospitals and federal facilities.
While these real shortages were occurring in the workplace, nursing schools witnessed a drop of approximately 682 nurse practitioner students and 92 graduates annually between 1997 and 2001. To complete the dire picture, another study finds that despite an increase of 320,000 physicians in the past 20 years, the country is still facing a shortage.
Congress recently passed the Nurse Reinvestment Act, offering financial incentives to attract more women and men to the nursing profession. But a new study by Julie Sochalski, associate professor at the University of Pennsylvania School of Nursing, finds that more energy must be put into retaining current RNs and making certain that recent graduates seek work in nursing.
According to Sochalski, in 2000 close to 120,000 RNs were either not working or were working in other fields - this at a time when nursing positions were prevalent. About 81,000 of those not working were 43 or younger, and 58 percent had young children at home. At the same time, 40,000 RNs were working in fields other than nursing. They were also 43 or younger, and 25 percent of them had young children at home.
The most common reasons given for working in other fields were better hours, more rewarding work and better pay. The study suggests that enhanced career ladders, better wages, flexible hours, and child care might help attract some RNs back into the workforce.
Alarmingly, Sochalski's study also found that an increasing proportion of new RNs are not working in nursing -- this is especially true of male graduates. The proportion of men not seeking work in nursing more than doubled between 1992 and 1996, from 2 percent to 4.6 percent, and then rose again by more than half to 7.5 percent in 2000. The proportion of new women RNs not pursuing work in nursing increased at a slower rate, from 2.7 percent to 4.1 percent, remaining steady through 2000.
A striking growth in prescription drug use and spending, coupled with greater responsibilities on the part of pharmacists, has lead to a situation where the current number of pharmacists cannot meet the demands of patients, according to a new study by Judith Cooksey, director of the Illinois Regional Health Workforce Center at the University of Illinois.
According to Cooksey's study,
the number of pharmacists increased by 24,400 in the last decade. But as the
pharmacy profession has moved from one of merely dispensing medications to one
of providing certain clinical services, pharmacists have seen their workloads
rise. There are also concerns regarding patient safety, as pharmacists have
been forced to rely on technicians with less skill and training. Among her findings:
|Vacancy rates for pharmacists in 2000 were 7 percent in community pharmacies, 9 percent in hospitals, 11 percent in public hospitals, and up to 18 percent in federal facilities.|
|Pharmacists' workloads have increased dramatically. The average number of prescriptions dispensed by retail pharmacists increased by 35 percent from 1992 to 2000.|
|Due to a steep drop in the number of self-employed pharmacists, there were 3,600 fewer stores at the end of the 1990s despite expansions in large chain drug stores.|
|The shortage has led to greater reliance on pharmacy technicians and assistants. Pharmacists, however, are reluctant to delegate dispensing to many of these technicians because the training is highly variable and often limited.|
Despite warnings during the past 25 years that the nation was producing too many doctors, a new study by Edward Salsberg, executive director of the Center for Health Workforce Studies at the University of Albany, and Gaetano Forte, a research associate at the center, finds no physician surplus at all. In fact, the study warns the nation may be facing a physician shortage.
The number of physicians
has grown by more than 320,000 since 1980. But according to the study, the combined
growth of U.S. medical school graduates was only 12 percent between 1980 and
2000, while the U.S. population grew 24 percent. Other findings:
|The number of non-primary care physicans grew by 173,277 between 1980 and 2000, compared to 123,390 for primary care physicians.|
|Despite a great need for African American, Latino/Hispanic and Native American physicians, their numbers in U.S. medical schools have actually declined.|
|Over the next 30 years, half of all practicing physicians will be women.|
Physician Assistants and Nurse Practitioners
The numbers of nurse practitioner (NPs) graduates is declining, while physician assistants (PAs) are on the rise, according to a study by Rod Hooker, chief of the Division of Health Services Research at the University of Texas Southwestern Medical Center, and Linda Berlin director of research and data services at the American Association of Colleges of Nursing. While NPs and PAs provide comparable physician services, NPs are the largest group of nonphysician primary care providers and they produce services in health promotion and disease prevention at much higher rates than is true for physicians or PAs.
They also are often the
only providers of care in some rural areas. According to the study, a declining
number of NPs could mean that certain populations might not have access to the
care that they need.
Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Copies of the September/October 2002 issue will be provided free to interested members of the press. Address inquiries to Jon Gardner at Health Affairs, 301-656-7401, ext. 230, or via email, firstname.lastname@example.org. Selected articles from the September/October issue are available free on the journal's Web site, www.healthaffairs.org.
©2002 Project HOPEThe People-to-People Health Foundation, Inc.