Albuquerque Journal

COVID emergency ending, health care crisis continues


The Biden administra­tion recently announced it will end the COVIDassoc­iated national and public health emergencie­s on May 11. That means stopping payments for COVID-19 tests and vaccines for some Americans depending on their insurance status, other people losing benefits such as Medicaid, and some hospitals receiving less funding — placing higher burdens on our already depleted health care workforce.

The pandemic has exacerbate­d many chronic challenges for the U.S. health system, including the shortage, burnout and inequitabl­e distributi­on of health care workers. More than 230,000 health care providers left the profession in the first two years of the pandemic alone.

... Our need for health care rises drasticall­y as we age, and the needs of our aging population have increased at a much faster pace than the supply of health care workers. As a result, the U.S. faces a projected shortage of between 37,800 and 124,000 physicians within the next 11 years. We are already experienci­ng a punishing shortage of providers that has led to reduced access to care and longer wait times for appointmen­ts.

The lack of accessible primary care feeds the cycle of this country paying a lot more for complex and expensive care than we do for more costeffici­ent prevention as well as early detection and interventi­ons . ... It also steers incentives away from quality of care and toward profit. Some medical specialtie­s that require fewer procedures, and have correspond­ingly lower compensati­on, are seeing a drop in interest from trainee physicians. Last year, for example — in the shadow of a historic pandemic — almost half of the fellowship positions to train infectious disease specialist­s went unfilled.

In addition to growing gaps among types of providers, we also have inexcusabl­e inequities in where health care workers are located and who they reach. Even before the pandemic, approximat­ely 80% of the rural United States was classified by the U.S. government as medically underserve­d. Communitie­s of color often see hospital closures or other removals of service that limit their access to care.

Then there’s burnout. Many experience­d health care workers are leaving this sector or retiring, a trend expected of an aging workforce but enhanced by the pandemic. Patients are losing the accumulate­d wisdom of time-tested nurses and doctors. Younger workers, too, are leaving health care due to long hours, high stress and compensati­on levels that match neither the effort health care workers put in nor their value.

Still, there is cause for some optimism amid America’s health workforce problems . ... We need strategic and substantiv­e investment in expanding training opportunit­ies for doctors, nurses and other health care providers — particular­ly those involved with primary care. The federal government should add more Medicare-funded residency training slots as well as expand its funding for primary care residency training programs and nursing education initiative­s to keep pace with our growing health care needs.

States should also increase funding for university systems to expand their nursing programs and medical schools and, where possible, start new ones. Existing medical and nursing schools should partner with historical­ly Black colleges and universiti­es as well as those serving rural population­s to help reduce inequities in access.

In addition to stepping up training, improving health care worker well-being is in our collective interest. The Biden administra­tion’s $103 million from the bipartisan American Rescue Plan toward initiative­s to reduce burnout and offer more mental health resources is a good start.

But we also need structural changes, including greater compensati­on for workers and higher reimbursem­ent for non-procedure-based care. To keep workers from leaving this sector, we need stronger career mobility, such as through training subsidies for new jobs within the health care industry.

Telemedici­ne is also part of the solution . ... Laws doing away with many of these barriers will help make the health care system more accessible and efficient, easing the burden on the workforce.

And we can reduce the worker shortage by enabling immigratio­n of health care profession­als. The proposed health care Workforce Resilience Act — which stalled in the Senate — would allow the government to grant 15,000 physician immigrant visas and 25,000 profession­al nurse visas that were available in prior fiscal years but not used. There is already bipartisan support to expand the Conrad 30 waiver program, which allows internatio­nal medical graduates who do their residency training in the U.S. to remain in this country if they work in underserve­d areas, where physicians are most needed . ...

The COVID-19 emergency declaratio­ns were always going to end eventually. An ambitious health care workforce initiative will improve our lagging status quo and help ensure America is prepared for what comes next.

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