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ASSADI: Healthcare is due structural, organizational change


Column: Dose of Reality

Yara Assadi is a School of Arts and Sciences sophomore majoring in public health. Her column, “Dose of Reality,” typically runs on alternate Thursdays.
Yara Assadi is a School of Arts and Sciences sophomore majoring in public health. Her column, “Dose of Reality,” typically runs on alternate Thursdays.

But they are not real doctors.

As a premedical student, I have heard these words in every conversation surrounding the allied health professions, such as nurse practitioners, physician assistants and even osteopathic doctors (DO), who are board certified physicians. 

It typically comes from medical doctors (MD) who observe a disjointed healthcare system that misplaces these clinicians, making them unable to properly contribute where they are needed. This phrase also typically comes from older physicians who see only two routes to treating patients: becoming an MD or a nurse. 

Along with this mindset is a hierarchical status quo for the health professions, with MDs on top in terms of status and income and then everyone else below them.

Unfortunately, this status quo of individualism for physicians leads to a high cost healthcare system that leaves geographical pockets of the United States with few to no hospitals or clinics because it is not economically feasible. Concern for achieving a higher income clouds the judgement of health professionals, who decide which delivery methods produce better patient health outcomes. 

Due to the high concentration of hospitals in metropolitan areas, as they are the most profitable areas, rural areas have been left with major doctor shortages. Although there will be a slight growth in the number of physicians, there will be a steep increase in the demand for their services. 

This is due to the changing demographics of our population, namely due to our aging seniors and immigration. The Chief Health Officer of Association of American Medical Colleges (AAMC) Dr. Janis Orlowski, cited that the demand will increase by 17 percent, and that the shortfall of physicians could reach 90,000 by 2025 if the healthcare system maintains the status quo. This status quo not only refers to too few residency programs, but also refers to the unwillingness to incorporate non-physician clinicians (nurse practitioners, physician assistants and more). 

By diversifying the healthcare workplace in terms of professions, not only are there a wider range of skills to better patient care, but also there will be a more cost-effective model for training clinicians. It costs approximately "$152,000 a year to train a physician, of which Medicaid pays $40,000," according to the AAMC

This costs tax-payers approximately $3 billion through Medicare. Although we are producing more physicians, we are not increasing the proportion that enters primary care or the rural healthcare force or underserved communities. Therefore, the government is currently investing in a workforce that may not return that investment and care for the populations that we have a shortage of care for. 

There are several ways to combat this issue. One is diversifying the primary healthcare setting. This includes racial and gender diversity, but also diversity in training for clinicians. This means a healthcare team can be led by a primary care physician, but can also consist of a nurse practitioner, physician assistant, social worker, pharmacist and more. 

This range of experience will increase patient satisfaction, lower costs, improve health outcomes and clinician satisfaction. Operating as a team with other professionals that bring their own skill set can be reassuring and may alleviate non-clinical responsibilities from their schedule. 

A large source of stress for physicians is dealing with charting and electronic health records. A clinician wants to treat people, not spend half of their billing hours filling out charts. These responsibilities can be distributed throughout the team, or the team may even include a medical scribe. 

Therefore, any implication that non-medical clinicians are less worthy because they chose not to spend exorbitant amounts of money on a medical education lacks an understanding of the diversity of perspectives that are necessary in our changing healthcare workspace. Neither physicians or non-physicians clinicians are obsolete. 

Rather, there needs to be an effort to change the organizational structure of our healthcare system so that we can best treat patients and reduce costs along the way. 

Yara Assadi is a School of Arts and Sciences sophomore majoring in public health. Her column, “Dose of Reality,” typically runs on alternate Thursdays.

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