03 March 2010

Healthcare corner #8 - Workforce supply and efficiency

fear not people, we only have 5 more healthcare system classes to go!

there was an introduction to healthcare system efficiency today, but since it was mostly the generic basis of what is efficiency and how do people measure it, i will spare you the details. a few canadian specifics that came out though:
1. canadians spent $2535 per person on healthcare in 2003 and visited physicians an average of 6.4 times per year compared to americans who spent $4631 per person on healthcare in 2003 and visited physicians an average of 5.8 times per year. of course this a crude measure and doesnt get at a complete picture of efficiency, it is something to consider.

2. a typical graph you see when initially talking about this subject area:

(life expectancy being a crude output measure of seeing what you get for the healthcare dollars you input)

3. current canadian weaknesses related to efficiency: they are lagging on the IT end of healthcare (in terms of electronic health records, IT infrastructure, etc. which would streamline many services and increase patient safety) and there is a need for an "integrated and formalized framework for turning innovations and experiments into action." there does exist however, a website called "canada values health" which seeks to inform the public about current health system information and to engage them in a dialogue to gather input and real-world values to incorporate in the ongoing evolution of the system. this way, as it changes to be more generically efficient, it can also hope to actually change in ways the public actually desires.

we also discussed the physician workforce supply in canada. one of the hot button issues of the health media in canada (along with system sustainability and wait list times) is the idea that the supply of doctors is thin. this seems to have been swirling since the 1990s. we talked about some of the factors that led to this perception and some of the actual facts:
1. the supply of doctors in canada rose steadily in the 1980s and peaked in 1993.

2. in 1993, tons of doctors were finishing their degrees and having a hard time finding a job as fellow students were flooding the market. canadian medical schools reacted to the situation by changing post-medical school training programs to make them longer. in the past, if you wanted to be a family physician, you could be in the field only one year after graduating. the new shift made this more like 2-3 years...so, many people thought it was more worth their while to enter into specialist programs that take about 3-8 years. in the early 1990s, about 80% of physicians started as general/family practitioners. by 2000, only 45% started as GPs/FPs.

3. other factors that were occurring in the 1990s: a decreased intake of international medical graduates, increased retirements, beginning (slight) decrease in medical school enrollments, and the fact that the 1993 surge was in the natural process of receding anyway.

4. to look at the numbers, there has actually been a pretty stable physician-to-population ratio, however its important to look at who is practicing, and how. the younger physicians are carrying lighter workloads than their older counterparts. this is due to the fact that there is a lifestyle preference for a better work-life balance in this newer crop of doctors, as well as the fact that female doctors are in much greater supply now, than in the past. females obviously lower their productivity when they take leave for childbirth and childrearing, also, it is shown that they tend to interact with their patients differently (and often longer) than male doctors.

5. so, to sum up, there isnt a doctor shortage according to the numbers. it has been suggested that complaints may derive from patients and perhaps doctors who put their "minimum standards" bar at the services/access that were present during the 1993 peak. in 2004, 86% of canadians said they had a "regular" doctor, but 16% said they had difficulties getting access to routine non-urgent care. in 2002, 80% believed there was a shortage of family doctors and 97% of them considered the problem to be serious. 93% of physicians also felt that doctor shortages were widespread.

older physicians, who carry the higher workloads, typically dont take new patients, and younger physicians are carrying smaller workloads and thus cant service as many patients. what seems to need to happen is an adjustment to increase productivity in the doctors that already exist (because clearly their shear numbers are adequate) and perhaps to finds ways to encourage more doctors into the non-specialist route (or start up more nurse practitioner programs!).

6. lastly, a recent nursing supply shortage article in the media, though not on the same topic of doctors, its still healthcare related.


Jody said...

This post was really interesting. I'm guessing the US spends more/has lower life expectancy because we live such unhealthy life styles compared to the other countries on the list. I've heard the statement that kids now are the first generation that is not expected to outlive their parents (because they're all lazy and tubs). I've heard it a couple times on programs recently, just stated as fact. Do you know anything about this?

amw said...

ive definitely heard and read that statistic before (for example: http://www.fns.usda.gov/cga/speeches/ct091504.html). i would say it is fair to say that unhealthy lifestyles do stress a health care system. if you hope to turn to drugs and surgeries to combat years of unhealthy eating and behaviors then it will definitely decrease the amount of "bang for your buck."