More than 82 million people currently live in Health Professional Shortage Areas (HPSA), according to the Health Resources & Services Administration’s first quarter 2021 summary.
This means that roughly 25% of the U.S. population resides in regions without a sufficient number of primary, dental and/or mental health care providers. As a first-world country that spends the most per capita in healthcare, how does the U.S. find itself with a quarter of the population experiencing a lack of critical care services? According to the University of Southern California’s Keck School of Medicine, four critical factors contribute to whether an area might experience a healthcare worker shortage.
An aging population
The Health and Aging Policy Fellows reports that by 2030, the youngest baby boomers will have reached age 65; this group will include 1 in 5 Americans whose health care needs will be escalating.
An aging and retiring healthcare workforce and COVID-19
The American Association of Medical College (AAMC) projects that by 2027, over one-third of practicing physicians will be 65 or older. Thus, as healthcare needs rise in the Boomer population, the number of available physicians will decrease. In 2016, 42% of physicians were aged 55 and older and thus in the at-risk demographic for COVID-19. The pandemic led some doctors to leave their professions or retire early rather than place their physical health at risk.
The rising incidence of chronic diseases
According to the CDC, six in ten U.S. adults suffer from a chronic disease; four in ten are diagnosed with two or more chronic diseases, the most common of which are heart disease, chronic lung disease, cancer and diabetes. AAMC CEO and President Darrell G. Kirch, MD, finds “the projected shortage [of healthcare workers] especially troubling, since as patients get older, they need two to three times as many services, mostly in specialty care, which is where the shortages are particularly severe.”
A finite number of educational programs
A report by the American Association of Colleges of Nursing (AACN) published in 2019 reported that nursing schools in the United States were forced to deny admission to 80,407 skilled applicants from nursing programs due to a lack of clinical and classroom space, restrictive budgets and, most commonly, faculty shortages. In addition, a report by The Atlantic stated that one-third of nurses will retire in roughly the next decade, a figure that may increase due to COVID-19 and related burnout.
Technologies such as telehealth have already begun to help bridge the gap for those residing in HPSAs. The recent COVID-19 pandemic thrust patients and providers into the already burgeoning prospect of remote solutions for limited healthcare access (patients struggling with distance and transportation issues as well as socio-economic variances that make them unable to access other health care options).
In 2020, state legislatures worked to loosen the stringent regulations that limit reimbursement for telehealth visits. Because it can be delivered quickly and easily, telehealth has become popular with people of all ages, notably for the convenience in obtaining appointments, the efficiency of the zero-commute and the comfort of meeting from home. A study from the Journal of General Internal Medicine found that in a poll of 2,052 adults aged 20 and older, only 15% were using telehealth for behavioral health when the pandemic began, but this percentage rose to 53.6% by May 2020. And it has been working well. In a National Poll on Healthy Aging that included 2,074 participants 50 to 80 years old, 72% showed interest in follow-up telehealth appointments with previous providers.
Virtual medical visits are not feasible for all physical tests (like lab draws and cardiac stress tests), but for behavioral health, the security, affordability and convenience of “zooming in” might be just what the doctor ordered. And it certainly eases the strain in areas with health professional shortages, making timely and quality intervention a possibility in remote areas with aging populations.
Health Professional Shortage Areas present a complex logistic issue requiring a multifaceted solution; therefore, healthcare professionals continue to piece together permanent answers to the increasing demand for equitable healthcare services.