Reverse Shortage of Doctors and Nurses

by Pat Salisbury

In what many consider an extraordinary turnaround, in the last few years, the major gate-keepers of the medical profession have been forced to acknowledge that the shortage in the supply of physicians in the United States has reached a crisis level. Until 2003, except for a few bold voices, such as that of Dr. Richard A. Cooper (see interview this issue), the official, uncontested position of these institutions has been, that there is, and will continue to be a glut of physicians in the United States, and that therefore, measures need to be taken to reduce the number of doctors, with the possible exception of primary-care physicians.

Reality, and the stubborn refusal to buy into the fraud by a few, such as Dr. Cooper, have forced a grudging reassessment. The dimensions of the shortage crisis have thus begun to emerge. Immediate action to begin the reversal of this crisis is necessary if all Americans are to receive decent health care.

More Primary-Care Physicians Needed

A report on the status of officially designated Health Professional Shortage Areas (HPSAs) from the Government Accountability Office (GAO), released in October 2006, provides some basic figures on the shortage throughout the United States, of primary-care physicians, the first line of defense against ill-health. Updated in 2005, it shows that as of September of that year, there were more than 5,500 health-professional shortage designations, indicating not enough doctors in either a geographic area, among a population group such as migrant workers, or a particular health-care facility such as a rural health clinic.

Looking at the deficit for geographic areas and population groups, the study showed that 831 entire counties were designated as HPSAs, while another 815 consisted of service areas within counties. There is no state that does not have some HPSA designation. The GAO estimate concluded that 6,941 additional full-time primary-care physicians are needed to achieve ratios that would eliminate HPSA designations; this is based on a ratio of one physician for every 3,500 people in a geographic area, and 1:3,000 persons in a population group.

While the HPSA designation was created in 1978 to identify areas and populations that needed doctors, and is used by a number of Federal programs to make decisions about financial and manpower aid, it has a built-in rationing system. The administering agency, Health Resources and Services Administration (HRSA) designates HPSAs based on the ratio of population to the number of primary-care physicians and other factors, such as the area's infant mortality rate, the percentage of the population below the poverty level, or the area's birth rate. HRSA then gives each HPSA a score based on specific criteria that ranks its shortage of primary-care providers or other needs, relative to other HPSAs. Each HPSA is ranked from 0-25. A low score can disqualify an HPSA for certain Federal aid programs.

The GAO study was conducted to prove that the number of HPSAs in the nation is over-estimated, and through the usual process of redefinition and sleight of hand, manages to assert exactly that: a finding which, if left standing, would have dire consequences for numerous under-serviced areas and population groups.

Link: http://www.larouchepub.com/other/2007/3401dr_nrs_shortage.html