The TAP-IN Blog

Health Workforce Solutions Now Available on the Web

It's not only our free clinics that are understaffed these days. The entire health care system is seeing critical shortages of doctors, nurses and allied health care workers, all across the country.

The U.S. Department of Health and Human Services now provides a Web site called the Health Workforce Information Center (HWIC) where you can find "information on health workforce solutions in one centralized and easy-to-access online location."

Funded by the U.S. Department of Health and Human Services Health Resources and Services Administration and operated by the University of North Dakota (UND) School of Medicine and Health Sciences, the center will offer the latest on health workforce programs and funding sources; workforce data, research and policy; educational opportunities and models; and news and events, also available through e-mail updates.

Visitors will have a broad range of publications and other resources at their fingertips. The site also offers free, customized assistance from information specialists (digital librarians), who will search databases on workforce topics and funding resources, furnish relevant publications, and connect users to workforce experts and federal programs, among others.

“Many people in government and private and nonprofit organizations need access to the type of quickly assembled, user-friendly data the center will make available,” said Kristine Sande, HWIC deputy director at the UND School of Medicine and Health Sciences. “Accurate information on the health workforce will be vitally important in the ongoing health care debate, and we provide a way for individuals to get it from a single, trusted source.”

ERs are the New (Beleagured) Safety Net

In California, the wave of unemployed and uninsured is breaking on hospital emergency rooms, over-taxing staff and resources, and putting a dangerous load on hospital finances. The overload situation is having increasing impact on seniors.

When Dr. Tony Musielewicz walks through Dominican Hospital's emergency room, he muses that it often "looks like a nursing home."

But Musielewicz, the emergency department's medical director, doesn't mean that in a bad way. In fact, he's angry about the rising numbers of Medicare patients who are forced to rely on the ER or urgent care clinics to treat common problems that should be monitored by a primary care physician.

"One is too many if there is even one senior citizen who doesn't have access to a primary care physician," said Musielewicz, who has worked at Dominican for 10 years.

The problem: Fewer primary care doctors are opening practices in Santa Cruz County because of low reimbursement rates compared to counties over the hill. Those who have patient openings are likely to accept the privately insured over retirees bearing Medicare cards. Even seniors who have regular doctors sometimes are forced to wait weeks to get in.

Given all this, "We're the safety net for everyone," Musielewicz said.

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At San Joaquin General's emergency room, Dr. Richard Buys has seen a marked increase in volume, while at the same time, hospital admissions from the ER have been flat.

That tells him that people who normally would have gone elsewhere for care, such as a physician's office or same-day clinic, are seeking out the ER because it does not require payment upfront.

"On a personal note, I've noticed more often that when I ask a patient if they need a note for school or work, the answer used to be 'yes' or 'no.' Now it's, 'I just lost my job.' The number of times I used to hear that was virtually nil. It puts a more human touch on what is going on, and they don't say it with a smile," Buys said.

* * *

Urgent care clinics also see a wave of seniors who can't get into their doctor or can't find one. The Santa Cruz Medical Foundation, which is part of the nonprofit Sutter Health network, has a freeze on all new Medicare patients who are not part of an HMO network, but will continue to see seniors in its urgent care areas.

Dr. Lawrence deGhetaldi, the foundation president, said urgent care doctors in his six clinics are seeing older patients for high blood pressure, diabetes and medication refills. But when the seniors seek ongoing general care, they are shut out because the clinic's primary care doctors are at capacity for Medicare patients.

And that is a shame, Musielewicz said.

"Our health care system is breaking," Musielewicz said. "The fact that the elderly have difficulty finding primary care is something the community, the county, the state and the nation have to work on as a whole."

Rationing Free Clinic Care

The Washington, D.C. area is one of the more affluent regions in America, yet the numbers of uninsured are swamping the capacity of networks of free clinics in suburban Virginia and Maryland.

Rising unemployment in the D.C. area has more and more uninsured people turning to free clinics to receive care.

One report shows about 54 percent of Americans who are unemployed are also uninsured. They often can't afford coverage and aren't eligible for Medicaid.

Unemployed, uninsured and unable to afford private care, the Arlington Free Clinic was Richard Templeton's only option.

"We're one of the folks that has to choose between food and medicine sometimes and that's what we've been doing lately," Templeton said.

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People young and old crowd the hallway outside the locked door of the Arlington Free Clinic. They grip small pieces of paper that will determine whether they get in -- or give up and go home.

It's lottery day, and 45 county residents who lack health insurance and money to pay for medical care are competing for 30 openings on a cold afternoon in January.

Mary Gleason, a clinic volunteer, draws letters from a plastic box. Those holding matching letters will be ushered through the door for interviews. If they meet the clinic's criteria, they'll return in a couple of weeks to see doctors or other staff.

The lottery is just one example of the fate of the newly uninsured -- the growing numbers who once had jobs and insurance and now seek treatment with neither. Although most of the clinic's clients have low incomes, the nonprofit, privately funded operation and others like it in the region are seeing more people who used to be solidly middle-class. Victims of the deepening recession, they're now wondering where to turn for help.

Neither rich nor poor, this group doesn't readily qualify for public programs such as Medicaid but often can't afford to buy insurance or pay hospital, doctor and drug bills. The Democrats' economic stimulus package would significantly enhance options for the unemployed and their families through insurance subsidies and a possible expansion of Medicaid, a package that some experts say would ease the financial dilemma.

Hospitals Closing. Even the Insured Face Health Care Crisis.

A report out of New Jersey makes plain the fact that our health care system is crumbling, not only for those without insurance, but for all of us.

Eight hospitals in the state (New Jersey) have closed in the last two years, but the survey indicates the industry's economic pain is far from over.

 The most common trend is a growing demand for treatment by people without insurance, according to the survey, which included top officials from half of New Jersey 74 hospitals. Eighty percent of hospitals reported a spike in charity care patients, and 76 percent reported their emergency rooms were busier.

Over that same period, 72 percent of hospital executives also reported charitable contributions declined. The amount of cash available to run their institutions dropped by an average of 27 percent.

Last year, almost one out of every two hospitals in the state coped with the economic crisis by laying off workers and eliminating jobs. Already in 2009, 21 percent of those surveyed said they expected to trim jobs later this year.

"Contrary to business myths, hospitals are not immune to an economic downturn," said John Gribbon, president and CEO of CentraState Healthcare System in Freehold who also heads up the association's board. "Quite the contrary: hospitals struggle with the same financial difficulties that the other employers face -- plus they hold the added responsibility of providing an essential public service at a time when a growing number of individuals are in need."

The survey also found 60 percent of hospitals said patients are scheduling fewer elective surgeries and other procedures, and 17 percent reported closing clinics and discontinuing psychiatric services to save money.

Number of Uninsured Projected to Grow

An Associated Press story found on the Detroit News website describes a worsening situation that will surely have repercussions across American society. In the short term - as following articles in this blog will report - the load on free clinics will continue to grow, requiring more volunteers.

Without changes in federal policy, the number of Americans without health insurance will grow from about 45 million this year to about 54 million in 2019, the Congressional Budget Office said Tuesday.

Driving the increase will be health insurance premiums that rise faster than incomes. The CBO says premiums will increase to keep ahead of increased costs of medical breakthroughs that are extending and improving people's lives. Also contributing to higher insurance costs will be wasteful and unnecessary medical care.

"A substantial share of spending on health care contributes little, if anything, to the overall health of the nation," CBO Director Douglas W. Elmendorf told the Senate Budget Committee.

Reform and Crisis Management - There's a Big Difference

If tens of millions of Americans were becoming malnourished, would we wait on meeting their basic needs through years of discussion and argument about reform of the food system?

I would hope that we'd address the crisis immediately even if more permanent solutions would take a while to be agreed upon. In the case of health care, we know of the existing crisis, but there's very little action being taken towards mitigating it. People are suffering and dying invisibly.

I've just been reading the latest articles posted on the Cover the Uninsured website. Of course, we are in total agreement that a great country like America should have no uninsured residents, and that the government should be urged to devise a program to make that a reality. That's important for economic as well as social and cultural reasons. The approach taken by Cover the Uninsured - a project of the Robert Wood Johnson Foundation - is one of raising awareness without directly advocating that services be provided immediately to the 46 million Americans living without coverage.

Clearly, health care reform is needed, but even with reform millions are likely to remain without options for treatment. We are in a crisis where ill people are dying, hospitals are becoming insolvent and fewer doctors are treating ever more patients. Our health care system is collapsing and the only stopgap alternatives for the working poor are the free clinics staffed by volunteers who are, themselves, working over capacity. Reinforcements are needed now.

Aside from the occasional articles lauding the volunteerism that keeps these clinics operating or announcing the opening of new clinics or describing the financial challenges facing existing clinics, there is precious little explanation or discussion of how crucial these services are in caring for our neighbors in need while taking the load off of hospital emergency rooms.

The collapsing global economy is only adding to the crisis as more people lose jobs and health insurance. And even those with coverage are putting off treatment to avoid rising copayments deductibles. Tap-In is about finding more volunteers for free clinics - our finger in the dike - to preserve alternative resources for the uninsured until the day when comprehensive reform has taken place. What we learn through staffing and operating free clinics will be useful in the design of new health care institutions for America.

We know there are tens of thousands of retired health care professionals and many more who are considering retirement. We also know that many of you retired or retiring doctors, nurses, social workers, PAs and NPs have gained most of your professional satisfaction from treating patients - not from doing the business of running a medical practice. We say to you that there's a current and critical need for your expertise, experience and compassion. Tap-In is one route for your connection to the free clinics that need your services during this worsening health care crisis.