Slashing Red Tape Can Ease The Doctor Shortage
The coronavirus pandemic is threatening to stretch many hospitals to their breaking point. Beds are filling up with stricken patients, and public health officials are concerned about whether we’ll have enough doctors and other healthcare professionals to care for them.
So they’re scrambling to roll back years’ worth of regulations on the healthcare labor market—many of which never should’ve been in place to begin with. There’s no shortage of red tape for policymakers to cut to boost the supply of care during the pandemic and beyond.
The U.S. doctor shortage preceded COVID-19. But the crisis has exposed its severity. If current trends continue, the United States will be short up to 122,000 physicians by 2032, according to the Association of American Medical Colleges. That projected shortfall includes up to 55,000 primary care doctors.
One million registered nurses are expected to retire over the next decade. We’ll need to replace them—and then some—given our nation’s aging population.
Within the last few weeks, almost every state has conditionally eased out-of-state licensing restrictions on physicians, physician assistants, and nurse practitioners to help meet demand for care. In New York—the epicenter of the outbreak in the United States—more than 21,000 out-of-state healthcare professionals have already volunteered their services.
There’s no reason to re-impose those state licensing restrictions after the pandemic passes. Why should a doctor who’s good enough to practice in California be unable to do so in New York?
Some states have relaxed “scope-of-practice” barriers on nurse practitioners and physician assistants. Historically, these medical professionals have been barred from diagnosing patients or prescribing drugs independently in many states.
That makes little sense now—or in the future. People need refills of their blood-pressure or birth control medication, and doctors may not have time to see them. NPs and PAs are more than capable of taking on work like this. They typically have either master’s or doctorate degrees and advanced clinical training.
There’s also more that pharmacists can do. Right now, just 19 states allow them to administer vaccines without a doctor’s order or protocol. If vaccines were easier to get—say, at the local pharmacy—then inoculation rates would almost surely go up. That’s important now, when hospitals can ill afford to see patients with vaccine-preventable conditions like the flu, given the onslaught of COVID-19 patients.
Scrapping restrictions on vaccine administration for pharmacists would also put the country in better shape to undertake a nationwide inoculation campaign against the novel coronavirus, when a vaccine is finally ready.
The list of drugs that are available over the counter deserves a revamp, too. Many common medicines currently requiring a prescription, like contraceptives and migraine medication, could be purchased safely from a pharmacist without one. This approach could reduce trips to the doctor’s office, which would save patients money—and physicians, PAs, and NPs valuable time.
Deregulatory moves like these will help increase the supply of care in the short term. In the long term, we must streamline the path to becoming a physician. In the United States, the typical doctor spends four years in college, four years in medical school, and anywhere from three to seven years in post-graduate residency and fellowship.
By comparison, students in almost every other developed country can earn their medical degrees in six years or less—and then begin their residency programs.
Some U.S. medical schools are responding to the pandemic by graduating students ahead of time. To date, more than 20 schools—including New York University Grossman School of Medicine, Tufts University School of Medicine, and Boston University School of Medicine—are allowing the class of 2020 to receive their diplomas early to help fight COVID-19.
Measures like these don’t have to be temporary. Before the pandemic, three-year M.D. programs at the likes of Duke University, Ohio State, and Texas Tech were already starting to gain traction.
We could also look to expand accelerated Direct Medical Programs, which guarantee motivated high school seniors admission into medical school pending completion of required courses and a certain GPA during their undergraduate years.
Participating DMP students at California Northstate University School of Medicine can complete their bachelor’s and medical degrees in only six years. George Washington University and Rutgers University offer seven-year programs.
It’s unfortunate that it took a pandemic for public officials to free up the healthcare labor market. We mustn’t abandon these deregulatory efforts. Until the United States addresses its shortage of doctors and other qualified healthcare personnel, the country will remain underprepared for public health crises.
Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All, Encounter Books, January 2020. Follow her on Twitter @sallypipes.