UK Releases Report on Global Healthcare Teams

The UK All-Party Parliamentary Group on Global Health and the Africa All-Party Parliamentary Group have released their All The Talents Report on how global health goals can be reached through creating and managing more effective healthcare teams.  With this report and the “Value for Money” meeting of African Finance ministers in Tunis last week, I think it’s finally safe to talk about cost-effectiveness in healthcare again.

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Health Jobs on List of Jobs with “Highest Licensure Burden”

The New York Times Sunday Magazine has a timely article about the over-regulation of professions in the US and how it creates unnecessary barriers to entering these professions.  This problem of over-regulation is especially important with nearly 13 million Americans unemployed.  Many of these workers lost jobs in fields such as manufacturing and construction that are either dying or won’t rebound for decades–requiring workers to find new professions.

Yet the incumbents of many professions have purposely thrown up barriers to entry to avoid competition.  The Institute for Justice, a Libertarian law firm, ranked over 100 low and moderate income professions based on five criteria (including number of years of education needed and licensing fees).  For those who have read Insourced, there should be no surprise that four of the top ten over-regulated professions were in healthcare.  These included athletic trainer, optician, midwife, and dietetic technician.

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Insourced Called “Intriguing and Lucid” by Publishers Weekly

Publishers Weekly, a leading website and newsletter for the publishing industry, has reviewed Insourced:

Tulenko, a physician and director of clinical services for a global health nonprofit, pursues a new angle in the ongoing healthcare debates in this intriguing and lucid study. She argues that the insourcing of health care workers–i.e. bringing them to the U.S. after they complete training in their own countries–is a destructive trend. Currently, 25% of physicians are “imported” from “countries that can least afford to lose them,” a practice that has resulted in a “multibillion-dollar international healthcare-worker recruitment” industry operating in at least 74 countries. In the U.S., she says, this results in lower salaries and employees who are less likely to unionize, as well as medical errors due to cultural differences or language barriers. Despite insourcing, there is nevertheless a scarcity of trained medical staff, and that shortage of workers will grow as baby boomers age. To address this deficit and provide jobs for Americans, Tulenko suggests reducing the cost of education needed to attain necessary credentials, training more workers at every level, better aligning students with healthcare needs (such as those of rural communities), and increasing efficiency in hospitals and doctors’ offices (e.g., via the use of electronic records, which technology has been available since the 1960s, but largely unutilized). Those interested in healthcare management or public policy will find plenty of cogent information in this well-researched treatise. (May)

http://www.publishersweekly.com/978-1-61168-227-4

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Appearance on “Shore Law” with Chad Malkus

I had the opportunity to have a one hour interview about Insourced on Shore Law with Chad Malkus on Radio1240 AM (WCEM, ABC affiliate).  The Eastern Shore of Maryland is rural and has a great shortage of all categories of health professionals.  I’ve had the pleasure of doing clinical work in Centreville and spent most of my childhood summers on my uncle’s farm in Rock Hall.  

In order to increase the number of health workers in rural communities such as those in the Eastern Shore, we need to align health professional school admissions with community needs.  In some communities, math and science courses will need to be improved or “bridging programs” developed.

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I’ve Been Caught Being Disruptive!

My blog on how to retain healthcare workers in underserved communities has been featured on the Disruptive Women in Healthcare website.

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Steve Thompson, CEO of Johns Hopkins Medicine International, Responds to Insourced

Steve Thompson, MBA, the CEO of Johns Hopkins International (the arm of Johns Hopkins Medicine that provides a focus for all its international activities) has written a blog in response to the excerpt from Insourced that appeared in Salon.com.

Thompson’s response focuses on what Hopkins and other international organizations can do to improve the health systems in developing countries to make them a more attractive place to work so that health workers will not want to migrate to the US.  I applaud this sentiment.  In fact this is much of what IntraHealth, the global health NGO I work for, does in thirty-four countries throughout the developing world.  Making sure that health workers have the skills, equipment, and motivation to save lives is crucial to their retention.   We desperately need more investment in this area.

Thompson’s blog then focuses on building world class hospitals.  There can be some trickle down retention effect, but we must be cautious about investing in hospitals. In most developing countries, the vast majority of people who die needlessly die at home having never been to a hospital.   We see this in countries like Lesotho where the tertiary Queen Elizabeth Hospital takes up the vast majority of the country’s health budget while children die at home from diarrhea, pneumonia, and vaccine preventable diseases.  These hospitals divert funding from the more critically needed community health and public health investments.

Yet making investments in the health systems of developing countries, no matter how large these investments are, will not solve the problems outlined in Insourced.  Insourced addresses problems beyond the retention of healthcare workers in developing countries.  The US is not training enough of our young people to meet our own healthcare needs.  This is especially true in American communities with the greatest health disparities and fewest health workers per capita: rural, poor, and minority communities.  Also, the costs of training health workers is spiraling up faster than inflation and faster than the costs of general tertiary education in the US and we must find a way to educate our young people more cost-effectively.

In addition, a large motivator for health workers to leave their countries is beyond the power of their countries to change.   In general, health workers in the US have higher wages than in any other country in the world.  Most developing countries will never be able to compete with the wages offered to health workers in the US, even if they improve their health systems.  Consider the consequences if we open up all other American sectors to global recruitment the way we have opened up our health sector: with special earmarked visas, licensing exams, and clear entry pathways.  You would see foreign workers flocking to US jobs, willing to work for less than US citizens.

(For full disclosure, I should let you know that I am an alumna of the Johns Hopkins School of Medicine and the Johns Hopkins School of Public health and serve as adjunct faculty at the Johns Hopkins School of Public Health.  IntraHealth has bid on grants with the Johns Hopkins School of Nursing as a partner. )

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Health IT Workers in Short Supply

Health IT blogger Bobby Gladd has commented that as more hospitals and physicians in the US use electronic health records, the demand for health IT (HIT) workers is growing exponentially.  These workers are essential to keeping electronic records functioning so doctors can access them in a timely manner and secure so they can’t be viewed by anyone else.  Unfortunately there are few training programs for HIT workers and most workers have to be trained on the job.  Bobby notes that in Nevada and Utah where he provides assistance to doctor’s offices to adopt electronic health records, the HIT workers shortage has resulted in offices hiring staff away from one another in a zero sum game.

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