Health Corps
President-Elect Barack Obama’s transition webpage has a new video up featuring the nominee for Secretary of Health and Human Services, Tom Daschle, discussing health care. The transition team opened up the website last week to comments by ordinary Americans about what they would like to see in a health care reform. In the video, Daschle and an associate (Lauren Aronson) read through a few of the comments they received that they found particularly “interesting.” One of the citizen ideas that the pair latch on to is a national “health corps,” analogous to the Peace Corps. The skeletal concept is that doctors finishing their training would be encouraged to do a year or two of domestic service in communities with uneven access to health care professionals.
The attention given to this idea (one of only three mentioned, and the only concrete suggestion alongside “cost control” and “prevention”) is politically savvy: it is the kind of policy that no one is likely to disagree with, unlike the nitty-gritty details of an actual health reform. A systemic reform isn’t going to happen on http://change.gov. It is going to happen in Congress (it is already happening), and there is going to be serious horse-trading. The public won’t be welcome, although a President Obama may try to use the internet to rally supporters if the going gets tough.
That doesn’t mean the video, or the idea of a health corps, are irrelevant. In fact, a health corps should be part of a wider strategy to deal with one of the biggest problems in the American health system: the shortage of primary care physicians. Any reform of American health care is going to rely heavily on primary care physicians to manage care and keep costs under control. Yet, as a recent White Paper from the American College of Physicians argued, primary care physicians are a dying breed. The Journal of the American Medical Association reported that, in one 2007 study, only 2 percent of fourth-year medical students intended to study general medicine. A 2008 Health Affairs study predicts a shortfall of around 40,000 primary care physicians in the United States by 2025.
Primary care physicians do not get either the respect or the salaries necessary to keep the field attractive. Previous efforts to reduce the salary gap between primary care physicians and specialists have generally failed because they involve redistributing money from powerful specialists groups to PCPs, a result that is unacceptable to specialists. Senator Max Baucus’s health plan, which is currently making the rounds in Congress, would call for just this kind of redistribution, and has already been criticized on these grounds. Boosting PCP salaries without cutting specialist salaries may require some upfront costs that politicians find distasteful, particularly given the current economic climate. But if PCPs help to manage care appropriately and encourage preventive measures, the overall cost of providing care should come down, meaning that enhanced salaries are an investment that would at least partially pay for itself. It would also be easier to redistribute over time by allowing inflation to erode the salary gap rather than making a direct assault on specialists’ current salaries.
But increasing the flow of doctors into primary care is not just about salaries, it is also about respect. Medicine is no different from other fields, in which specialists doing cutting edge work that is intellectually interesting tend to have higher status than those who make the more hum-drum but essential contributions upon which the poor depend. This is where the Health Corps comes in. If the President were to authorize a Health Corps that helped doctors who dedicated themselves to primary care not only receive enhanced salaries, but also enhanced status, primary care would become a more attractive field. The American College of Physicians has already called for debt reduction for doctors that go into primary care. PCPs want more autonomy and less paperwork, too. A series of presidential honors for service, starting with recognition in the Health Corps, but moving on to mid and late-career recognition (monetary and non-monetary alike) could also enhance the profile of primary care physicians. PCPs could be preferentially called on to serve on governmental panels to guide the health system, and receive Master status as teachers and mentors through a system that would parallel the academy, but be based on experience, service to the disadvantaged, and mentoring, rather than academic publications.
The program would need some fleshing out, but a Health Corps shouldn’t just be a temporary foray into service for doctors who are willing to sacrifice a couple of years of high salaries. That should be part of what a Health Corps does, but it should also be a way to encourage doctors to remain in primary care, and to become experienced providers who receive salaries and status commensurate with the vital services they provide.
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Pingback by Health Blog » Blog Archive » Harvard International Review Blog » Health Corps — December 4, 2008 @ 11:38 am
What about the existing Medical Reserve Corps sponsored under HHS and the Surgeon General’s office: http://www.medicalreservecorps.gov/HomePage
We don’t necessarily need to create a new organization but hopefully leverage the MRC’s work within Public Health to be a stopgap to the lack of primary physicians.
Also we need to do a health disparity analysis of those areas that are under served by the lack of a primary physician compared against a trend analysis of what is impacting that populations health i.e. high rate of STD’s, HIV, GI, Flu, etc. then PLAN accordingly to that analysis BEFORE enacting programs.
Comment by TDG — December 4, 2008 @ 4:31 pm
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Pingback by Harvard International Review Blog » Health Corps — December 4, 2008 @ 9:15 pm
I find it ludicrous that proposed solutions to the health care crisis, particularly in Primary Care (PC) services,is that the only solution proposed is always more of the same: more PC physicians, more money, more respect, more satisfactions, less paperwork, etc.. While I am very sympathetic to the undeserved plight of the PC MD, perhaps a reality check is in order.
For over 43 years, Nurse Practitioners have been providing primary health care services to the underserved, often disadvantaged urban and rural population. These NPs have documented evidence of their ccmpetencies, safety, and patient acceptance and satisfaction. They have increased accessibility, availability, affordability and affability to a crippled health care sector. Not without a monumental struggle with organized medicine as it fought practice legislation that would allow the NPs to practice to the extent of their academic and clinical preparation.
NP have been responding to health care needs of our people in primary, secondary and tertiary prevention, for education in life style adjustments in chronic illnesses, and self-care, self-determination and choice. All the while, NPs have worked successfully and collaborating with MDs and other health professionals in team relationships in case finding and referrals, case management and consultation.
Christensen, et al, in the 2000 Harvard Review article, said it all: The NP is a “Disruptive Innovation” in health care, but maybe we haven’t been disruptive enough!
Comment by Loretta C. Ford — December 9, 2008 @ 2:43 pm
Hello,
If we are going to continue our role as global leaders, we need to create systems outside of our borders that further reflect this posture. Medical humanitarianism and other positive foreign policy is paramount. I submitted the following on Obama’s transition website a few days ago.
Ryan
Growing A New Global Surgical Workforce: A “Peace Corps” of US Resident Physicians
By: Ryan J. Jense, MD
As man advances in civilization, and small tribes are united into larger communities, the simplest reason would tell each individual that he ought to extend his social instincts and sympathies to all the members of the same nation, though personally unknown to him. This point being once reached, there is only an artificial barrier to prevent his sympathies extending to the men of all nations and races.
-Charles Darwin
Although many facets of humanity can and do provide valuable energies to stabilize the human ‘super structure’, the United States academic medical education system has only begun its entrance into this field. I believe this to be an incredibly important step towards a quantum leap in stability. If value recognition is added at the highest levels to improving global wellbeing, the United States can further establish its positive leadership role in global citizenry.
We have reached a period of global interconnectedness in which the Federal government and the individual US medical societies should consider revising their mission statements to further reflect their dedication to improving global wellbeing. The Obama administration and congress in collaboration with the Institute of Medicine, American Association of Medical Colleges, American College of Graduate Medical Education, Association of Academic Health Centers, and the departmental Residency Review Committees can support and guide this process.
As an anesthesiologist, I have focused my efforts on global surgical disease, but please understand this logic could be applied to all medical specialties. I have been pursuing an idea that will help bridge the surgical gap of humanity, and in the process, improve the lives of millions. It is a result of, and a response to, evolving global health interests circulating within our communities and our institutions. This idea requires changing culture within the United States medical education system.
Injury prevention and basic surgical care are increasingly recognized as important cost-effective components of global health. Worsening political-economic disparities and global industrialization are greatly responsible for the growing surgical burden. The resulting violence and rapid introduction of mechanization into countries with minimal regulatory systems and dismal surgical care infrastructure have accelerated injury related death and disability worldwide.
The World Health Organization (WHO) estimates that one million people die from road traffic accidents (RTA) each year, with 50% being between the age of 15 and 44 years. A much greater number are disabled from RTA’s. Violence, trauma, and routine surgical pathology also contribute greatly to the overall surgical burden. Furthermore, surgical health needs of women in developing countries continue to be grossly neglected. The WHO estimates that over 500,000 women die each year from complications related to pregnancy/childbirth, and approximately another 10 million suffer delivery-related injuries.
Surgical disparities are ubiquitous. Vast majorities of the world’s population do not have access to basic surgical healthcare. Dismal surgical systems, and a grossly inadequate surgical workforce are to blame. I present you a mechanism that will alter this disparity.
A growing set of data recognizes that US resident physicians are ready and eager to provide clinical, research and educational global health services while in training. This group of physicians represents the future of US and global medicine, and if given the chance, tomorrow they will begin to function in a synergistic way to help grow global medical capacity where it is needed most.
Selected surgical training programs across the US will join forces. This coalition can be thought of as a “Peace Corps” of resident physicians. International global health electives will be integrated into these surgical residency programs. Each program will devote intellectual and human resources to a select international site. Resident and attending physicians (A.K.A. – the doctors who train the residents) will rotate to these sites and serve a clinical, research, and educational role on a continuous year-round basis.
Through careful evaluation, and in coordination with international medical officials, a rigorous curriculum will be developed to serve the needs of the international sites. These curriculums, coupled with appropriate health systems planning, will result in the massive growth of international surgical capacity. The endpoint is the formation of self-sustaining surgical systems at each international site. When that important threshold is met, the model will transition to another site and begin again.
This is an idea of scale, but most importantly, of potential. A tremendous increase in the global surgical workforce will be realized through the sheer number of US physicians serving internationally, and more importantly, through the systematic training of international local providers who will continue to serve in their respective communities.
Underserved international communities will benefit greatly from the implementation of collaborative surgical systems centered on a chosen district level hospital. These “hospitals of surgical excellence” will provide perioperative and surgical services to a grossly underserved population, and will permanently serve as centers of research and medical education for the local population. Beyond the core mission, these centers will support political-economic stability, and also instill a sense of community pride.
A fully funded pilot program is essential to the growth of this idea. We have taken preliminary steps at the University of Washington (UW) to initiate this process. We aim to create an “International Surgical Care Center” within UW Health Sciences to attract expert faculty from around the world to achieve the following goals:
1. Develop specific curriculum to grow the global surgical healthcare workforce through training of international providers and UW personnel.
2. Integrate year-round global health electives into UW surgical residency programs such that resident-attending pairs will function in an educational, research and clinical capacity.
3. Integrate UW capacity into a specific international site to construct/enhance sustainable education, research, and clinical capacity.
4. Provide training in creation and evaluation of surgical infrastructure (initial response, trauma care, etc.) through the UW Harborview Injury Prevention Center.
5. Attract worldwide expertise and become the model academic clinical educational global outreach research center.
We aim to enhance global surgical systems and grow a highly qualified global surgical workforce through the maintenance of numerous collaborative and parallel relationships. A coalition of US academic surgical residency programs will be the driving energy to provide clinical and educational expertise to selected international partners. They will be responsible for maintaining high quality clinical/educational curriculum and expertise for targeted low-income populations.
An umbrella entity such as the World Health Organization will oversee and maintain communication with international Ministries of Health and other officials to promote the relationships between the US academic programs and their partners. Most importantly, our international partners will lead in the evaluation and evolution of site-specific educational models and curriculum to best serve their goals.
Gross success will be measured by evaluating the number of:
1) International students trained
2) Self-sustaining global surgical centers created
3) Patients treated
4) US physicians practicing abroad
I believe the Obama administration will assist in stabilizing the human ‘super structure’ on countless fronts. Value recognition in the form of new humanitarian foreign policy, such as an initiative directed to create and sustain a “peace corps” of global US resident physicians, is a great way to assist this effort. Let’s further embrace our interconnectedness and give the stars to our children.
Comment by Ryan J. Jense — December 10, 2008 @ 6:55 pm
These health corps got so many liabilities.
Comment by Acai — December 20, 2008 @ 7:20 am
It seems kind of rediculous how these health corps operate their day to day operations.
Comment by Acai — January 25, 2009 @ 3:02 pm
while a “healthcorps” for medical doctors- in particular, PCPs- is an interesting idea that should be further explored, we should not forget preventative efforts targeted at youth. there is actually an organization called healthcorps, founded by dr. oz, which sends recent college grads into high schools to educate students and their families about fitness and nutrition. such programs should be significantly expanded across the country.
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Comment by RezV — March 31, 2009 @ 10:18 am
It seems kind of rediculous how these health corps operate their day to day operations.
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Dr. oz, which sends recent college grads into high schools to educate students and their families about fitness and nutrition. such programs should be significantly expanded across the country.
Comment by Acai — May 15, 2009 @ 2:17 pm
I really hope that Obama can follow through on his grant plans.
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I think that the current direction Obama is taking is the right one. We need change and we need it fast. It is tough times during these economic crisis and we must act fast to fix it.
Comment by Acai — June 3, 2009 @ 7:35 pm
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Comment by Going Green — September 12, 2009 @ 12:27 pm
Lately more opposition is coming towards obama’s healthcare reforms.
Comment by vijay — September 16, 2009 @ 8:59 am
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Comment by Insurance — September 28, 2009 @ 1:31 pm
The question is how many of these doctors will be willing to take the jobs. I know many of them have been in derision of the health care package and are totally against it in the first place.
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Comment by vera bradley — October 13, 2009 @ 12:23 pm
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