Clinical doctors smiled (actually, they grimaced) while reading two recent headlines. The first was “Wyden, Blackburn Introduce Bipartisan Legislation to Tackle Health Care Workforce Shortages.” This is one more demonstration of Ronald Reagan’s prescience when he said in his 1981 Inaugural Address, “Government is not the solution to our problem; government is the problem.”
Every direct care provider understands from painful daily experience that government regulations stemming from federal legislation are the real reason for shortages.
The shortage of nurses, therapists, and physicians is undeniable and getting worse. Understanding why people are leaving helps to know why they became care providers, especially doctors, given the time, stress, and cost necessary to become one.
The answer is the psychic reward, what Maslow called self-actualization. As a nurse shared one day, “When my [patients] do well, it feeds my soul.” Care providers prove their self-worth to themselves when they help heal a sick person through their personal efforts. The number of Washington advisories, guidelines, prohibitions, clinical algorithms, crisis standards, and clinical mandates is literally uncountable. These federal commandments effectively take care decisions out of clinicians’ hands.
As the number of regulations goes up, the psychic reward shrinks until it is gone. And when the psychic reward goes, so go the care providers.
Federal health care regulations make it harder for caregivers to do their jobs, not easier. The security elements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) obstruct communication between clinicians, frustrating them and increasing the likelihood of medical errors. Workers everywhere rightly expect their employers to help them do their jobs, yet caregivers face obstacles everywhere they turn as the federal government tries to protect the patients from their supposed fiduciary doctors and nurses.
Such “protection” drives people out of caregiving.
The “health care workforce shortage” applies to doctors and nurses but not to nonclinical healthcare workers: administrators, agents, bureaucrats, billers, coders, compliance officers, lawyers, managers, etc.
This number expands every time Washington imposes more regulations. Between 1970 and 2010, the supply of U.S. physicians increased by 100 percent. Over the same time, the number of healthcare bureaucrats increased by more than 3,000 percent. Texas, for instance, has 50,000 licensed physicians and 62,000 overseers in the Texas Health and Human Services Commission.
Where does all the money come from to pay healthcare bureaucrats? From payments to caregivers.
To pay for the BARRCOME — bureaucracy, administration, rules, regulations, compliance, oversight, mandates, enforcement — in the Affordable Care Act of 2010, President Barack Obama took $716 billion out of the Medicare Trust, funds earmarked to pay for seniors’ hospital care. The Trust is slated to run out of money by 2028. Medicare bureaucrats will still be paid, but seniors won’t get medical care.
Increasing numbers of doctors still in practice are refusing to see new Medicaid patients. In a survey of Texas physicians, where more than 50 percent do not accept new Medicaid patients, the two reasons they give are regulatory burdens and low payment schedules as funds for care providers are diverted to pay for BARRCOME.
To suggest that the government will solve the shortage is laughable, given that Washington’s over-regulation is the cause of care provider shortages.
The second eye-catching headline reads, “Healthcare leads July job growth.” Yahoo Finance reports, “Healthcare led the way with 55,000 new jobs in July. This increase was distributed across various subsectors: home health care services added 22,000 jobs, hospitals contributed 20,000, and nursing and residential care facilities saw a 9,000 job increase.”
Not described was how many of these “health [] care jobs” were care providers and how many were not, i.e., they were bureaucrats. A prior report showed that at least 90 percent of new healthcare jobs are administrative. As more nonclinical jobs are added, more money is necessarily diverted away from patient care.
The result is more death-by-queue: more Americans dying while waiting in line for care.
Is it surprising that the shortage of nurses and doctors is worsening when they can see that paying government bureaucrats is more important than paying them to provide patient care? When the system they work in undervalues them, takes away the psychic reward, and hogties them with regulations to protect the patients from them?
The true wonder is that any care providers are still willing to put up with this.
The solution for the shortages is simple, though politically radioactive. Since government incursion into the practices of medicine, nursing, and therapy is the root cause, the cure is to withdraw Washington’s heavy hand from its illegal and harmful malpractice of health care.
Jesus Christ is King
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