Hiring Ahead: The Affordable Care Act and 32 Million New Patients
By: Heather Boerner
From where Dr. Irene Krokos sits as chief medical officer of Molina Healthcare in New Mexico, a storm is coming.
“It’s a perfect storm, the product of advancements in technology, the need to address rising healthcare costs, the lack of primary care capacity,” she says. “And, of course, the new health care law.”
When the Supreme Court largely upheld the Affordable Care Act in June, healthcare organizations finally had some direction on how to proceed.
It’s estimated that, under the law, 32 million more Americans may have health coverage by 2014 -- about 15 million of those under the individual mandate and the rest under the Medicaid expansion, depending on the number of states that implement that provision of the law.
Recruiting the healthcare workforce needed for this increased demand is more than a numbers game -- it’s a creative endeavor.
Filling the Physician Gap
The majority of future healthcare hiring efforts will be aimed at primary care and coordination, part of the ACA’s one-two punch aimed at improving care and reducing costs. But filling that need is going to be challenging.
The Association of American Medical Colleges predict a 45,000 physician shortage over the next decade, a trend that will be worse in rural areas that already lack doctors.
Surprisingly, the solution that hiring managers are finding to fill this need is not in medical schools but nursing schools.
Julie Novak, RN, pediatric nurse practitioner and executive director of the University of Texas Nursing Clinical Enterprise at the University of Texas at San Antonio, gets calls daily from health care organizations looking to hire her advance practice nurses -- nurse practitioners, clinical nurse specialists, nurse midwives and nurse anesthetists -- all of whom receive master’s degrees or doctorates. Some experts expect demand for nurse practitioners to grow by 94 percent in the next decade.
“You can hire two primary care nurse practitioners for every one primary care physician without sacrificing quality of care,” says Novak. The University of Texas has created nurse-run clinics, training primary care nurse practitioners to run their own clinics to take the positions that the Affordable Care Act necessitates.
A Collaborative Workforce Model
Beyond the doctor gap, workforce planning for the Affordable Care Act should also include a range of providers who can back-fill the new collaborative care model of the law. These jobs include RNs and social workers who visit newly discharged patients’ homes to insure treatment compliance, as well as physician assistants, medical assistants and community health workers.
Community health workers, who provide care coordination and health coaching, can be trained relatively quickly. The key is, says Sanjeev Arora, MD and professor of medicine at the University of New Mexico Health Sciences Center, is that they be willing to “work to the highest possible level of their experience.”
Additionally, since primary care providers will have to work differently, newly hired medical assistants will need to do more than simply room patients.
“We can train them to be, say, diabetes experts,” says Arora, “so they can help people with their diet, exercise, nutrition, how to do finger sticks.”
Connecting Rural Healthcare
How will healthcare recruiters find some of these providers and extend healthcare to larger rural areas? One option is to join one of the many pilot projects around the country being funded by the US Department of Health and Human Services and its Center for Medicare and Medicaid Services (CMS).
For example, CMS recently announced grants that were issued to hospitals in five states that train advance practice RNs. Other grants went to 10 states to retrain war veterans as physician assistants.
Or consider the model of Arora’s Project ECHO (Extension for Community Health Outcomes).
Project ECHO was founded to address the lack of healthcare resources in rural communities and extend primary care providers’ abilities to treat specific diseases. It pairs a multidisciplinary team of doctors, pharmacists , specialists, social workers, community health workers and physical therapists with primary care providers in rural areas by webcam and conference call.
To date, the model has been replicated in Illinois, Washington state, Massachusetts, Nevada, Utah, Florida and 11 regions of the Veterans Administration.
This multidisciplinary approach increases the regional knowledge network that can address specific chronic health issues and provides an incentive to primary care providers to settle in rural areas.
“When you look at the issue of recruiting primary care providers for rural and frontier areas, one of the issues is isolation,” says Krokos. She adds that the strategy works well in rural counties with a handful of providers. “Having a team you can tune in to like Project ECHO builds on knowledge, alleviates isolation and allows a path for career growth as you become an expert in a specific disease and a resource for your community.”
Hiring Team Players
If there’s one quality that a collaborative healthcare model calls for it’s a willingness to collaborate, says John Scott, MD at the Harborview Medical Center in Seattle.
Scott implemented the Project ECHO model from his office in Seattle, across rural parts of Alaska, Oregon, Montana and Idaho. When hiring for the project from his own staff, he was specific about what he was looking for: exceptional clinicians and exceptional teachers.
“They have to have a heart for service,” he says.
And it goes the other way, too: Selecting rural doctors to partner with also requires specific skills as a healthcare administrator. To successfully recruit for these positions, Scott had to get out of the office and visit rural clinics on sight.
“You have to go out, spend a day in the clinic, meet everyone from the medical director to the RNs, get a sense of the challenges they’re facing, and do a little teaching about how the program works,” he says.
This drives home another point. Healthcare hiring isn’t just changing for clinical staff -- it’s also changing for healthcare administrators.
In fact executive recruiting firm Witt/Kieffer has seen a 121 percent growth in searches for chief medical officers in the last year and a 43 percent increase in searches for medical executive searches overall.
“If you’re going to make this paradigm shift to primary care, it’s a huge opportunity for job growth, but administrators need to adapt to the changing landscape, as well,” Krokos says. “As primary care hiring goes up, the number of administrators may go down, and you have to prove your value.”