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Awhile back, the consensus was that America was facing a surplus of health care providers. A popular refrain then was that new nursing grads would be “driving taxis” for a living.

Turns out, the rhetoric worked and too few people entered the health care field. Now, just as the baby-boomers reach the age when they need health care more than ever and as the health care system is besieged with other cost and access challenges, we also now face a serious shortage of both nurses and physicians, said OHSU President Peter Kohler during his remarks at a recent Oregon Health Forum meeting in Portland. Nurses will definitely not be driving taxis in the future.

Kohler agreed with Kitzhaber’s premise that fundamental change to the health care finance system is needed (see Part 1: “What’s Wrong With That Fish?”). Kohler then talked about delivery models, which both speakers also said need to evolve to meet current and future needs.

Specifically, in terms of its (negative) impact on patient care, the workforce shortage will exacerbate a phenomenon known as “door-knob docs” - providers who can only spend an average of six minutes with each patient in order to meet costs. Nobody likes this situation - not patients, not physicians - but our finance system reinforces it.

A possible fix? A focus on caregiver teams with medical assistants on the front line supported by computer technology. This could bring down costs and improve health care.

Kohler has presented the idea about health care teams before. This time, Kohler expanded his presentation to include a software demo by Dr. Steve Detana, president and chief medical officer for Lifecom, a company working to develop decision-making diagnostic clinical software. Detana took the stance of an MA seeing a patient complaining about a headache. The software prompted for detailed physical information, included body diagrams for a patient to pinpoint pain, and ultimately compiled a list of diagnoses with probabilities, and so on (check out www.lifecomhealth.com).

The demo was impressive but Kohler reiterated that a historical problem with our current health care system is that new models of delivery are not always rigorously tested before being adopted. “When you talk about re-organizing the delivery of health care, you raise interesting questions: Will it be cheaper or more expensive?  Will it be more effective or less? The short answer is that we need to test it to find out the answers,” he said.

Kohler announced a tentative July 2007 date to start a test of the medical teams/IT model. He has assembled a diverse group of advisers in informatics, outcomes measurements, family practice, nursing, psychiatry and so on to help design this clinical test which may involve thousands of people. Kohler also noted that this delivery model would fit under any reimbursement system that eventually evolves from the efforts Kitzhaber and others are spearheading.

The questions asked afterwards were telling of the challenge of changing health care culture which emphasizes the patient-physician relationship. For instance, a med student worried the move toward medical teams might preclude his goal of being a primary caregiver with meaningful patient relationships. Not necessarily, noted Kohler, as the new model would likely give way to a circumstance where physicians would instead have better relationships with a smaller subset of people who needed their expertise. This will free them from the door-knob doc constraints and appropriately expand the role of MAs, RNs and other caregivers. And it’s more than costs and workforce shortages driving health care toward the team/IT direction he said: there’s now too much medical information for a single practitioner to retain it all.

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