What Nebraska’s Physician Shortage Says About the Emerging Healthcare System Nationwide | Mark Hagland | Healthcare Blogs Skip to content Skip to navigation

What Nebraska’s Physician Shortage Says About the Emerging Healthcare System Nationwide

April 17, 2018
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A new report looks at Nebraska’s physician shortage—and the potential role of HIT in resolving some staffing issues nationwide

I read with interest a report issued earlier this month by a work group at the University of Nebraska Medical Center, which focused on the widespread, challenging physician shortage in the state of Nebraska. The report, entitled “The States of the Healthcare Workforce in the State of Nebraska,” revealed that while there has been an 11 percent increase in the number of physicians in the state over the last 10 years, there are 13 counties that still do not have a primary care physician, according to a press release published by the University of Nebraska Medical Center (UNMC).

According to the April 4 press release published by UNMC, that finding was one of a number of key findings in the 64-page report. Among those challenges, the report found “the reality that nearly one-fifth of physicians in Nebraska are more than 60 years old, and thus likely to retire in the near future”; found that “18 of 93 Nebraska counties have no pharmacist”; and found that “demographics in many counties are becoming more diverse, but the current health workforce doesn’t necessarily reflect the populations being served.”

Inevitably, physician assistants and advanced nurse practitioners (PAs and APNs) are filling in the gaps in Nebraska. “Since 2007, there has been a large increase in the number of active physician assistants (PAs) in the state,” the report noted. “There are 908 PAs (or 47.3 PAs per 100,000 population) versus 598 (33.5 {As per 100,000 population) in 2007—a 52-percent difference in number of PAs. PAs currently provide a total of 35,878 work hours, equating to 897 FTE PAs. Half of the PAs are 40 years old or younger, and over 70 percent of PAs are female.” Further, the report stated, “Analysis of the distribution of PAs by county showed that 16 counties in Nebraska do not have an active PA.”

Meanwhile, the reported noted that, “In 2017, there were 1,148 nurse practitioners (NPs), 36 certified nurse midwives (CNMs), 49 clinical nurse specialists (CNSs), and 308 certified registered nurse anesthetists (CRNAs). The number of NPs rose from 767 to 1,148 in 2007-2017—a 50-percent increase. For CNMs, the increase was from 22 to 36 professionals.”

Importantly, the report’s authors state, “Our results highlight the substantial deficit in the supply of physicians across counties in Nebraska, particularly for the primary care specialties of internal medicine, OB/GYN and pediatrics. In addition, nearly one in five physicians in the state are older than age 65, and thus are likely to retire in the near future. In contrast, the number and rates of physician assistants and nurse professionals have grown substantially over the last decades and provide wide-ranging geographical coverage in Nebraska. The greater reliance on physician assistants and nurse practitioners,” they wrote, “has helped to offset the inadequate supply of primary care physicians.” Even so, they added, “[T]here remains substantial variation in the rate of nurse professionals across the state, with relatively low numbers of RNs, LPNs and APRNs in west and central Nebraska.”

Can healthcare IT be part of the solution?

Of course, Nebraska is far from alone among states with widely dispersed, broadly rural populations; Nebraska’s situation mirrors the situations of nearly all of those states. What’s more, with both the physician and nurse cadres aging these days, all of those states are facing accelerating challenges in providing high-quality care to their populations, including those sub-populations living with single or multiple chronic illnesses—particularly diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD).

But here’s the thing: the potential for leveraging important technologies is quite considerable in states like Nebraska. We all know that the adoption of telehealth technologies, strategies, and care delivery are advancing rapidly everywhere in the U.S., but particularly in states like Nebraska, which have a few large metropolitan areas, with medical specialists, imaging centers, and academic medical centers and other teaching hospitals, along with vast rural areas that have shortages of all physicians, including primary care physicians, as well as of mid-level professionals.