Gate Keepers

The hardest decision for medical students is narrowing their studies to a specific field. With so many different options, I researched several different fields that appealed most to me. With each field comes entirely new and unique training, but each practice is just as demanding as the next. After the long road of medical school and the selection of a practice is complete, each student must complete a residency. A resident student is a student with a medical degree, who is practicing their specific field under a licensed doctor. Generally, residencies last from 3 to 5 years and usually the final stage before one can practice on their own. Each step along the road to becoming a doctor is more and more competitive and demanding as the last.

I was regularly identified and characterized by my teachers as an introverted child growing up. Each year, I had to designate my future career aspirations, and every year until the end of my high school career, I wrote down “MD.” This may have stemmed from the fact that, in my culture, growing up as a child of an immigrant generation, education was the primary emphasis. Having minimal access to delve into possible career options, I assumed that the MD route was the only way to become a health care provider. My parents probably pondered how a quiet, soft spoken child like me would want to become a doctor. My journey did not take me in the track to become a medical doctor, but I am confident that this path is in fact a true blessing in my life. As I prepare to begin the FNP graduate nursing program, I am delighted to announce to my family and friends that I am finally on the road to becoming a primary health care provider.

The aim of the ACA is to provide affordable health care to all Americans, but it still leaves some issues unaddressed that will impact the access to health care. Covino (n.d.), “Though the intentions of the legislation are good, the Affordable Care Act does little to improve the actual health care delivery system” (para.1, page 2). According to the American Medical Association, we are facing an increasing Physician shortage. As of 2010 we faced a shortfall of 13,700 physicians, the estimate is that number will increase to 62,900 by 2015, 91,500 by 2020, and 130,600 by 2025 (Krupa, n.d.), with primary care taking the largest impact. Health Care coverage will be of no benefit if there are no doctors to treat the patients. An example of this occurred in 2002 when Thailand’s’ “30 Bhat Scheme” added (CNN n.d.) “14 million people to the country’s health care system, resulting in long waits and subpar service” (Your health is covered, but who is going to treat you?) Several factors contribute to the physician shortage. Many physicians are reaching the age of retirement, the Association of American Medical Colleges estimates nearly 15 million physicians will be eligible for Medicare in the coming years (CNN n.d.). The increasing cost of malpractice insurance also deters many from pursuing a career in medicine, and is forcing some doctors to retire. Also contributing to the physician shortage is a lack of spots in residency programs. “In 2011, more than 7,000 were left

The payment system in the healthcare industry has appealed to specialty care providers, they make a higher income than the primary care physician. The physicians are attracted to specialty care, and the individual feels that specialty care is better. If physicians were all paid well, in order to pay for their education and then continued quality training, we would not be confronting the lack of primary care doctors who are available to treat the general needs of the population (Fisher, 2013). Just as the physicians seem to be treated differently in our health system so are the patients. Using a multi-tiered system of health care where some insurance gives out a higher payment to physicians, some patients seem to be wanted while others are less well received, this leads to an “everyone for himself or herself ethic” within our medical system (JAMA, September).” The design of the system is flawed in reference to the primary care physician and with the patient who has insurance which pays less, the way to reorient both is to make the pay scale more competitive for both. The primary care physician should be able to make money and cover this educational expenses and the patient should have insurance that will equate to

According to Health Resources and Services Administration If the system for providing primary care in 2020 were to stay fundamentally the same as today, there will be an estimated shortage of 20,400 primary care physicians ("Projecting the Supply and Demand for Primary Care Practitioners Through 2020," n.d.). In addition this projection doesn’t include the decreasing number of people perusing the medical degree and the baby boomers retiring form this filed of science. In the hand we are experiencing a significant increase in NPs and PAs. Considering this projected shortage, which is actually a very frightening situation the increasing number of NPs and PAs, can effectively be integrated; we could reduce the number of physician shortage by over 69 percent in 2020.

The new federal health-care law has raised the stakes for hospitals and schools already struggling to train more doctors. Evidence suggests there won’t be enough number of doctors to treat the newly insured millions under the ACA. At current graduation and training rates, America faces a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges. The greatest demand will be for primary-care physicians. Emergency rooms, the only choice for patients who can't find care elsewhere, may grow even more with longer wait times under the new health law. That might come as a surprise to those who thought getting 32 million more people covered by health insurance would ease ER

Currently, there is still a large shortage of primary care practitioners in the United States. The margin between available providers and those in need continues to grow. Many people without proper access to care have to delay seeking help for what ails them ("Health Wanted," 2012). Glicken & Miller (2013) state that approximately 16,000 primary care providers would be necessary to meet the existing demand. Rural communities would represent the area of greatest need followed closely by low-income urban areas. The number of underserved individuals is estimated to have reached fifty-seven million. This demand will only increase, as 52,000 primary care providers are expected to be needed by the year 2025 (Glicken & Miller, 2013, p.1883-1889).

One class of American citizens view on the Patient Protection and Affordable Care Act is doctors, and it is very negative. Third-party payment plans already hinder the independence and integrity of the medical field. This act now will reinforce the worst of these features. Physicians will fall prey to more government regulation and oversight, and will now be increasingly dependent on a not to reliable government reimbursement for their services. A doctors job will only be become more difficult.

Primary care access is a growing concern for all Americans and the reason behind this concern is an imbalance between demand for care and capacity to provide care. Demand is growing as the population expands, ages, and faces chronic illnesses and the capacity is shrinking as the ration of primary care clinicians to population drops (Ghorob & Bodenheimer, 2012). A primary goal of the Affordable Care Act (ACA) was to improve access to quality health care for uninsured Americans, largely through public and private insurance expansions (Polsky et al, 2015). At the same time, the architects of the law recognized the need to increase the availability of primary care providers to meet the increased demand for health care (Pg. 538, 2015).

In the wake of the 2016 presidential election, concerns have been raised regarding the Republicans’ desire to repeal the Affordable Care Act, informally referred to as Obamacare. The ACA was originally enacted into law in 2010 and has been annually provisioned to expand its ability to not only improve the nation’s access to health care, but also to reform the health care delivery system. Through the ACA, private and public insurance has become more available and affordable, new health care delivery models have improved quality of care, and several workforce policies have made primary care a more desirable profession for medical students.

The Affordable Care Act set forth millions of dollars to address the problems and concerns that are associated with existing physicians shortages. The Affordable Care Act also has provisions that are aimed to improve the education, ongoing training as well as to help with the recruitment of nursing, physicians, doctors as well as other health care personnel. In addition, there are provisions in place that help to increase workforces’ cultural competency, enhance faculty training of healthcare professionals, and diversity. The provisions also play a vital role because of the fact they are put into place to examine innovative reimbursement and care delivery models that highlight primary care services value and offer in improvement in the patient care coordination.

The overall health care industry has undergone fundamental change over the last decade. Most of the changes have occurred within the underlying business operation of the healthcare industry. Legislation in particular has had a profound impact on the health care industry. First, due to the Affordable Care Act of 2010, the nursing profession is undergoing a fundamental shift in regards to the patient experience. The U.S. health care system is now shifting the focus from acute and specialty care to that of primary care which requires a shift in business operations. Also, due primarily to that aging of the baby boomer generation, the need for primary car overall is shifting and will be needed heavily in the future. The last 10 years in particular has seen an increasing influx of retiring baby boomers that subsequently need care. A positive impact on the ACA legislation is that more individuals are now insured. As such, the need for primary care will also increase over subsequent years, particular within the minority population. This patient centric approach will require more care predicated on specific communities in a seamless manner. Furthermore, primary care physicians will be in high demand over the coming years.

The number of physicians in the country has been decreasing at such a great rate that the government and other stakeholders in the health care sector are trying to camouflage this by increasing the number of foreign doctors practicing in the country. The American Medical Association has been trying to promote these re-entry programs designed for physicians since the year 2009 to help curb this problem. There are many people who can see what the problem is, but it is not possible for them to do much about it. Physicians also see this problem, and they are well aware of why the shortage is arising, but they are also unable to do much to prevent the issue. There are many problems that lead to the shortage of physicians, and unless something is done, it will continue escalating ADDIN EN.CITE Lynch19721573(Lynch, 1972)1573157317Lynch, MichaelThe Physician "Shortage": The Economists' MirrorAnnals of the American Academy of Political and Social ScienceAnnals of the American Academy of Political and Social Science82-88399ArticleType: research-article / Issue Title: The Nation's Health: Some Issues / Full publication date: Jan., 1972 / Copyright © 1972 American Academy of Political and Social Science1972Sage Publications, Inc. in association with the American Academy of Political and Social Science00027162http://www.jstor.org/stable/1040122( HYPERLINK l "_ENREF_6" o "Lynch, 1972 #1573" Lynch, 1972).

Donald Super’s theory of career development focuses on the different stages people progress through as they go through life, and how these stages correlate with important events and career choices. During growth (birth-14 years), people grow physically and begin to form ideas of their self-worth. During this time, many people

I have taken stock of myself, considering my skills, experiences, and goals. I have looked to family and friends, some of whom are doctors, for advice. Because of this self-examination, I have decided to pursue a career in health care. The process has been difficult at times but always illuminating. Throughout it all, I have never lost confidence - the confidence that I will actively absorb all available medical knowledge, forge friendships with fellow students, and emerge from my training as a skilful and caring physician.