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Health Sector Job Creation and Medical School Expansion: What are we really achieving?

 

A recent piece in the New England Journal of Medicine by Drs. Katherine Baicker and Amitabh Chandra explores an alternative perspective on health sector job growth. In the thick of election year campaigning and economic recovery, job creation is a hot topic on the local and national stage. Critics from both sides of the aisle are citing candidates’ ‘job-killing’ or ‘job-creating’ policies as criteria to make or break the campaign. With such hyperbolic attention placed on this issue, it is worth analyzing the true implications of job creation in the industry with the highest rate of employment growth; healthcare.

 Based on a recent report, health care employment has grown by 9.5% compared to a 5% decrease in non-health employment since 2007. Over 1.2 million jobs have been added in the health care sector, accounting for nearly 11% of total employment in the United States. Many see this astounding growth in health sector jobs as playing a key role in our nation’s economic recovery, but as the authors assert, “the goal of improving health and economic well-being does not go hand in hand with rising employment in health care.”

Emphasizing measurable outputs (number of jobs, number of patients seen, number of procedures, etc.)  rather than the quality of outcomes (better health and disease prevention) has resulted in a bloated, unsustainable healthcare sector which detracts from other aspects of the economy. The authors point out that “if the same outcomes can be achieved with lower employment and fewer resources, that leaves extra money to devote to other important public and private priorities such as education, infrastructure, food, shelter, and retirement savings.” To this extent, economic recovery will be achieved from more focus placed on improving the efficiency and value of health care delivery.

This argument can extend to the expansion of medical schools as an approach to address physician shortages across the nation. New medical schools are often embraced by communities eager for the economic growth associated with new job opportunities, keeping clinical services in the area, and added draw for research funding. While none of these appear negative, particularly for the community which benefits, as the article suggests, we should be critical of the actual long term benefits of establishing these new medical schools. Ultimately, are they producing physicians that will meet the health care needs of the community and of the nation?

As the baby-boom generation ages, the health care market will see an increased demand for services and a decreased supply of physicians due to retirement out of the system. Health reform will lead to millions of newly insured Americans seeking health services, but are new and expanded medical schools training the workforce needed to meet these challenges? Unfortunately, the training and distribution of the 800,000 practicing physicians and residents in the U.S. is disjointed and inequitable. Higher volumes of physicians practice in wealthy, urban and suburban locations, while rural counties continue to struggle with access to care. In 2011, only 34% of medical students entered into primary care residencies (family medicine, internal medicine & pediatrics), fueling a medical workforce distributed so that 77% of rural counties are designated primary care health professional shortage areas (HPSAs). If medical schools divert local resources towards a system that will not have a long term return, they are forfeiting investment in other areas of growth.        

As the authors suggest, legislative goals should focus on removing barriers to efficient allocation of health sector resources, namely, providers. Metrics of success must be redefined to better health outcomes and high quality care across all populations. Job growth and education expansion is certainly part of the equation, but should not be the end goal. As the authors conclude, “treating the health care system like a (wildly inefficient) jobs program conflicts directly with the goal of ensuring that all Americans have access to care at an affordable price.”