In these times of advanced medical science and technology, statistics show that people are living longer. It is estimated that, by the end of this decade, one in five people will be in the over-65 age bracket. This is great news, provided there is quality of life and access to good medical care. However, the healthcare sector is currently battling a shortage of qualified physicians for various reasons, so how will this impact us in 10 to 20 years? We discuss the facts surrounding longevity and the lack of skilled physicians in the medical fraternity and present the prospect of advanced nursing skills playing an ever-increasing role in alleviating the problem.
How we age
Aging is a gradual process whereby the accumulation of cellular and molecular damage leads to a slowing down of our bodies and minds, increasing the risk of disease and, eventually, death.
Loss of hearing and sight, arthritis, diabetes, and dementia are some of the common ailments that afflict the elderly, with older people often experiencing two or more chronic conditions at the same time. These chronic conditions are generally long-term and need efficient management by relevant medical nurses and physicians. There is also a tendency to become frail and unsteady, resulting in frequent falls and related injuries.
All of this means increased hospital stays and complex procedures, more visits to the primary care practitioner, more medication, and more monitoring of side effects. Mental health plays a role too. Depression is a mood disorder associated with anxiety, distress, and suffering. Although mental illness is not a normal part of growing older, when present, it can lead to impairments in physical health. Conversely, prolonged chronic pain and disability often lead to depression. Older adults dealing with anxiety and depression visit their physician more often and take more medication. They visit outpatients more often, and hospital visits last even longer.
Geroscience is defined as the intersection of basic aging biology, chronic disease, and health. In a report released by the National Institute of Aging (NIA), research has focused on curing life-threatening diseases such as cancer and heart disease—a welcome intervention indeed. However, elderly people now have to live with other debilitating ailments that need additional medical attention.
The NIA has established that, in many cases, chronic disease speeds up the loss of function and resilience, leading to further disease and disability in other areas of the body, including the surrounding organs. The NIA is busy with thorough investigations into alleviating the acute conditions that plague older people. Their holistic views on treating age-related illness and degeneration of the body should lead to more comfortable aging. Of course, without the pain and suffering, people will live longer and hopefully, have a better quality of life.
This is heartening news. However, with people living longer and an increasing shortage of healthcare personnel, where does this leave us? Do we have the resources to care for our older generation, who are not necessarily terminally ill but battling age-related health issues? Can we rely on a new generation of physicians and nurses entering the job market in time to replace physicians who retire or change direction? Apparently not.
In June 2021, the Association of American Medical Colleges (AAMC) published a report on the complexities of physician supply and demand, giving the following predictions for shortages in the medical profession:
- Primary care physicians: a shortage of between 17,800 and 48,000 by 2034.
- Specialized physicians: a shortage of between 21,000 and 77,100 by 2034.
These demographics were based mainly on the growing population and aging, with the US population growth predicted at 10.6 percent by the end of the decade:
- Predicted population growth under age 18: 5.6%.
- Predicted population growth over age 60: 42.4% (primarily due to a prediction of 74% over age 75.)
More than two out of five physicians are about to reach the retirement age of 65 in the next decade.
The projection for newly trained physicians entering the workforce each year is 29,627. However, it is difficult to say which direction they will take, and trends change. Primary care physicians currently reaching retirement age outnumber graduating medical students. Many doctors retire early or move into research roles, often due to job pressure resulting from the shortage of healthcare professionals, increased costs and administration, and a general burnout exacerbated by the Covid-19 pandemic. The pandemic has had far-reaching, mainly negative, effects on the healthcare system. Still, at the same time, the sudden need for intensive healthcare has highlighted shortfalls in access to proper medical care, with hopefully, some positive outcomes in the future.
The number of people over 60 has tripled since 1950, and it is projected that the combined number of seniors and geriatric people will reach 2.1 million by 2050. Fertility rates in America have declined steadily since the 1970s. The years leading up to 2008 saw a gradual increase, but when the Great Depression hit, the figures plummeted once more. Nothing much changed after that, and prior to the Covid-19 pandemic, figures showed 43 states recording their lowest fertility levels.
Declining birth rates mean that, in all likelihood, there will be fewer medical graduates in the next 10 to 20 years, while the number of seniors and geriatrics is steadily increasing. If the research undertaken by the NIA successfully alleviates geriatric illness and discomfort, this bodes well for the healthcare industry. However, getting the necessary treatment to people in rural and underserved areas will still be a challenge, as it is now.
Part of primary and family healthcare is educating communities on how to deal with long-term, chronic illness, prevent further illness and disease and lead healthy lifestyles. When things go wrong, the lack of this education and primary care in underserved areas often means additional pressure on emergency services.
The Covid-19 pandemic brought with it many challenges and has had long-reaching effects on the medical profession. Studies have shown that the core principles of the medical profession have been challenged, with the sudden challenges taking a toll on the health and wellbeing of doctors and nurses, their personal safety, and their families. Many doctors have had to change how they work, face shortages of essential items, withhold treatments, and make difficult decisions. It is no wonder, then, that the incidence of resignations and burnout is particularly high at this moment in time.
Solutions – hospitalists
Despite all the above, things are not as bad as they seem. There is an emerging trend for primary-care-trained hospitalists to take up work in hospitals, which indicates a shift in how care is provided, as conversely, the need for outpatient services has dropped.
Hospitalists are the same as primary care physicians but have specialized training in working in hospitals, with the possibility of some other specialty as well as their basic physician training.
Statistics regarding hospitalists were not considered in the above projections due to insufficient data being available at the time. However, supply projections indicate that at the current rate of employment, if the trend continues, there will be more than enough hospitalists to meet future demands. Hospitalists reduce the time primary care physicians need to spend doing hospital rounds, freeing them up for the more specialized work they were trained for.
Solutions – healthcare policies
Prevention and wellness: Screening and early detection of illness, education of patients regarding good eating habits and exercise.
Coordinated care intervention: Encourages healthcare providers and paying members to seek coordinated delivery of primary and long-term care, disease management programs, and specialized units.
Patient self-care and self-management: Better management of chronic diseases, sometimes assisted by technology, avoiding expensive visits to emergency rooms.
Palliative and end-of-life care: Ensures patients are pain free and their families get the necessary support they need. It is estimated that around one-third of Medicaid dollars are spent in the last two years of a patient’s life.
According to the Stern Center for Evidence-Based Policy, unless sizeable changes are made to existing treatment and service delivery approaches, Americans will soon experience unsustainably high medical care costs and a decline in the availability of medical services. A multi-disciplinary team at the Stern Center for Evidence-based Policy recently conducted a study regarding the challenges of reducing healthcare costs while improving health outcomes for the elderly. They predict that by 2030, over 40 percent of people over 65 will have diabetes, and almost 80 percent will suffer from hypertension. In the last ten years, the number of individuals with three or more chronic conditions has increased considerably. A rising prevalence of age-related functional impairments will mean an increase in daily caregivers.
How can you help?
A 2012 study by the University of California, in conjunction with physicians, estimated that patients receiving care from primary care physicians received only 55% of recommended chronic and preventive services. AAMC authors attributed this figure to physicians being overworked. It was estimated that between 50% and 77% of the preventative care and 25% to 47% of the chronic care done by primary care physicians could be delegated to advanced practice registered nurses (APRNs) or nurse practitioners (NPs) and physician assistants (PAs).
Nurse practitioner training covers disease diagnosis and treatment, recommending tests and analysis of the results, prescribing medicines, and educating patients and communities on disease prevention and how to lead healthier lifestyles.
The nurse practitioner starts as a registered nurse (RN) and then studies further to obtain a master’s degree and certification. After that, a post-master’s diploma is available for specialization in specific areas of healthcare, for example, acute care and taking care of the elderly.
The role of the nurse practitioner
It is important to note that regulations regarding the authority of NPs differ from state to state.
Generally, three different levels of practice authority exist:
- NP Full practice authority: more than half of the states in the US embrace full practice authority, and this figure is gradually increasing as the shortage of healthcare providers becomes more urgent. An NP residing in a state with full practice authority may run their own private clinic and provide direct patient care within the state board of nursing regulations. This enables the state to allocate much-needed healthcare resources to previously underserved communities.
- NP Reduced practice authority: these states require the NP to enter into a collaborative practice with a physician.
- NP Restricted practice authority: the certified NP must comply with additional conditions such as prescription limitations, supervision requirements, and restrictions regarding practice setups.
With a master’s degree in nursing, the nurse practitioner can now take on the following responsibilities:
- Assess the symptoms of illness by taking the complete patient history into account.
- Conduct physical examinations.
- Order diagnostic testing and interpret the results to arrive at a diagnosis.
- Prescribe medication for the treatment of illness.
- Educate patients on how to manage their illnesses.
- Encourage preventative measures, such as improved hygiene and healthier lifestyles, particularly when working in underserved communities.
This relieves primary care practitioners of a significant portion of their workload, allowing them to focus on more advanced healthcare services.
It gets better! With a master’s degree in nursing science, NPs can go on to specialize in an area in which they have a particular interest. Given the current shortage of healthcare practitioners and the predictions of a greater need for gerontology care, an online agacnp post-master’s certificate from Rockhurst University would enable nurse practitioners to become involved in an interesting and challenging healthcare field while helping to alleviate some of the shortages.
An AGACNP is qualified to work with adults and older adults with acute illness in oncology, cardiology, and endocrinology, amongst others.
Acute Care patients require constant monitoring, such as those who are physiologically unstable or vulnerable to complications, often dependent on technology, and in intensive care units.
There are other areas of specialization that an NP can choose, which are not restricted to geriatric care but certainly involve caring for people of all ages. Here are some other post-master’s options that an NP can specialize in:
- Family nurse practitioner (FNP): this involves caring for patients of all ages. The FNP provides diagnosis and treatment of ailments, advice, and counseling on disease prevention and healthy lifestyle choices. Options for work include clinics, care facilities, and hospitals. Primary healthcare in rural areas is often understaffed. Having an NP onsite helps to alleviate the shortage by establishing a stable environment for health care in the area.
- Women’s health nurse practitioner (WHNP): the WHNP focuses on reproductive, obstetric, and gynecological health for women of all ages, mainly in a clinic or primary care office environment. Please note that this position differs from the Certified Nurse Midwife (CNM) position.
- Orthopedic nurse practitioner (ONP): for an ONP, the focus is on caring for and treating patients with musculoskeletal disease or injuries, including bones, joints, connective tissue, and muscles. This can include congenital disabilities and genetic abnormalities.
- Psychiatric-mental health nurse practitioner (PMHNP): PMHNPs, also known as psychiatric nurse practitioners, assess and diagnose patients with mental illnesses and disorders, as well as treat people with substance abuse problems.
In addition, a licensed clinical social worker can assist the elderly in coping with emotional and psychological issues they may face. A qualified social worker helps people who are battling a debilitating illness.
To begin with, a bachelor’s degree in social work is an excellent place to start. With some experience, a social worker can take their career to the next level with a master’s degree in social work (MSW) and finally become a licensed clinical social worker (LCSW).
Being a nurse practitioner involves more than just primary care: an NP promotes healthy communities through easier access to basic healthcare and easing pressure on medical facilities and physicians.
There’s no time like the present
The Covid-19 pandemic has highlighted some problems in the healthcare system, and hopefully, some good will come from it. Research is still ongoing, and we are learning all the time. Technology does not stand still, and what better time to get involved in this most interesting world of medicine.