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Just What the Physician’s Assistant Ordered

June 21, 2012

The United Nations Millennium Development Goals provide healthcare providers with ambitious objectives ranging from reversing the spread of the HIV virus, to reducing child and maternal mortality rates.  Unfortunately, meeting these goals is highly contingent upon an adequate supply of health care professionals.  Health Affairs estimates that Africa alone lacks 800,000 healthcare professionals necessary to meet the United Nations Millennium Development goals.  This shortage represents an expensive impediment to global development, the reversal of which requires billions of dollars in healthcare infrastructure investment.  Not to worry: new and innovative approaches to this issue are a cause for optimism.

Map detailing health care workforce shortage

One of the main issues contributing to health care professional shortages worldwide is the so-called “brain drain.”  Health care professionals that are trained in the developing world are emigrating in increasing numbers to developed nations in search of better jobs.  Indeed, as of 2010 there were more Ethiopian doctors in Chicago than there were in all of Ethiopia.  The effect of this mass exodus of doctors is doubly damaging, costing developing nations the resources invested in training doctors as well as the utility of a trained doctor.  While the issue is both prevalent and well documented, it proves difficult to address.  Indeed, in 2010 the World Health Organization (WHO) issued a document covering the global migration of health care professionals.  The issue is wrought with the inherent tension between the pernicious effects of migration and the right of individuals to pursue work wherever they choose.

But the answer to the worldwide doctor shortage may not lie in creating incetives for doctors to remain in their countries of origin.  In fact, the answer to overcoming obstacles in health care development may not revolve around doctors at all.  Paradoxically, the best way to overcome a worldwide doctor shortage may be to rely on doctors less.  An Economist article details a myriad of programs that utilize nurses, nurse practitioners, physician assistants, and other health care workers in lieu of traditional doctors and surgeons.

The LifeSpring Hospitals in India, for example, provide low-cost birthing services by using midwives and specializing in only high demand procedures.  Supplementing doctors with midwives and avoiding costly investments in rarely used procedures has cut delivery costs to one sixth of their normal price.  The result is a viable alternative to the dangerous and sometimes deadly practice of home delivery.

LifeSpring nurse treating a patient

Similarly, technology is being implemented to fill gaps in the healthcare industry and maximize the impact of doctors.  The Jiva Telemedicine Center, located in India, services over 1 million rural patients with only 125 doctors.  The center is able to deliver services to Indians with limited access to health care experts by providing online and telephonic consultation.  The Bill and Melinda Gates Foundation supports a similar program, which provides pregnant women in Ghana with relevant medical information via phone.

However, these new, innovative strategies are not without criticism.  Dr. Festus Ilako  notes that the substitution of doctors with other professionals in an NPR story.  Ilako argues that all people, regardless of education, should have access to the same quality of care and professionals.  Nevertheless, it is undeniable that diversifying the health care work force and remote treatment help to bring care to poor and rural communities, even if the care is of a sub-optimal quality.

The promise of recent efforts to overcome the issue of a worldwide doctor shortage is certainly encouraging and makes achieving the Millennium Development Goals seem all the more realistic.

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