Key Takeaways from the 25th Annual Kovner-Behrman Health Forum
The 25th annual Kovner-Behrman Health Forum provided attendees with the opportunity to hear from an expert panel discussing “The Great Resignation’s” impact on healthcare. The Panel was moderated by Carla Jackie Sampson and featured Anu Ashok (MPA 2004), Jane Maksoud (MPA 1997) and Gail R. Wilensky. The panelists unpacked surrounding the healthcare workforce from a wide variety of perspectives, shedding light on a number of key themes that left attendees of the Kovner-Behrman Health Forum, particularly the students among them, with a lot to consider:
1. Labor shortages in healthcare is nothing new
While at times it can be easy for all of us to forget what the world was like prior to the COVID-19 pandemic, all three panelists made a point of stressing that labor shortages within healthcare are nothing new. Unsurprisingly, much of the conversation centered upon the impact of the pandemic and the lessons it taught us about points of weakness and resiliency within the healthcare system; however, panelists also discussed some of the root causes of labor shortages in healthcare that extend well beyond the past 24 months, including medical school debt, an inadequate supply of available residency positions, physician burnout, and less international students seeking medical training in the U.S. These insights shared by the panelists serve as a good reminder, especially to current students who may understandably view many issues in healthcare through pandemic-tinted lenses, to not lose sight of the policy challenges that predate the pandemic and thus may warrant different solutions.
Another big idea that permeated throughout the discussion was the importance of making the healthcare system more flexible, both on a system-wide and individual level. All three panelists highlighted how the COVID-19 pandemic hastened the arrival of new understandings of how, and by whom, care can be delivered. Jane Maksoud spoke of taking a “sandbox” approach to healthcare delivery, whereby policymakers and healthcare leaders should reconsider the delivery of any care that does not require a license, which in many cases could be delivered by a registered nurse or physician assistant, in a more community-based setting, or even by professionals outside the U.S through telehealth. However, Jane Maksoud cautioned that these changes would require some tolerance of role dissonance among healthcare professionals as well as a flexible and entrepreneurial mindset. The COVID-19 pandemic has necessitated the arrival of some of these new ways of delivering care; while this may emerge as a silver lining of the pandemic, it has also meant that healthcare professionals must “drive down the road while building it” in many cases, further warranting flexibility and creativity within the healthcare system.
A key application of a more flexible approach to healthcare discussed by the panelists is the shifting of medical licensing away from the state level. Allowing for the movement of clinicians across state lines is both an essential step to preparing for future strains on the healthcare system and one of the most obvious interventions to alleviate physician shortages in many parts of the country. Gail Wilensky described the current medical licensure system as an approach that has “gotten in the way more than it has helped” and cited policy changes part of the Affordable Care Act as examples of how it is possible to shift responsibilities within the healthcare system that are traditionally managed by states. While this policy shift would certainly be a “political hot potato,” Anu Ashok saw progress on the issue within the recently proposed New York State Assembly 2022-2023 budget which includes provisions for New York to join the Interstate Medical Licensure Compact and the Nurse Licensure Compact.
3. Telehealth is here to stay
Another major shift in healthcare that will certainly require imaginative and flexible thought leadership is the rapid growth of telehealth. Clearly accelerated by the COVID-19 pandemic, the advent of telehealth has created a wealth of new possibilities for how care is delivered; the panelists highlighted how, particularly in conjunction with the easing of inter-state licensing requirements, telehealth has the potential to significantly lessen the burden of labor shortages. However, this new growth has not come without its own set of challenges. Anu Ashok highlighted a lack of focus on telehealth in physician training, which Anu Ashok noted was already often inadequately preparing physicians to practice in the more outpatient-focused care environment that has developed in recent years. Gail Wilensky raised the question of how telehealth should be reimbursed in a way that is fair to everyone involved, a key question within the field of Health Economics and particularly relevant within parts of our healthcare system that operate under a fee-for-service payment model. All the panelists agreed that in spite of these challenges, telehealth is here to stay as a new frontier in healthcare and therefore warrants innovative policy and regulatory changes in response.
4. Challenges ahead
Lastly, Professor Sampson invited the panelists to reflect on how the healthcare system may prepare for and respond to future challenges. All the panelists stressed how the likelihood of a future pandemic, and the public having even higher expectations of how the health system will respond, creates a call to action for healthcare leaders to embrace some of the afore-mentioned changes to alleviate labor shortages and create a more effective and resilient healthcare system. Additionally, Jane Maksoud stressed the importance of addressing what continues to be the relatively unknown impact of post-traumatic stress disorder among healthcare professionals following the COVID-19 pandemic. Providing care for individuals who experienced moral and psychological injury, particularly in response to the care rationing that had to occur at various points during the pandemic, is not only the right to do but also a key measure to mitigate burnout and increase workforce retention and effectiveness. As a more long-term solution, Jane Maksoud sees a shift toward a more “team-based” approach to care, whereby less pressure is placed on individual actors within the system, as a key solution to limit future burnout within the healthcare system. Gail Wilensky also stressed how we are just beginning to see the consequences in health outcomes among individuals who forwent care such as cancer screenings during the early months of the pandemic. Responding to this, along with the still-unknown impacts of Long COVID, may put further strain on the healthcare system and will be a major challenge that future policymakers and leaders must respond to.