Good news and otherwise

For certain segments of the healthcare industry, these are booming times. As the population ages and the demand for quality health services intensifies, many healthcare organizations are experiencing sustained growth and enviable profitability.

Rudolph Williams, (left) executive director of the National Medical Association, a leading organization of minority physicians, has this to say:

"Healthcare is a rapidly growing field considering the new technology, the aging population, and the demand for quality patient care. People will always need accurate medical diagnosis, drugs prescribed and competent treatment by physicians and other health professionals."

This is good news for many hospitals and healthcare organizations. The business press regularly reports on new hospitals being built and older ones expanding to accommodate patient demand in rapidly growing communities around the nation.

On the other hand, managed care has squeezed many medical practices to the precipice of becoming unprofitable. As a result, a number of for-profit hospitals have closed their doors or otherwise issued unexpected layoffs, including physicians.

"One result of the onslaught of managed care is that more and more, doctors work for large corporations and not for themselves," Williams explains. "As a result, a large amount of their time is devoted to the business of medicine instead of concentrating on providing quality patient care."

True enough, many physician groups have become disillusioned with certain aspects of managed care. Yet others have risen to the challenge of keeping priorities straight: ensuring quality patient care by empowering doctors to do what they are trained to do.

"The physician is, and should always be, the central figure in the healthcare arena. After all, the business of medicine should exist to support the practice of medicine," advises Keith Wilson, M.D., (right) and CEO of the Talbert Medical Group, a growing multi-cultural, multi-specialty practice with eight medical centers in Southern California.

"Unfortunately, corporate structures sometimes lose sight of that fact. When this happens the patient suffers. Physicians have to be--and feel--empowered to do what is in the patients' best interests," he adds.

Incidentally, his board of directors is composed of physicians who bring to the table clinical expertise along with business acumen.

Not-so-good news

One segment of the healthcare industry hit particularly hard by the current economic slump is the "e-health" sector. Scores of dot-com start-ups that supplied medical products and services-such as online pharmacies-have scaled back operations or shut down altogether. No longer are venture capitalists eager to fund start-ups based on the faint promise of revenue generation rather than actual profit.

Manpower shortages

Another trend affecting the industry at large is the acute manpower shortage within many health professions.

Case in point: The Georgia Department of Community Health has issued a report entitled "Code Blue: Workforce in Crisis." According to the report, there is a vacancy rate of 10-20% among nurses, allied health and behavioral healthcare professionals working in hospitals, nursing homes and public-health programs in the state. Georgia's headaches are not unique.

In fact, the nationwide shortage of registered nurses, in particular, is well documented and poses serious problems for both rural and metropolitan medical facilities. Testifying before a U.S. Senate Committee, Sister Mary Roch Rocklage, representing the American Hospital Association (AHA), put the matter in clear perspective, as reported in a Reuters Health news article (5/17/01):

"The public's demand for the highest quality patient care at the lowest possible cost has come face-to-face with the tightest labor market in the past 30 years."

"Government predictions state that the nation will need 1.7 million nurses by 2020. But just more than 600,000 will be available, making up 35% of the nurses that will be needed to care for the people of the nation."

Some unique factors compound the problem of nurse shortages in minority communities. Dr. Hilda Richards, (right) Ed.D., RN, FAAN, president of the National Black Nurses Association, offers this assessment:

"Due to economic circumstances, many minority nurses begin their careers later in life (around age 30). Some must start in LPN training and work their way up, which puts them somewhat behind the curve. If they are the first in their family to attend college, they don't always have the financial resources and personal role models to turn to when experiencing difficult times or facing occupational burnout.

"Without a good support system, some nurses of color lose the stamina to deal with the heavy emotional aspects of the job. Additionally, when young nurses experience salary compression and limited advancement opportunities, they re-evaluate their commitment to the profession altogether. At that point, other career options look quite appealing."

Manpower shortage is one key issue facing the healthcare industry. This article examines several other challenges facing the industry at large and college graduates who set their sights on entering some health profession.

Let's first begin with an assessment of the breadth and vitality of the healthcare industry at large.

Defining the healthcare industry

The healthcare industry can be defined economically as representing approximately 18% of the nation's Gross National Product (GNP), or $1.6 trillion in annual healthcare expenditures.

It can also be defined in terms of the wide variety of companies and institutions that provide, directly or indirectly, healthcare for the vast majority of American people. These include: medical facilities of all sizes and descriptions (hospitals, clinics, ambulatory care centers, nursing homes, hospices, mental health institutions), major health insurers (HMOs, for instance), pharmaceutical and biotech firms, providers of specialized medical care (dental, chiropractic, podiatry), Web-based suppliers of health content and services (firms like www.webmd.com), and a myriad of other companies, government agencies and research institutions devoted to preventing disease and improving the health of the general population.

Collectively speaking-and broadly defined-healthcare is the single largest industry in the United States. Health professionals include hundreds of thousands of clinicians and non-clinical personnel who contribute to the smooth operations of hospitals and other medical treatment centers across our nation.

Types of hospitals

According to the AHA, there are over 6,500 hospitals in the United States. The vast majority are "general" hospitals that treat the full range of medical conditions that patients present. Over 1,000 hospitals offer specialized medical care for particular diseases or conditions: cancer, psychiatric illness, physical rehabilitation, or elder care.

Many hospitals across the nation are struggling financially, especially the tax-supported, public institutions. Yet other hospitals are financially sound, well managed, and sources of quality patient care and top-notch clinical instruction provided by competent, dedicated health professionals.

To illustrate the point: U.S. News and World Report issues a yearly ranking of the top hospitals in the United States, referred to as the "Health Best Hospitals Honor Roll." The top ten hospitals listed this year include: Johns Hopkins Hospital (Baltimore, Md.), Mayo Clinic (Rochester, Minn.), Massachusetts General Hospital (Boston), Cleveland Clinic (Cleveland), UCLA Medical Center (Los Angeles), Duke University Medical Center (Durham, NC), Barnes-Jewish Hospital (St. Louis, Mo.), University of Michigan Medical Center (Ann Arbor), University of California, San Francisco Medical Center, and Stanford University Hospital (Stanford, CA).

In addition to these leading research and teaching hospitals, there are hundreds of community hospitals, proprietary hospitals and "voluntary" hospitals, such as religious-affiliated institutions, that capably meet the medical needs of the communities that they serve.

Other major suppliers of healthcare are local, state and federal governments. Collectively, state mental health hospitals and correctional facilities annually treat hundreds of thousands of residents and inmates presenting a wide variety of illnesses.

On the federal level, the Department of Defense supplies health services to over a million men and women and their families in all branches of the military. Similarly, the Veterans Administration Health System treats veterans and their beneficiaries through a nationwide network of hospitals, outpatient clinics and nursing homes.

The Indian Health System-a component of the Department of Health and Human Services-is tasked with providing quality healthcare to 1.5 million Native Americans and Alaska Natives through the staffing of medical treatment centers within 550 federally recognized tribes in 35 states.

Major healthcare insurers

When most Americans think of healthcare, they focus on the particular managed-care health plan that covers them and their families. The leading companies that provide individual and group health insurance are virtual household names: Aetna U.S. Healthcare, Blue Cross/Blue Shield, CIGNA, Humana, Mutual of Omaha, Prudential HealthCare, and United Healthcare, to name a few.

These corporations contract for the services of doctors, nurses, physician assistants, and other healthcare practitioners who directly treat patients with general or specialized medical needs.

Non-traditional healthcare

As Americans become more aware of how they can contribute to their own health and well-being, increasingly they are turning to practitioners of complementary and alternative medicine (CAM). Patients who seek such treatment may be inspired by deeply held religious or philosophical beliefs. Also, they gravitate toward "holistic medicine," which focuses on the interplay of all parts of the body and mind in the healing process. Proponents of CAM are convinced of the health benefits of chiropractic treatment, message therapy, vitamin and herbal dietary supplements, spiritual meditation, etc.

It is important to mention this trend because CAM is growing in popularity within academia and among consumers, thanks in part to the widespread influence of the Internet. (See http://www-camra.ucdavis.edu/complmedicinerel.html.)

Issues and challenges facing the industry

Any informed discussion of the healthcare industry should point out some of the prominent topics of current policy debate. Space permits mention of only three areas of challenge facing health professionals.

Bioethical Issues

"Stem cell research." "Human cloning." "Genetic mapping and gender selection."

These are article topics found in medical journals along with major consumer publications. Clearly, medical procedures that were confined to the realm of science fiction several decades ago are present-day realities.

The domains of genomic research and biomedical engineering have overlapped the field of medical practice to produce a Pandora's Box of bioethical issues that affect society at large and every segment of the healthcare industry.

Anyone working in a health profession should carefully follow the ongoing debates among bioethicists, policymakers, and persons in the faith community. The future of medicine as it is taught and practiced will be influenced by the legislative policies and professional protocols shaped by these discussions.

Reducing medical errors

In November 1999, the Institute of Medicine released a report entitled "To Err is Human." It claimed that up to 98,000 patients die each year due to preventable medical errors. The report set off a firestorm of consumer and Congressional outrage. Everyone agreed that something had to be done to address the problem-and quickly!

Several years later, newspaper headlines still report alarming incidents of medical malpractice-e.g., doctors amputating the wrong limb. To address this problem, the National Quality Forum, a nonprofit membership organization, is working with several federal agencies to develop quality measurement standards for hospitals to minimize the possibility of medical errors. The organization is also lobbying for greater public disclosure of medical errors by means of a national reporting databank.

Not surprisingly, many hospitals, physicians and healthcare insurers staunchly oppose public reporting of medical errors. Unfortunately, some healthcare workers are inadvertently caught in the middle of a battle that will continue to have serious moral and legal ramifications in the coming decades.

Healthcare disparities

There is a growing awareness that quality healthcare is not equally available to all segments of the U.S. population. Numerous studies have pointed out that racial, ethnic and cultural minorities have less access to quality health services due to lack of insurance coverage or availability of adequate medical resources within their communities.

Correspondingly, within these communities there are, statistically speaking, greater incidences of life-threatening diseases: diabetes, hypertension, obesity, cancer, and cardiovascular disease. Furthermore, as the Centers for Disease Control reported last June, there is an alarming increase in HIV/AIDS infection within African-American teen and adult populations. Unfortunately, minorities who contract this dreaded disease are less likely to receive the same kinds of comprehensive medical treatment that non-minority patients receive.

Fortunately, the issue of healthcare disparity has drawn the attention and action of concerned persons in health professions, educational institutions, legislative bodies, and the philanthropic community. Responsible healthcare should not be "skewed by a patient's cultural, racial or ethnic background," says Dr. Keith Wilson. "Providing the best healthcare is always our primary focus. Whenever possible we try to communicate in the patient's native language. That could be Spanish, Chinese, Arabic, Vietnamese, or Tagalog. And patients select their own primary care doctors and in general choose providers that they feel comfortable with."

Minority college graduates who enter the healthcare industry should understand that the practice of medicine concerns, literally, life and death matters. Whatever involvement they have as people of color in promoting better health services to their communities should make their occupational choice all the more rewarding.

Launching a healthcare career

As noted from the outset, the healthcare industry is extremely broad. It encompasses both clinical and non-clinical professionals joined by shared goals to improve healthcare delivery and other medical services for the general population.

Many health professions require schooling beyond the baccalaureate level. These include medical doctor, dentist, pharmacist, and so forth. In addition to meeting stringent educational requirements, successful practitioners must also complete supervised training (internship, residency) before receiving licensure to practice in their respective states.

The entire education-and-training process is lengthy and demands a level of commitment that not every college student contemplating a healthcare career can honor. Other challenging and fulfilling healthcare careers require educational preparation that can be completed in four years or less-such as medical-technical certificate programs lasting 9-24 months. Baccalaureate programs can prepare students for health professions such as registered nursing, occupational and physical therapy, dental hygiene, health information technology, recreational therapy, hospital social work, dietetics and nutrition, and so on.

For more specific information on work conditions, earning potential and the general employment outlook for specific healthcare-related jobs, readers are advised to consult the Occupational Outlook Handbook, 2001 edition. It can be accessed at http://stats.bls.gov/ocohome. Click on "Professional and Technical" for jobs in the health field.

Compensation potential

As a general rule, health professions pay well, depending on market conditions of the area and the demand for specific practitioners. The Occupational Outlook Handbook lists median earnings (based on 1998 statistics) for many healthcare professions. Examples:

Registered Nurse - $40,690
Occupational Therapist - $48,230
Dental Hygienist - $45,000
Physician Assistant - $47,090
Recreational Therapist - $27,760
Dietician-nutritionist - $35,020.

In addition to above-average compensation, some entry-level healthcare positions in great demand (such as nursing) offer sign-on bonuses as added recruiting inducement.

Career advice

What advice would the health professionals quoted above offer to college students contemplating a healthcare career? "A career in medicine is certainly a worthwhile and honorable profession with unique challenges," says Rudolph Williams. For eight years, he served as Associate Dean and Deputy Vice President at SUNY Downstate Medical Center in Brooklyn. "The opportunities are definitely there for students who are prepared for the challenge. Even though the political climate has changed-due to assaults on Affirmative Action programs-students who achieve good grades and high MCAT scores have unlimited opportunities to advance in the medical field," he adds.

Dr. Hilda Richards encourages students who are thinking about nursing to look beyond the traditional roles. "Look at the full array of career possibilities, not just hospital nursing. If you have the commitment, concern for people and dedication required to succeed, nursing can open up the world to you. There is no limit to where you can go within the health profession with a solid background in nursing," said Richards.

Dr. Keith Wilson sounds a cautionary note in advising college students who set their sights on a medical career. "My advice to anyone entering medicine is to only do so if you feel a genuine calling to do so. Medicine is demanding and requires a lot of self-sacrifice. There are easier ways to make money. If it is your desired career, then go for it with all that you have. Study hard because it remains very competitive. Eliminate distractions. Stay focused," Wilson remarked.

These industry spokespersons would further agree that attitude, motivation and keen academic preparation establish a foundation for success. College students who meet the challenge will reap the rewards of contributing to the medical profession and to the health of their communities.

Addressing Healthcare Disparities

Improving "culturally competent" healthcare delivery to minorities is a monumental task that numerous hospitals, educational institutions, government agencies and philanthropic organizations have begun to address. Here's a sample of Web sites focusing on important programs and initiatives:

National Black Women's Health Project:
http://www.nbwhp.org

"Eliminating Racial and Ethnic Disparities in Health": http://www.raceandhealth.omhrc.gov

"Health Information for Minority Women": http://www.4woman.gov/minority/index.htm.

Healthy People 2010:
http://www.omhrc.gov/OMH/Health%20Disparities/index.htm.

Univ. of North Carolina School of Public Health: http://www.minority.unc.edu/events/recent.htm.

Association of American Medical Colleges: http://www.aamc.org/newsroom/reporter/january2001/disparities.htm

Center for the Advancement of Health: www.cfah.org/website2/Newsrelease/minorityscholars11-11-00.htm.

Agency for Healthcare Research and Quality: http://www.ahcpr.gov/research/minorix.htm

University of Virginia Health System:
http://hsc.virginia.edu/cimh/mission.html

Academic Medicine and Managed Care Forum: http://www.latnn.com/2001/May/Other_Info-PR405.html.