As the old joke goes, “Everybody talks about the weather, but nobody does anything.”

The same might be said about health care reform, which has been batted about by political leaders and policy pundits for years without any observable result. Thanks to this year’s presidential elections, what to do about healthcare is a hotter topic than ever. Everyone, it seems, including the leading Democratic and Republican presidential candidates, wants to change our health care system so that more people have access to care. Generally, the Democratic candidates want to enlarge existing government programs such as Medicaid, and create new programs that would cover virtually everyone in the country. The Republican candidates also want to expand access to health care, though they prefer market-driven levers that would increase competition, drive down costs and make healthcare more widely affordable.

Healthcare providers provide the link
What both parties and many health care policy experts seem to miss is the simple fact that health care is provided by people – mainly by physicians and nurses. If the goal is to make health care accessible to more people, a corresponding goal should be to increase the supply of doctors and nurses who actually make healthcare happen. After all, health care is fundamentally a matter of staffing.

Unfortunately, as much as the candidates tout their plans to expand health care access, very few of them appear to make the connection between access and staffing. This is particularly egregious because the supply of physicians and nurses already is inadequate to meet our current needs, let alone the increased demand for healthcare that expanded access would create.

Hospitals already are experiencing an 8.5% nurse vacancy rate, according to the U.S. Department of Health and Human Services (HHS.) HHS projects that by 2020 there will be 800,000 too few nurses, a deficit of 24%. Richard Cooper, M.D., co-chair of the Council on Physician and Nurse Supply, has projected a deficit of 200,000 doctors by 2020. These projections do not take into account the additional stress put on physician and nurse supply that would result from expanded or universal access.

A few of the presidential candidates are calling for an expanded nurse workforce. John Edwards proposed initiatives to retain nurses who now are leaving the profession and to train an additional 50,000 nurses. He also favored increasing openings at nursing schools by 30% over five years. But he is now out of the race. Hillary Clinton similarly proposes to devote more financial resources to expand nursing schools. Other candidates would make improvements in the work environment for nurses, aiding retention, and emphasizing preventive care in an attempt to reduce overall healthcare utilization.

Positive steps fall short
While these would be positive steps, they fall well short of what is needed. Prominent researcher Linda Aiken (also co-chair of the Council on Physician and Nurse Supply) projects that about 110,000 new nurses per year will be needed between 2002 and 2012 to meet demand. The number of new nurses needed does not fall in the tens of thousands but in the hundreds of thousands.

In addition, the candidates’ proposals do not address the primary bottleneck limiting nurse supply, which is a dearth of nurse faculty. Over 30,000 qualified applicants to four-year nursing programs were turned away in 2007 due to insufficient faculty to train them.

Traditionally, foreign born nurses have helped fill staffing gaps when shortages occur. Current immigration policies, however, severely limit the number of foreign nurses U.S. employers are able to recruit. None of the candidates propose amending immigration laws to open the door a little wider for foreign nurses.

When it comes to physicians, the access/staffing disconnect is even greater. None of the candidates propose measures that would increase the supply of physicians in the U.S. To do so would require an expansion of the number of residency training slots offered at U.S. teaching hospitals. Only Joe Biden has advocated this measure, and he is no longer in the presidential race.

Given the way the political winds are blowing, health care reform will be a top priority for the next president, no matter who is elected. How best to change our vast and complex healthcare system is a very complicated puzzle. Physicians and nurses are key pieces, and the puzzle will never be complete without an adequate supply of these vital healthcare providers. After all, just what are we creating access to if not doctors and nurses?

Kurt Mosley is vice president of business development for Merritt, Hawkins & Associates, a national physician staffing firm and a division of AMN Healthcare. He can be reached at kmosley@mhagroup.com.