Doctors face new challenges in staff, costs

Technology

John Bentley, physician and former director of the Jordan Valley Community Health Center, said technology has advanced by leaps and bounds in the last two decades.

But as physicians have come to rely more on tests and computers, the impact is not all positive.

“What we have is results-based medicine,” he said. “It helps us decide what medicines would work better, and we thought we knew what we were treating better. But at the same time, the physicians lost their ability to make decisions somewhat independently. It was cost-saving and dehumanizing at the same time.”

Walter Gaska is president of St. John’s Clinics. He said the technology has allowed for rapid growth of the facilities in Springfield.

“When I came to the city in 1972, the emergency room was capable of holding four patients, and it didn’t have a physician in the ER,” he said. “Now we see more than 200 (patients) per day.”

That growth led St. John’s to kick off a multiyear, $326 million expansion. The new 216,000-square-foot emergency facility, a $30 million project, opened Feb. 1.

Steve Edwards has been with Cox Hospitals for 13 years – he currently serves as senior vice president and administrator for CoxHealth – and his father, Charles Edwards, was CEO of the organization from 1985–1993, when it was known as Lester E. Cox Medical Centers.

The health care industry, Edwards said, faces a unique technology dilemma: as machines advance, costs don’t go down like in other industries.

“If you’re a manufacturing industry, if you add new capital you can reduce your cost of labor because you have efficiencies in automating your plant,” he said. “With health care, when we have new technology, that technology actually drives a need for more highly trained people – that equipment actually demands more labor.”

Staff

The medical field in Springfield’s metropolitan statistical area employs 20,000 people, according to Springfield Business and Development Corp.

And that number is growing.

With the baby boom generation approaching retirement age – the oldest boomers turn 60 next year – there is increased need for qualified staffers, especially nurses.

Edwards said the problem is twofold.

“You’ve got this age wave of people coming through that have been working and will no longer be working and require more health care,” he said. “So we’ve got to prepare for that not only from a capital standpoint but also in our staff; the irony is that our staff are the ones moving into that range.”

While there are currently 125,000 nursing job vacancies nationwide, Edwards said the estimate is that by the year 2020 the number of vacancies will reach 800,000.

Cox and St. John’s are both increasing their training services for the medical fields, and they’re getting help.

“With the growth of the health care industry in Springfield, (Southwest Missouri State University) over the last 10 or 12 years has significantly expanded our health care program,” said Bruno Schmidt, SMSU vice president of academic affairs. “We’re hoping we can train professionals in a variety of health care professions.”

Cost

But in the end, any discussion of changes in health care always comes back to the same issues: the cost of care and how to pay for it.

Edwards said the percentage of patients without insurance – those who use Medicare, Medicaid or self-pay options – has increased dramatically in the Cox system. Currently about half of all patients at Cox North are uninsured, and about 25 percent in the Cox system overall have no insurance.

The change in patients’ ability to pay has caused a change in the way hospitals do business.

“The welfare ranks have increased, but the responsibility to care for these people continues for the hospitals, and that financial burden is nearly overwhelming for many hospitals across the country, including Cox and St. John’s,” Edwards said. “It puts an additional burden on us to be more efficient.”

Edwards added that Cox writes off nearly 55 cents of every dollar charged for medical care due to inability to pay.

The advent of the HMO system in the early to mid 1990s was an attempt to stabilize costs. Bentley said the system worked, for a while.

“There was a saving at first; the escalating costs leveled off and looked like they were going to improve, but they then quickly escalated again despite those attempts,” he said.

Gaska added that the costs of health care will probably never decrease because of technologies and demands for services. He said that’s why a good relationship between Cox and St. John’s is so important.

“This town will always need two strong hospitals,” he said. “One couldn’t take care of all the people in the city.”

The solution, Bentley said, lies in health care facilities not overutilizing medical technology, such as angiograms and magnetic resonance imaging.

“We do a poor job of deciding who should get these tests, and then when you do the tests, who should be treated,” Bentley said. “Nobody’s wise enough to know how to limit care, and ultimately we’re going to have to learn how to limit care if we’re ever going to get a handle on cost control.”