President Obama stepped up to the podium last week to an expectant audience, The American People. The press conference, which was set up to alleviate some of the fears regarding the impending healthcare initiatives, left myself and many others with more questions than answers. I am a healthcare professional.  I work on the frontlines of community health nursing and on a daily basis I encounter many of the programs and services addressed in the upcoming healthcare reform. To say our system is in desperate need of improvements is an understatement.

In my job at a local health department I see first hand the individuals attempting to navigate state medical assistance programs in hopes of gaining insurance for themselves and their families. The healthcare crisis is real and multi-faceted. Therefore, when attempting to repair this complex system there are many things to take into account; namely, staffing limitations. This question of staffing has gained increasing media attention over the past few months site. President Obama has said, “I want to cover everybody;” a lofty statement in a time of economic crisis and growing unemployment site.  More or less the President wants to take those 47 million Americans who do not have health insurance, insure them and throw them into our doctors offices, hospitals, clinics and health centers.  This leaves me asking, where is the staffing going to come from? Currently I believe there are not enough doctor’s offices or medical professionals to handle the massive influx of patients such legislation would generate.

Lets say this legislation is enacted and approximately 40 million more Americans enter the world of primary care and preventive medicine. And suppose our country responds and thousands of dedicated Americans enter the healthcare profession as doctors and nurses. Even if that were to happen, it takes 7 years to train a family practice or primary care doctor and at least 2-3 years for an individual with a degree to obtain the title of nurse practitioner or physician’s assistant.Therefore, I would estimate there is no viable solution to the issue of staffing for another 6-8 years. Meaning it would take at least 6 years for enough doctors to enter the workforce to meet the demand of a newly insured 40 million Americans. This is of course assuming more medical schools and nursing schools are built to accommodate the vast number of professionals that are needed to run a functioning healthcare system for 98% of Americans. That isn’t even taking into account the increasing number of administrators needed to make operations run smoothly.

And what about compensation? Chicago Tribune recently did a review of Illinois’ Medicaid system and reported that, “it’s not uncommon for a physician to be paid $25 to $75 for a Medicaid patient’s routine visit. That can be 20 percent to 30 percent less than what the sitehealth insurance for the elderly pays and less than half the $100 to $125 or more a private insurer would pay for the same service site.” The staffing and compensation issues are only the corner pieces to the 2000 piece puzzle of healthcare reform. There is still the question of funding, which the President claimed could be fixed with reallocation (though the current bill reportedly imposes a new tax to wealthy Americans) site.

Over the past few days questions have filled my mind regarding these issues; it seems that everyone has an opinion and few have concrete solutions. But I think a few things are clear. Based on my aforementioned concerns, wouldn’t it make sense to first ensure our healthcare system can handle such an increase in patients before we rush to insure all Americans? And shouldn’t we create a delivery model that affectively serves those who currently use it before bringing more people in? Why must there be a massive bill that overhauls the system and overwhelms congress? Why not do incremental changes that cost less and save money rather than drafting trillion dollar plans? These are questions that I am sure are buzzing through the heads of hospital administrators, doctors and nurses alike. If our government is smart it will turn to the experts who know the system; those people who don’t just know healthcare from a textbook or policy memo, but those who have actually seen it in action. I believe small steps can be taken to effectively change healthcare, but it will not happen overnight and it will not happen with one bill.