How can you prevent an epidemic?

An Ongoing Problem: Physician Shortages

The United States has been suffering from an ongoing problem: physician shortages. With a population that is getting older and older, the number of physicians available to care for the aging population is not sufficient. This strain on the medical system was already a weakness in the United States’ health system, and if proper measures are not put into place in order to increase the physician workforce, then hospitals and the public could face dire repercussions. The Association of American Medical Colleges (AAMC) published an article in May 2018 in which they broke down the physician shortage problem [1]. By 2030, the AAMC Workforce Studies team projects that their demand for physicians will far exceed the supply with a shortage of 46,900 - 121,900 physicians. When broken down by speciality, primary care will endure a shortage between 21,100 and 55,200 physicians while speciality care will endure a shortage between 24,800 - 65,800 physicians. It is important to note that one third of all physicians will be over the age of 65 within the next decade, with the retirement wave also contributing to the physician shortage problem [1]. 

 

Health is not accessible to everyone. It depends on your socioeconomic status, geographic location, insurance coverage and many other factors. If equitable access to care were to be immediately established, then approximately an additional 95,900 doctors would be needed [1]. All of these aforementioned projections emphasize the lack of resources already present within the United States, aspects of healthcare that were setting the United States behind in terms of proactive approaches to preparing for and preventing an epidemic as a whole. The current physician workforce is not enough to keep up with demand under normal circumstances, add an infectious epidemic, and you have major problems taking care of the public. This critical lack of human capital should have been addressed earlier, and it is absolutely essential that it is addressed now. Physicians are going to be in greater demand everywhere, not just in low resource areas. Medical schools have begun to slowly increase enrollment in order to meet this demand for more physicians; however, residency slots (post medical school training) have not expanded since 1997 due to the cap in Medicare support for graduate medical training [3].

 

The lack of a sufficient physician workforce is only being further strained by the physician suicide epidemic. In the pursuit of serving others, physicians are placed under so much physical and emotional pain. They have become victims to a system ignoring their well-being, with residents being on 28 hours shifts. The Journal of the Missouri State Medical Association put it very well, “[P]hysicians are human too and need care like anyone else” [2]. This same journal defined burnout as “the triad of emotional exhaustion, depersonalization and feelings of inefficacy resulting from chronic work-related stress.” The nature of medical school in the United States seems to contribute to an overall lower quality of life for medical students, which in turn contributes to lower satisfaction rates and higher rates of burnout during residency training. Compared to the general population, male physicians have a suicide rate that is 40% higher, while female physicians have one that is upwards of 130% higher [2]. Physicians are trained, starting in medical school and even before that during undergraduate years, to practice with no room for error. This pressure subjects physicians to a significant amount of stress. When it comes to preparing for an epidemic, such incessant problems in the physician workforce must be addressed for both current wellness and epidemic preparedness. 

 

[1] Heiser, S. (2019, April 23). New Findings Confirm Predictions on Physician Shortage. Retrieved from https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage

[2] Kalmoe, M. C., Chapman, M. B., Gold, J. A., & Giedinghagen, A. M. (2019, May). Physician Suicide: A Call to Action. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690303/

[3] The Role of GME Funding in Addressing the Physician Shortage. (2019, May 9). Retrieved from https://www.aamc.org/news-insights/gme
 

 

Minority Communities: Are They Vulnerable?

In order to prevent an epidemic from occurring, the United States needs to guarantee that all of the population is protected. However, this protection is not accessible to everyone, resulting in some communities being more vulnerable than others. The news and media have recognized many populations that are more at risk of contracting severe illness from Covid-19 such as those who have preexisting health conditions or are elderly, but not many have recognized additional vulnerable populations who are more at risk of exposure to Covid-19. So what is and who is a vulnerable population in healthcare? 
Vulnerability is defined as the degree to which a person or group is unable to “anticipate, cope with, resist and recover” from health events [1]. Vulnerable populations are groups and communities that are at higher risk for poor health outcomes due to many social, economic, political and environmental barriers, limited resources, and limitations from illnesses and disabilities [2].The CDC recognizes racial/ethnic minorities and homeless individuals as communities who are at higher risk due to structural barriers, and therefore are included within vulnerable populations[3]. These groups, especially, are at higher risk of exposure to COVID-19 and having an increased severity to the disease outcomes. 

 

In New York City, for example, the African American population is a large proportion of hospitalized patients, about 33%, while only making up 18% of the community [4].  In addition, they may be thrice as likely to die and be non-hospitalized as compared to Asian communities, who have the least cases of non-hospitalized individuals, non-fatal hospitalized patients, and deaths [4]. The best way to combat Covid-19 is for individuals to social distance. This may not occur in minority communities as they  usually have lower socio economic statuses which may require them to work even when they're sick as well as living in dense neighborhoods, increasing the chance of spreading the disease to others.  Minority communities are more likely to work in essential industries such as the food and agriculture sector as well as being frontline workers in the health sector which are not likely to have opportunities to work remotely. Unlike countries such as South Korea who are creating relief funds for families, so that they do not have to worry about paying rent and finding groceries, the United States does not have a unanimous procedure of distributing relief funds or taking measures to reduce monetary crises that families may encounter during this pandemic [5]. Families from minority communities will have to continue working in order to pay necessities such as a place to live and food, unless they want to potentially be vacated from their homes when not making payments. Although many state governments have created relief acts now to decrease the pressure of paying rent and creating relief funds, these are actions they took only when the Covid-19 situation exploded. However, we are hoping to show that these measures should have been taken before, so that these minority communities had higher levels of protection and didn’t have to risk their physical health to retain their living situations. 
Racial and ethnic minorities lifestyles have an immense impact on their health, exacerbating their risk of having more severe illness from Covid-19. These communities are more likely to have additional chronic diseases such as hypertension, diabetes, and asthma. Many minority communities live in well populated areas that are next to freeways putting them at higher risk of having respiratory issues which is directly related to having an increased chance of contracting a severe case of Covid-19 [6].

 

Minority communities are also more likely to have issues with the healthcare infrastructure from not having sufficient access to insurance or services to having racial biases from healthcare workers. Many minority community members do not have health insurance due to the industries that they work in, forcing them to look for additional government services such as Medicaid or other private programs such as TRICARE or direct purchases [7]. Minority groups such as Hispanics have the lowest health care coverage overall which may reduce their chances of being tested and treated if they were to be diagnosed with Covid-19 [7]. Doctors without Borders, an organization known for helping many countries outside the United States, had to dispatch its first group of healthcare professionals in the US to the Navajo Nation. This community has a very high number of Covid-19 cases, but is not able to socially distance as they have to go into urban communities for food and resources as well as not having an efficient number of healthcare professionals [8]. This was the first time Doctors without Borders had to help a community within the United States, showing a lack of efficient government strategies to protect minorities. Even when groups are able to gain access to healthcare, healthcare professionals may have implicit biases against minority groups which may create negative consequences on their treatment and experience in healthcare [3]. 

 

Through examining different structural barriers that minority communities encounter and by examining two groups in regards to Covid-19, we hope to show that the United States has created a situation throughout the years that gives a disadvantage to ethnic and racial minorities for being safe and healthy during an epidemic. There needs to be changes in many sectors of life such health insurance coverage, food and home security, access to education and healthcare which may allow for these communities to socially distance as well as receive proper treatment if they do contract an infectious disease thereby reducing the chance of an epidemic occurring. 

 

REFERENCES: 
[1] World Health Organization (2002). Environmental health in emergencies: Vulnerable groups. Retrieved from https://www.who.int/environmental_health_emergencies/vulnerable_groups/en/

[2] National Collaborating Centre for Determinants of Health (2020). Vulnerable populations. Retrieved from http://nccdh.ca/glossary/entry/vulnerable-populations#:~:text=Vulnerable%20populations%20are%20groups%20and,due%20to%20illness%20or%20disability. 

[3] Centers for Disease Control and Prevention. (2020). Coronavirus Disease 2019. Retrieved from 
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html

[4] New York City Health Department (2020). COVID-19: Data. Retrieved from https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-deaths-race-ethnicity-041620201.pdf

[5] Cha, S., & Shin, H. (2020). South Korea to Pay Families Hundreds of Dollars to Ease Coronavirus Impact. U.S. News and World Report. Retrieved from 
https://www.usnews.com/news/world/articles/2020-03-29/south-korea-coronavirus-cases-rise-steadily-more-financial-aid-expected

[6] Wu, X., Nethery, R. C., Sabath, B. M., Braun, D., & Dominici, F. (2020). Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study. MedRxiv. doi:https://doi.org/10.1101/2020.04.05.20054502.

[7] Berchick, E. R., Barnett, J. C., & Upton, R. D. (2019). Health Insurance Coverage in the United States: 2018. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-267.pdf

[8] Capatides, C. (2020). Doctors Without Borders dispatches team to the Navajo Nation. CBS News. Retrieved from https://www.cbsnews.com/news/doctors-without-borders-navajo-nation-coronavirus/

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