Tagged: female physicians

Insourced

 

It’s been a rough year for workers in the US, with about 10 percent of the population unable to find a job, and many more not able to find enough consistent work. One sector that is consistently adding jobs is the healthcare industry. Since about 90 percent of healthcare support workers are women, and over half of new medical students are female, this should be great news for women, right?

Well…maybe. But maybe not.

In reality, the healthcare field is a complex and varied industry that often perpetuates inequality on a global scale. In her new book  — Insourced: How Importing Jobs Impacts the Healthcare Crisis Here and Abroad — Kate Tulenko exposes how global inequalities are reproduced by US immigration policy and lack of strong healthcare worker recruitment policy.

For example, almost 6,000 regions in the US don’t have enough healthcare workers, but recruitment of potential healthcare workers from these communities is rare. At the same time, a study in Malawi showed that there are more Malawian physicians in Manchester, England than in Malawi. Ironically, poor countries such as India and Malawi, invest a significant part of the income into training physicians and nurses who often go abroad because the pay and working conditions are better, meaning that the countries don’t even get a return on their investment.

 

The US facilitates this process by providing special healthcare worker visas to those seeking to immigrate.

Tulenko, the senior director of health system innovation at IntraHealth International, has worked both domestically and abroad and experienced many of these inequalities firsthand. She points out that when the US facilitates immigration of healthcare workers from these countries, it negatively affect health indices.

It is irrational and immoral to recruit health workers from countries where one in five children die before their fifth birthday when we could be recruiting and training workers domestically. Doing so would help our economy, global public health and the 314 million Americans who rely on our medical system to provide high-quality, affordable care.

This immorality crosses over into domestic policies as well, since many African American and Lation communities are served by transient physicians and nurses, who come to these communities to gan experience but rarely stay on longterm. Tulenko argues that recruiting healthcare workers (of all levels) from the communities that need them most could better serve disenfranchised neighborhoods in the US.

She  writes:

There are other casualties, closer to home. Every study that has examined how to incentivize health workers to move to underserved areas has shown that training people from these communities is the most cost-effective approach. But because we’ve essentially given up on recruiting from underserved places in the United States, we’ve made their chronic lack of health workers much worse. Some 54 million people live in the 5,700 parts of the country defined as “health professional shortage areas,” the communities with the worst health statistics and the worst unemployment.

Even with the high unemployment rate, there is often a healthcare worker shortage in this country. This shortage is attributable to a variety of factors: medical school (and post-secondary education in general) has become extremely expensive.

It’s similar to the so-called “skills gap” in manufacturing, described in this article. When manufacturing workers are paid only $10 an hour to do a complex job that requires they pay for training at a community college, they often find that financially they would be better off working at McDonalds.

At the same time that there is a growing demand for healthcare workers, the educational requirements have increased.  According to a report from Georgetown University:

The demand for postsecondary education and training in healthcare, already high, will continue to edge upward. In 2010, it was 81%; by 2020, it will rise slightly to 82%. For professional and technical occupations, however, that number rises to 94%. A bachelor’s degree will be required for 24% of all healthcare jobs, up from 21%  in 2010. This high demand for postsecondary talent in healthcare is second only to STEM and education occupations

Almost 90 percent of health support workers are women.

While nurses and other healthcare professionals are paid well, according to the report, 70 % of healthcare support workers earn less than $30 000. Soon, most of these jobs will require at least some post-secondary education, but there’s no guarantee that wages will go up.

Healthcare systems – like the economic system – are intertwined, we don’t live in a vacuum. This is an interesting example of the ways that the broken US healthcare system has spread its tentacles all over the world.

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Think before you pink

Welcome to October. As you probably know, it’s National Breast Cancer Awareness Month.

That means you’ll be inundated by things like this

Breast Cancer Awareness Makeup Palette from Sephora

and this:

Tic Tacs for breast cancer awareness

and this:

Corn Chips for The Cure

Women will be racing, biking,  eating, climbing and knitting for  The Cure.

Breast cancer has become so hyper-visible that it’s hard to believe we really need any more awareness. So many of the activities related to breast cancer are just an opportunity for corporations to pay lip service to women’s health.  National Breast Cancer Awareness Month has become just a tired ritual, when women’s magazines trot out their “Five Things You Need to Know about Breast Cancer,” articles and publish yet another “profile in courage” of a woman stricken with the disease who finds that it makes her a better, kinder, more spiritual person.

Every year, about 35,000 American women die from breast cancer. That’s over 100 women a day. Treatment is still limited to “slash, burn and poison,” and we don’t know what causes it.

As I’ve written elsewhere, men tend to set research priorities and be the main clinical researchers. But one of the best known breast cancer researchers is Dr. Susan Love.

This month, Dr. Love has launched a new research initiative dubbed the Health of Women Study (HOW), and she’s asked women’s health bloggers to help her publicize it.  According to the study website:

The majority of women who get breast cancer have none of the known clinical risk factors. This means we don’t know what causes breast cancer or how to prevent it. The HOW Study is a first-of-its-kind international online study for women and men with and without a history of breast cancer.  We will collect information about your health, your job, your diet, and your family history, among other topics that can help us get a better understanding of breast cancer and its potential causes.  Periodically, we will send you questionnaires about anything and everything. All you have to do is fill them out online. It’s that simple. This is a partnership and we need you for the long haul. The more questionnaires you fill out, the more information we will have that can help us have a better understanding of why women get breast cancer.

Anyone over the age of 18 — male or female, with breast cancer or without — can join. There’s no poking, no prodding, no blood samples, no humiliating tests; just some online data collection.

This October, think before you pink .How about joining the study instead? I’ve done it. Will you?

Image credits: TicTacsand Sephora and Frito Lay

Women in medicine: What’s to celebrate?

September was Celebrate Women in Medicine month, according to the American Medical Association’s Women Physicians Congress.

The AMA-WPC consists of more than 67,000 female members of the AMA working to increase the number and influence of women physicians in leadership roles—and to advocate for and advance the understanding of women’s health issues.

I missed it by one day, but I still want in on the celebration.

Did you know that  48 percent of students graduating from medical school in the US are women? That women make up 70 percent of medical and health service managers? And that 98 percent of nurses are women?  It almost makes me wonder if men are in decline.

Actually, no. It doesn’t.

I have no doubt that men are certainly not in decline. Back in the bad old days, women were nurses and men were doctors. Today, a third of all women are doctors, and women are still nurses. But the big dogs? They’re men.

Dr. Danielle Ofri wrote about this recently:

While women make up about half of all medical students and a third of academic faculty, they are nearly absent in the upper ranks. A recent review in The Journal of General Internal Medicine showed that only 4 percent of full professors are women. Only 12 percent of department chiefs are women. In the survey, men and women were engaged in their work to a similar degree, and both groups had comparable aspirations for leadership roles.

It’s a sobering realization for female medical students.

An article published in the Journal of Human Capital this summer compared the earnings of male and female primary-care physicians and estimated what they would have earned if they had been Physician Assistants (PA). The study found that while most male doctors are financially better off for having become a doctor, most female primary care physicians would have made more money as a PA.

Let’s celebrate women in medicine. But let’s also think about ways to change institutions and structures so that these wage gaps and persistent inequalities do not persist.