by Aimee Mendel

Created on: November 23, 2008   Last Updated: February 05, 2011

The health care environment is changing exponentially. Changes no longer take months or years; they are occurring daily, even hourly. The precipitous decline in the U.S. economy has caused hospitals to have to completely rethink their strategies.

The not for profit hospitals are housing more and more uninsured people, and these people are sicker than ever, because too often they wait until they are very ill to seek treatment due to lack of insurance. Even the insured patients only bring in a fixed amount of income; often the treatments required to diagnose/treat them are more costly than the reimbursement.

All medical staff, whether in the hospital or the physician's office, are experiencing huge workloads. Physicians must see more patients to make the healthy income they took for granted in years past. Physician extenders in the form of Physicians' Assistants and Nurse Practitioners do the bulk of the assessments and ordering for patients; this allows the physician to see many more patients. Registered nurses and Laboratory

Technologists are having to do much more with much less. The stress of working in the health care industry is monumental. Registered nurses have a high incidence of psychiatric disorders, most frequently depression. There is little thanks in the current health care field; patients expect gold standard care and most often this is simply not possible.

There is a movement to allow patients to stay home and be monitored from there. Patients can have their heart rhythms monitored, they can receive IV medications and they can receive physical, occupational and speech therapy at home. Being at home protects the patient from the possibility of acquiring a nosocomial infection. Infections are a huge problem in the hospitals today.

Because so many patients are diabetics, they are set up to acquire infections should they need surgery or a urinary catheter. Strict hand washing goes a long way towards preventing spread of infection, but even that is not sufficient to halt organisms from finding their way into bodies. Patients who are in the hospital for long periods of time become disoriented, depressed and angry. These negative consequences could be avoided by in home care.

Growing acceptance of physician extenders is very much in the future of health care. As it stands now, most often the extenders do most of the work. The physicians come behind to verify what the extenders have written. While NP's and PA's are already fully functioning in rural and other under-served areas, their presence will become more and more common in all settings.

Perhaps the greatest hope for the future of health care is a much more aggressive and successful preventative disease program that is across the board. The details of such a plan would be another book, but this does seem to be the most sensible and cost efficient solution to the monumental challenge of providing optimal health care to the most people.

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