Monday, April 30, 2007
New Orleans: "It's a dangerous place to live for unhealthy people"
Healthcare workers are not returning at the same pace as the residents:Residents are returning to New Orleans faster than healthcare workers. The shortage of doctors — on top of fewer and overcrowded hospitals, lost or destroyed medical records, and delays in everything from getting an appointment to lab test results — has contributed to a sense that medical care here is still not recovering.
Posted by Kevin |
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The state and federal governments have yet to face the reality that no professional in their right mind would practice in New Orleans right now--at least, not without some serious incentives. Destroyed infrastructure, a psychologically unhealthy environment, crime, soaring Medicaid and uninsured patients...So nice that 20 months later they're giving incentives to come to the area, but (1) what about those who decided to stay in the first place (the HHS grant is for recruitment, not retention), and (2) what about plans for long-term financial stability after that initial grant? We're still waiting for someone, ANYONE at the federal level to even start comprehending the problems facing health care on the post-Katrina Gulf Coast.
There are healthcare problems in New Orleans but it is not basically one of doctor numbers. How about some facts instead of anecdotes:
Louisiana has lost 5% of it's population to Katrina.
Louisiana has lost 4% of it's physicians to Katrina.
So where is the problem? Well, it is one of other ancillary personel for one. Doctors are not nealy as mobile as nurses for example. With property investments and long delays in liscensure, moves are not quite as easy.
Also there are disruptions in systems of care that go beyond mere numbers. The continuum of care for the chronically impaired population between nursing home, hospital, and outpatient services has been disrupted. The cash flow has been disrupted even where care is provided. Transient construction workers, many in the country illegally, are not reliable payors for operations unable to collect up front. Long standing patients are often just surviving sort of camping out in damaged homes without a job or insurance or with a job but home restoration expenses soaking up every dollar when it comes in with none left over for the doctor. Many docs have left New Orleans since the storm because of the difficulty, despite the hoopla about a shortage, of making a living. It is not more doctors that the Gulf Coast needs, but effective leadership in supporting and retaining existing institutions.
Dr. Scott is right to point out the oddity that 20 months later, recruitment grants are offered, when much more modest but timely efforts to sustain existing institutions would have made more of a difference.
An example. Gobs of federal money was spent on bringing in paid and volunteer counselors from all over the country, with the contract handled by an outside firm, to go into schools and churches and drum up misery with "crises counseling", while the critical psychiatric treatment infrastructure built up over more than a century collapsed for lack of cash flow. It made no sense to gin up psychiatric cases while the people who could then handle the cases uncovered were having to go elsewhere to eat. It would have been far far more rational to contract with local institutions with their existing networks putting them to work. They know the population, they know the culture, they know the resources, and doing so would have kept them alive and viable so they they would be still going now.
The complete absence of leadership at every level of political authority has been shameful in everything related to Katrina. Volunteers were wonderful, and still are. But as for government, except for a few isolated agencies like the Lousiana Department of Wildlife and Fisheries, it has been one vast society wide carpet of shame.
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Louisiana has lost 5% of it's population to Katrina.
Louisiana has lost 4% of it's physicians to Katrina.
So where is the problem? Well, it is one of other ancillary personel for one. Doctors are not nealy as mobile as nurses for example. With property investments and long delays in liscensure, moves are not quite as easy.
Also there are disruptions in systems of care that go beyond mere numbers. The continuum of care for the chronically impaired population between nursing home, hospital, and outpatient services has been disrupted. The cash flow has been disrupted even where care is provided. Transient construction workers, many in the country illegally, are not reliable payors for operations unable to collect up front. Long standing patients are often just surviving sort of camping out in damaged homes without a job or insurance or with a job but home restoration expenses soaking up every dollar when it comes in with none left over for the doctor. Many docs have left New Orleans since the storm because of the difficulty, despite the hoopla about a shortage, of making a living. It is not more doctors that the Gulf Coast needs, but effective leadership in supporting and retaining existing institutions.
Dr. Scott is right to point out the oddity that 20 months later, recruitment grants are offered, when much more modest but timely efforts to sustain existing institutions would have made more of a difference.
An example. Gobs of federal money was spent on bringing in paid and volunteer counselors from all over the country, with the contract handled by an outside firm, to go into schools and churches and drum up misery with "crises counseling", while the critical psychiatric treatment infrastructure built up over more than a century collapsed for lack of cash flow. It made no sense to gin up psychiatric cases while the people who could then handle the cases uncovered were having to go elsewhere to eat. It would have been far far more rational to contract with local institutions with their existing networks putting them to work. They know the population, they know the culture, they know the resources, and doing so would have kept them alive and viable so they they would be still going now.
The complete absence of leadership at every level of political authority has been shameful in everything related to Katrina. Volunteers were wonderful, and still are. But as for government, except for a few isolated agencies like the Lousiana Department of Wildlife and Fisheries, it has been one vast society wide carpet of shame.
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: 9:00 PM
