Care Shortage

Perspectives: Research and Creative Activities at SIUC, Fall 2007

:: research survey ::

Care Shortage

The SIU School of Law's Center for Health Law and Policy has received grants from the Commonwealth Fund and the California Health Care Fund to study causes of a nationwide shortage of physicians who care for nursing home patients.

The two foundations are finding "it's getting harder and harder for nursing homes to attract physicians to come into their [facilities] and care for their patients," says project director Marshall Kapp, Garwin Distinguished Professor of Law and Medicine and the center's co-director.

With 1.5 million Americans in nursing homes, the issue affects quality of care for a "significant population that often gets overlooked in health policy discussions," he says.

States grappling with the issue include Florida, Texas, California, and, anecdotally, Illinois.

"If you talk with nursing home administrators, particularly the smaller nursing homes, they almost all complain about the problem of getting physicians to come in and follow their patients," Kapp says.

The two foundations want to know the reasons for that reluctance and to come up with some solutions.

Malpractice litigation may be a key factor, Kapp says.

"Up until five to 10 years ago, doctors almost never got sued relating to their treatment of nursing home patients. [T]hat has changed to the point that a substantial number of lawsuits are being filed—not just against nursing homes but, we think, and this is what the study will look at, also against physicians who are caring for nursing home patients."

The study aims to separate genuine causes from exaggerated perceptions and unrealistic fears. It will review relevant legal, medical, ethical, health policy, and health services literature, along with legal cases, statutes, and regulations. It will include interviews with officials from relevant organizations, such as the American Geriatrics Society and the American Medical Association. And it will include interviews with physicians involved in caring for nursing home residents, as well as with attorneys who represent and advise nursing homes, residents or their families, and physicians.

The study will also examine if it makes a difference whether a nursing home is a for-profit or not-for-profit facility, Kapp says. Between 75 and 80 percent of nursing homes are for-profit facilities.

The findings, expected in spring 2008, could result in recommendations for more professional education in law schools and medical schools, better risk management by nursing homes, and legislation, if needed.

—by Pete Rosenbery