Who does what? We redefine the roles of healthcare professionals

Cristina Adroher

One of the ideas that have been more repeated recently in the health care sector is that there is a lack of professionals. A recently published study shows that in Catalonia, until next 2023, 2,571 doctors and 3,263 nurses will be lacking to cover the population's care needs. This lack is especially marked in certain specialities (primary care) and rural areas. Seemingly not enough professionals are being recruited to face the projected demographic change. It is estimated that by 2030, Spain will be the fourth country in the world with the highest average age in the population as a whole (50.1) and that in 2050, people over 65 will represent more than a third of the total Spanish population. It's reasonable to assume that the ageing of the population will lead to an increase in the need for health care and social resources.

If the figures for the staffing of professionals are comparatively observed, we notice that the average rate of doctors in the countries with OECD-36 sessions is 3.5 per 1,000 inhabitants, while in Spain it's 3.9 physicians per 1,000 inhabitants (above the average). In Catalonia, the rate is even higher (4.8 doctors for every 1,000 inhabitants). On the contrary, if we look at nursing professionals, we see that Spain stands at 5.7 nurses per 1,000 inhabitants and Catalonia at 6.09 per 1,000 inhabitants, below the average (8.8). So we have more doctors and fewer nurses than the average.

What's behind the apparent lack (or excess) of professionals?

Why the alarming perception of lack of doctors? One of the factors that we must consider is what care professionals spend their working time on. Different recently published reports, such as that of Medscape, confirm that a significant percentage of doctors' care time is devoted to administrative tasks with no clinical value, which could also have an impact on their levels of satisfaction and professional achievement. Half of the doctors in the countries considered in the study dedicate between 10 and 24 hours a week to administrative tasks, so we are facing a problem that is not exclusive to our country.

If we look at what these countries are doing to deal with the problem, we find the redefinition of professional roles and organizational models; reinventing the operation of medical consultations to ensure that each professional is focused on maximizing their clinical added value, acting in their top-of-license practice to ensure that everyone feels that they bring their knowledge and skills to their limit.

Proposals for action

In the first place, we can incorporate new professional profiles, such as clinical assistants, that help relieve doctors and nurses from administrative tasks. These figures began to be incorporated in the United States and are widely extended and integrated into the consultations of other countries, performing functions such as filling in anamnesis forms, carrying out schedules or filling in predetermined reports, always under protocol and with prior training. Experiences such as the one in Colorado (USA) show increases in productivity and a decrease in burnout as a result of the development of decongestion programs in doctors and nurses. In the United Kingdom, the Closing the gap report estimates that in the NHS, general practitioners dedicate 11% of their time to administrative tasks, so if 50% of them were assumed by other professional profiles, such as clinical assistants, the equivalent of 1,600 primary care physicians in the UK could be released.

Yorkshire and Humber - "Toblerone Model"

Second, we can increase the skills of professionals who are already present in the system, as is the case with the nursing community. These professionals can extend their role in chronic disease management to health promotion activities or family empowerment, among other possible fields. In the field of primary care, expanding the role of nursing, together with the incorporation of new profiles to teams (physiotherapists, pharmacists, social workers, etc.), can generate alternative situations with comparable outcomes and lower cost. Physicians will remain essential for the diagnosis and treatment of the disease but will be supported by support teams for the management of chronic diseases. The report "Reshaping the workforce to deliver the care patients need" exemplifies an experience of the NHS that is committed to a change in the composition of primary care teams (the "Toblerone Model"). This evolves from the current intensive model in physicians to a scheme with more support professionals and fewer clinical professionals. In the hospital setting, some examples of advanced roles can be anaesthesia nurses, surgical assistants, or ultrasound technicians, among others.

To conclude, I would like to emphasize that there is scope to take better advantage of the potential of new technologies in the optimization of resources and a better accompaniment to the citizen. All this require trained health care professionals with the corresponding digital skills to monitor chronic patients through apps, help them to handle wearables, manage a telematic consultation between professionals or complement diagnoses through artificial intelligence, among other important actions from the health point of view. We should consider who is going to carry out these actions, if they are not already exercising them, and what powers are required to do so.

Would professionals be lacking if were we able to do all this? Which? Maximizing the value that each of the different health care professionals (current and future) contributes in the framework of health care results in better use of available resources, better patient care and greater professional satisfaction regardless of whether there are or not enough doctors.