Health care.

• Position: Industry Outlook - Interview

As health care continues to play a leading role on the national stage, Utah's industry leaders gathered to discuss local solutions. The group tackled tough issues such as paying for uninsured patients, overutilization of the system and ways to keep top talent practicing in Utah. The leaders also discussed the Utah Health Exchange and how it helps employers provide more health care options to employees. Though costs and other health care issues are rising, Utah's industry leaders see improvements and reform options ahead.

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Why do you think there's a growing fervor over health care reform at the state and federal level?

POULSEN: I suspect most of us would agree that the current way that health care is provided in the United States is concerning. It's expensive and the costs are going up much more rapidly than inflation in terms of total expenses for health care. And the fact that in spite of the large amount of money that we spend as a country on health care, there are significant portions of the population that don't have access to health insurance. So while there are few people in the country who are satisfied with the health care system as it sits, there are many who are not satisfied. The question and the reason for so much controversy is it's not at all clear to people whether the mechanism to improve health care cost and access is through increased market reform, that is more market competition, or whether there should be more government intervention and oversight. And at the moment, the country is pretty polarized between those two perspectives. I think in most people's minds, it isn't whether reform in general is an appropriate thing, it's how do you approach reform.

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K. WIRTHLIN: I think the reason that health care reform has had so much momentum is that the country is not satisfied with the status quo. When you look back to the early 1990s, with President Clinton's effort to reform health care, the urgency wasn't as great which made it so the second choice, the status quo, was the preferable choice.

I think now we are at a place where most people agree that reform needs to happen. But any time you start talking about health care reform, you push on one part of the system to change and that has a positive or negative effect on another part of the system. It is such a complex multi-faceted system that to figure out how to change it in a large way is challenging practically and politically.

K. JOHNSON: I think we are confused as a public about what is out there and what is happening now. Unfortunately, people either don't take the time or don't know how to research what is really going on. There is so much confusion that people are scared about what might be happening to them.

Where do physicians fit into the health care reform discussion?

BARLOW: I think most physicians accept that the system needs reform. They are as frustrated with elements of the system that consumers generally are, and they recognize the cost drivers are untenable and unsustainable. I think the physicians have, for several years, expressed dissatisfaction with the system as it relates to what they perceive to be too much intervention and too many care hassles. I think that physicians are willing to look at reform, but they are concerned about the influences of reform and what is going to happen in the end. Is care going to become more difficult to provide to people than it already is today?

It is difficult to look at the trend of physicians in terms of the support of the profession any longer. I know in our organization of 100 physicians, a little more than 75 percent of physicians are generational physicians--they are fathers and grandfathers. Today, less than 25 percent of them have children going into medicine. I think it's a reflection of their perception of the profession and how difficult it is becoming. So while I think they're supportive of the reform, they are busy and they don't have a chance to be well informed themselves and that's perceived as being resistant to change, but I don't think that's the case. I think most physicians want to ensure the change is done thoughtfully, methodically and well measured so that we end up with something better in the end than what we have right now.

K. WIRTHLIN: In Utah, we've had a physician shortage in some specialty areas. At the University of Utah, we have a medical school where we educate 102 students, with the exception of this year, where we only accepted a class of 82. And the reason for that was because of a financial hit--we received a 30 percent cut of funds from the federal government and there were also state cuts. With these cuts, we had to make the difficult choice to reduce the class size, which is exactly the wrong direction that we need to be going in terms of having a supply of physicians. Luckily, Utah will always be a net importer of physicians. But as the rest of the country experiences a shortage, we are having a more difficult time recruiting physicians. So what we need to do is expand the class size at the university. We also need to expand the number of residency positions that we are training in the state. Overall, physician supply is a critical challenge for our state, and I think a key component we don't talk about enough with health care reform.

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B. JOHNSON: I read an article that talked about the transition from the baby boomer generation to Generation X. The premise of the article was that that is going to have a further adverse effect on the physician supply because there's a different kind of attitude about the work ethic--that they don't want to work 100 hours a week. That is going to have serious impact on staffing at hospitals and also the supply of physicians in general.

K. WIRTHLIN: It's something that we are seeing right now in terms of the new people who are moving in to medicine now. They are prioritizing family in a way that the generations prior to them had not. We are having more and more women who are coming into medicine, which is terrific, but they want to be able to balance family life and work life, so they are working less. That is a critical component of health care reform--that we structure the payment system so that using mid-levels appropriately is financially viable.

WILLIAMS: We are having similar problems in the dental care industry as far as physicians and dentists. The number of graduates coming out of school every year is falling, yet the population is increasing and it's a real problem.

What kind of difficulties are you having recruiting nurses and ancillary staff?

BATEMAN: In the hospital environment, we've had a chronic shortage for years of pharmacists and technical people in radiology and the laboratory. Certainly nursing also has a cycle that seems to come and go over the years. The last year or so has been a little bit easier for hospitals to hire...