Castorina says when patients wait longer than the services rendered, this lowers satisfaction rates.

DALLAS—Much has been reported about the dizzying pace of new residents streaming into the metro, at some 45 million expected by 2040. But, how is that growth affecting access to healthcare, the level of care and the load it is putting on facilities? In this exclusive, John Castorina, LEED green associate, managing partner and healthcare practice leader of Hoefer Wysocki, puts these issues into perspective as he specifically discusses how medical facilities are responding to population growth.

GlobeSt.com: How is Texas' rapid population growth affecting access to healthcare and care delivery?

Castorina: Demand from Texas' population growth is outpacing the growth of healthcare professionals rendering service within its borders. Studies indicate that the state's population is expected to grow to 45 million by 2040. With that statistic in mind, the current state of Texas healthcare is as follows: according to the Association of Medical Colleges, the national average of physicians per 100,000 population in 2016 was 271.6. Texas has 193.7 physicians per 100,000, ranking 41st. Most importantly, Texas' primary care physicians per 100,000 population is 72.1, while the national average is 91.7, ranking 47th. According to the Bureau of Labor Statistics, the national average of registered nurses per 100,000 population in 2017 was 892, while Texas offers 778 registered nurses per 100,000 population. According to these indicators, Texas may have a difficult time offering accessible healthcare to a rapidly growing population.

GlobeSt.com: Is the trend towards rural healthcare clinics helping to provide better access to care?

Castorina: According to the department of agriculture, Texas' rural population equals slightly more than 3 million people within 177 rural counties. This population is served by 305 rural health clinics and 73 federally qualified health centers, according to the centers for Medicare and Medicaid. These facilities are essential in offering health assistance in underserved communities where the Texas uninsured rate averages 15%, the poverty rate is 18.1% and the per capita income is $37,629 (18% lower than the Texas average). According to the Texas Office of Rural Community affairs, 63 counties in Texas have no hospitals. Currently, 27 counties have no primary care physicians and 16 have only one. Routine medical care is often more than 60 miles away and specialty care is typically 200 miles away. Outpatient clinical care is on the rise, however, several factors are essential to providing such facilities, including the development of additional rural health clinics and federally qualified health centers, allowing distant site providers for telehealth services, and the recruitment of qualified healthcare providers offering effective care, disease management, dental care, behavioral health and pharmaceutical distribution within underserved counties.

GlobeSt.com: How are critical access hospitals ensuring high-quality healthcare in rural communities?

Castorina: Texas has 85 critical access hospitals and each plays a vital role in rendering acute care, emergency and transfer services to rural counties. Each critical access hospital should be tailored to each community's unique health needs. However, as necessary as these facilities are to those communities, they often cannot provide the same level of care as their urban counterparts due to a lack of funding, physical size, inadequate staffing numbers, lack of specialists and lack of electronic document management. Their critical access hospital status also makes it less likely for the facilities to have an on-site ICU, offer cardiac catheterizations or have sufficient surgical facilities. The demographics of rural communities favor federal funding for services (Medicare or Medicaid) or uncompensated care for the non-insured. If federal funding for uncompensated care is further reduced and no expansion of Medicaid within the state occurs, critical access hospitals will have a difficult time maintaining their existence as exhibited by 11 critical access hospital closures and four critical access hospital conversions into clinics in Texas since 2010, according to the North Carolina Rural Health Research Program. However, technology and artificial intelligence can play a major role in the advancement of critical access hospitals, but adequate funding is required for this evolution to occur.

GlobeSt.com: How are medical facilities designing to decrease waiting room times and increase workflow?

Castorina: According to the National Center for Health Statistics, the average doctor's visit lasts 19.2 minutes but the average wait time is 23 minutes. When a patient waits longer than the services rendered, it can lead to a decline in satisfaction rates. In today's online society, speed to service is essential. It's a byproduct of our mobile culture. Healthcare systems are aware of this expectation and are implementing mechanisms such as patient portals. This automated system streamlines processes and allows a multitude of functions including pre-registration, questions to caregiver, medical history and appointment scheduling. The portal allows reduced appointment and exam room wait time due to efficient workflow in front-end operations, patient work-up and back-end operations.

Healthcare providers are also focusing on internal processes that affect wait times. An example is the development of load level follow-up procedures where repeat visits are scheduled for low volume times of the week and supply variation methodologies where the number of practitioners working per day best matches the demand of patient volume.

Facility improvements can reduce wait times as well. Since there are a multitude of appointment types, the universality of most exam rooms alleviate the need to relegate patients to defined rooms, thus increasing wait times when such rooms are occupied. Combined with adjacent support systems to facilitate quick room turnaround times and robust traffic systems that communicate room status, each system can assist in the reduction of queuing and wait times.

GlobeSt.com: Is the architectural industry responding fast enough to population growth?

Castorina: The architectural industry has the capacity to respond to population growth, however, its ability to adequately respond or greatly influence may be the question. Architecture has always been a reflection of culture. Our experiences and interactions occur in buildings and spaces that we live and work in, therefore, architecture is a historical marker of society. However, global mobilization is changing the face of cultures and societal demands. This is requiring architects to familiarize themselves with the intricacies and global perspectives of population growth and its impact on environmental consumption to adequately contribute to solutions. As architects, we cannot control the rate of population increase, but we can respond to the environmental impacts of such growth.

Most architects seriously accept the responsibility of being stewards of society and the environment, for the two are inseparable. With that, as an intellectual industry, it is looking to positively respond to population growth by expanding the concept of ecological urbanization, utilizing innovative technologies to reduce environmental impact and incorporating methodologies of balanced consumption of natural resources.

University architectural programs are quick to understand the impact that population growth will have. Curriculums are evolving to embrace global advocacy and initiatives that explore solutions for environmental impacts brought on by population growth and climate change. As this education happens at more universities, all future architects will have an advanced literacy rate of global perspectives and a greater ability to contribute to solutions that will advance the human condition.