Although they found areas of partial agreement, two experts who believe the threat of an imminent physician shortage is real disagreed with the basic premise of a recent Health Affairs report
that concluded that the projected shortage was “greatly overestimated.”
The report's authors, researchers with the Columbia Business School in New York and the University of Pennsylvania's Wharton School in Philadelphia, wrote that, with proper staffing, new scheduling methods and effective use of health information technology, “This projected shortage can be completely eliminated.”
“Our position is that you do have to do that stuff, but you also have to train a couple more thousand doctors a year—it's not an either-or proposition,” said Dr. Atul Grover, chief public policy officer for the Association of American Medical Colleges. “I don't think what they're saying is completely off because there are ways we can improve practices and we need to make better use of our professionals' time.”
Dr. Reid Blackwelder, president-elect of the American Academy of Family Physicians, noted that the researchers' recommendations included suggestions that were similar to those found in his organization's report Primary Care for the 21st Century,
which stated that team-based care was the way to address the projected primary-care physician shortage.
“In many ways, they're saying what we were saying in that we have to redesign how we provide care,” Blackwelder said. “One of the best uses of a family physician's time is not to see every patient with a chronic condition.”
Blackwelder said the better use of a primary-care doctor's time is to provide care to patients with acute conditions or whose chronic condition has destabilized, while leaving routine management tasks to nurse practitioners or physician assistants. But Blackwelder disagreed with the Health Affairs report's statement that—if patients are diverted away from doctors through the implementation of care teams or “virtual visits”
handled online or over the telephone—“the predicted physician shortage essentially evaporates.”
“I have a hard time accepting that,” he said.
Blackwelder also said the Health Affairs report also misses the issues involving underserved areas with few physicians, explaining that patients living in some rural regions should not be destined to only receiving care from nonphysicians or rarely seeing a doctor in person.
“It could lead to a two-tiered system where, if you live in one area, you get this care, and—if you live in another area—you get that care,” Blackwelder said.