The physician shortage that is just beginning will have a significant impact on healthcare delivery in the U.S. Since the 1980s, when the Association of American Medical Colleges predicted an oversupply of physicians, medical school graduation rates have been flat. Fast-forward 30 years, and we are in the middle of the perfect storm. The curves representing supply and demand suggest a crisis that will know no boundaries: The shortage will cross political and geographic borders and medical-specialty divides.
Better Medicine: Prepare now for worsening doc shortages
Demographics will fuel the demand/capacity mismatch. The population of the U.S. grows by 25 million a decade, and the number of people over age 65 will double by 2030. As patients age, their use of healthcare services goes up almost linearly. Patients older than 65 will average six to seven healthcare encounters a year, while those ages 45-65 will average 5.4, and young adults will average 2.2 encounters per year, according to a recent article in the online magazine Physicians Practice. At the same time, the number of physicians retiring is higher than was anticipated, and the younger physicians do not want to work the hours that physicians of previous generations have worked. This younger workforce has more female physicians and is smaller relative to the patient population and the volume of work hours performed has declined. For example, emergency physician contracts in the 1980s required close to 2,000 hours of clinical work a year. There are groups that now require only 1,300 clinical hours per year for full-time physician contracts.
The shortages across medical and surgical subspecialties will take the on-call crisis to new levels and make acute-care delivery in places such as the emergency department even more problematic. Difficulties in seeking primary and preventive care will mean that patients will present to the emergency department later in the course of diseases and outcomes will suffer accordingly. According to an article in Forbes, some have predicted that a three- to four-month wait to see a primary-care physician is not that far off, considering all of these factors.
Are there strategies for healthcare executives and managers to consider to help combat the profound shortage that looms? How will leaders prepare patients and providers for the changes that this physician shortage will bring? A two-pronged approach involving physician retention strategies and strategies that improve physician productivity should be considered. In terms of physician retention, forward-looking physician groups are doing everything possible to keep recruited physicians on board and practicing. They offer assistance to help physicians manage stress or personal problems, financial counseling and mentoring. Trying to help older physicians adapt and remain in practice longer is another approach: Reducing night call can keep older physicians with declining stamina in the workforce longer.
The second prong involves stretching the work capacity of the physicians by improving physician productivity. Scribes are one of the sentinel new approaches to improve physician productivity, and use of a scribe program can help prolong the careers of older physicians. One physician group in California introduced a scribe program that offloaded clerical tasks to nonphysicians, resulting in better retention of older physicians, improved physician efficiency and increased productivity. Scribes have been penetrating all areas of clinical work in recent years from ambulatory settings to inpatient services with the same positive reports of success.
The other big idea is to build out the service reach of the physician by introducing midlevel providers. Midlevel providers typically are employed by the hospital or healthcare system to do medical and procedural tasks that are within their scope of practice and can free up the physician for physician only tasks. Nurse midwives and certified nurse anesthetists are two more examples of this model at work. Some healthcare systems are using midlevel providers as first responders for on-call situations; the physician is called in as a backup. But the transition to this model can be difficult for healthcare providers and patients unless all parties understand the capabilities of midlevel providers and know to expect their involvement in healthcare delivery.
Finally, telemedicine has infinite possibilities as a solution to the physician shortage by allowing physicians to extend their reach by virtually undoing the constraints imposed by geography. There is already early data showing that intensivists can manage ICU patients from home at multiple sites and improve care through telemedicine.
The point is this: The physician shortage is real and looming. Your organization should begin exploring strategies to manage it. It is never too early to begin educating providers and patients about the new healthcare delivery model, and what it will look like when there is "no doctor in the house!"
Dr. Shari WelchUtah Emergency PhysiciansSalt Lake CityPresidentQuality Matters Consulting
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