Friday, August 28, 2009

Health Care and Physician Shortage

Doctors are forecasted to be in short supply. Although plenty of physicians are currently in practice across the country, surveys indicate that the availability is on the decline. According to AAMC.org, over the past several years, a growing number of national and state or specialty specific studies indicate
that the U.S. physician workforce is facing current or future shortages. Since 2002, there have been at least 24 studies of current or future state physician workforce needs. In
nearly all of these studies, the underserved and elderly populations are most likely to be affected. Additionally, many of the state reports point out shortages in specialties that are featured in the specialty report section, including allergy and immunology, cardiology, child psychiatry, dermatology, endocrinology, neurosurgery, primary care, and psychiatry. If physician supply and use patterns stay the same, the United States will experience a shortage of 124,000 full-time physicians by 2025. The report details shortages by state and specialty and can be found at http://www.aamc.org/workforce/stateandspecialty/recentworkforcestudies.pdf .

According to AmedNews.com (American Medical News--AMN), the number of physicians, especially primary care physicians, in the pipeline is not sufficient to keep pace with the needs of a growing and aging population. The problem is not that the supply of physicians, including those in primary care, isn't growing -- because it is. It's just not growing fast enough. Physicians, like the rest of the population, are reaching retirement age in large numbers. In 2017, more than 24,000 will turn 63, and the number of new physicians entering practice each year is about 26,000--just about enough to maintain the status quo. If suddenly, 20,000 to 60,000 more doctors retire because the stock market is back up, America will be in trouble.

The problem, according to AMN, has been highlighted by efforts at health system reform that, if successful, likely will require additional primary care physicians. Among the steps suggested to bolster the supply is to increase graduate medical education slots and to expand the use of support staff, including physician assistants and nurse practitioners, where numbers of new graduates are soaring. Some physicians describe another method -- reach out to students in medical school early, expose them to the health professions and "nurture the heck out of them". This approach has been under way for several years in rural areas and areas with high concentrations of minorities -- parts of the nation that have long faced a dearth of health care professionals.

There are reasons that physicians leave the medical practice, according to AMN. A chaotic work environment -- with insufficient time for proper patient care and lack of control over work -- takes a toll on primary care physicians. Studies show that more than half of these physicians feel time pressure during office visits, while 48% said their work pace is chaotic and 78% said they have little control over their work. These conditions were strongly associated with low physician satisfaction, high stress, burnout and intent to leave. Health system reform efforts to provide coverage to the uninsured make it especially important to attract and retain primary care physicians. A major issue in health reform is who is going to care for those millions of uninsured people, so recruitment and retention in primary care is a major issue for the country.

According to HealthLeadersMedia.com, an alternative suggestion is worth strong consideration. If experts are predicting a shortfall of doctors under the current workforce model, maybe it's the model, and not the number of doctors, that needs to be fixed. The analysis goes like this: While there is a healthcare services shortage, that doesn't necessarily translate into a doctor shortage. There are a number of ways to meet that demand for services, and the mistake reformers of any industry often make is to look for answers from existing models and stakeholders. The alternative is to ask what doctors are doing today that could be shifted to other workers who may be more affordable, but could have very specific technical expertise in treating certain select conditions, and do it very well, like a form of outsourcing.

Some care can be shifted from some of physicians' workloads onto nonphysician practitioners, such as nurses, physician assistants, and technicians, and shifting certain types of care to retail clinics and other settings outside of physician offices. Healthcare services are already being provided outside of doctors' offices more frequently, according to HealthLeadersMedia.com. It's not just happening in retail clinics—over-the-counter at-home tests and medical devices now let patients diagnose, monitor, and treat conditions that were formerly the physician's domain. If the shortage projections are accurate, increasing medical school enrollment and funneling more money into physician development aren't alone enough to meet the growing demand for medical services. So if there will not be enough physicians, consideration must be given on how to care for an aging population in that environment. The key in all this is to enhance, not replace, physician services. If physicians view nonphysicians and retail care as threats, then care will continue to be disjointed and the strain on the system will grow. But if physicians recognize the opportunity for collaboration, they can work with new nonphysician providers to coordinate care and focus even more on the high-level services at which they best serve.

But Americans get it, according to MedInnovationBlog.com. The American people in general get it – they are weary of waiting months for a doctor appointment. Rural Americans, in particular, get it- they are often unable to find a physician at all. Citizens of Massachusetts get it – they are having a hard time locating a physicians in spite of a state health care plan that promise universal coverage. Americans seeking care during the night, at dawn, on weekends , and on holidays get it – they must go to hospital emergency rooms to get help. Older doctors get it – they are working flat out to handle their current load of patients. Younger doctors get it - they are unwilling to work as low paying primary care physicians, swamped with patients and with limited family or personal life. Primary care physicians get it – their numbers are dwindling and they may become obsolete in the next two decades at present rates of decline. General surgeons get it – according to the American College of Surgeons, their declining numbers have created a “crisis.” Physician groups with retiring partners get it – they are unable to recruit replacements. The Physicians’ Foundation, which represents 500,000 doctors in state and local medical societies gets it – they have just completed a national survey of 270,000 primary care doctors and 50,000 specialists indicating that doctors are in despair, having difficulty recruiting, are thinking of retiring or quitting or seeing fewer patients, and are not recommending medical careers for younger people. Community hospitals get it – they find themselves unable to recruit, retain, or even afford physicians to staff for essential services, serve their communities, and cover their emergency departments. Physician recruiting firms get it - they have to hunt high and low to find the right persons for their clients. The nursing profession and the physician assistant association gets it – they are mobilizing to produce more physician extenders. The nation’s largest staff recruiting firm, AMN, and its subsidiary Merritt, Hawkins, and Associates, gets it. As the economy grows, the nation spends more money on health care, and there is a double whammy because of a an accompanying shortage of nurses of an even greater magnitude than the doctor shortage. A great overview can be found at http://medinnovationblog.blogspot.com/2009/01/physician-shortage-who-gets-it-who.html .

The bottom line is that America needs more doctors and nurses. Providing medical care to an aging population and an ever increasing overall population of over 300 million people demands action that will help solve some of the critical issues of shortages in the medical field.

Until next time. Let me know what you think.

1 comment:

John P. Zook said...

Another good case for the "CallMD" / "physician office visit over the phone" model.

Thanks Mark ...