April 05, 2016
The U.S. Physician Shortage: What You Need to Know
Supply and demand is a never-ending tug-of-war. In healthcare, one end of the rope is pulling toward progress, and the other end is being held back by insufficient manpower. Despite all the medical advancements and improved capabilities in modern healthcare, the problem is quite old-fashioned: There just aren’t enough available skilled physicians at the front line to utilize these advancements and provide their services to the fullest extent.
The physician shortage debate has raged for decades, but its existence is no longer a question; it’s a reality. According to the 2015 physician workforce projection report, released by the Association of American Medical Colleges, an even more pressing physician shortage is predicted by 2025.
However, such negative news can be an impetus for positive change in a system that requires much-needed, continuous improvements to make care more efficient and higher quality. To make this happen, the root causes of the problem must be understood. Here are some factors contributing to the physician shortage, as well as what could be done in each case to alleviate the problems.
More patients needing ongoing medical care
According to the AAMC study, a 17% increase in physician demand and a physician shortage of 46,000–90,000 are predicted by 2025. This increase in demand can be attributed to a steadily growing number of people in the older-age demographic who will require more medical services in the coming years. Demand has also been increased by the implementation of the Affordable Care Act (ACA): quite simply, more insured people means more people seeking medical treatment.
Primary care is particularly affected by these factors: the projected future shortage is estimated to be between 12,500 and 31,100 physicians, because physicians are increasingly choosing to pursue specialties to increase their value. This is perhaps not positive news for the baby boomer population and the newly insured, many of whom have chronic conditions that require continual support from a primary care or family practice physician.
Finally, the cap on the number of residency training positions that are funded by Medicare means resident physicians are having to move states to train because there aren’t enough spots available where they are. This leads to a loss of medical trainees for some states and a shortage of highly-skilled service in local communities.
Increasing workload, decreasing incentives
Then, there is all the work physicians have to do that isn’t directly related to patient care. It’s no longer enough to have top-notch skills as a medical provider, or to worry about how to treat all the patients who need to be seen. And many new policy mandates, meant to facilitate efficiency and increase revenue for hospitals and physicians, have also resulted in new burdens. For example, electronic health records (EHRs) were meant to make documentation easier, and the switching of billing codes from ICD-9 to ICD-10 was supposed to make medical billing easier and faster. Instead, both have contributed to extra work in data entry and seemingly endless technology updates for a properly functioning system. When these administrative responsibilities are piled on the working physician, the incentive to practice is siphoned away. It’s no wonder so many are at risk for physician burnout. The accumulated workload, combined with the trend toward business-oriented medicine, are sending established physicians packing, even as bringing in new ones is proving difficult.
Can we maximize efficiency and meaningful, quality care?
To prepare for the inevitable increase in patients, healthcare practices of all sizes must restructure. This starts with providing greater support to physicians in various forms.
- Team-based medical care redistributes tasks according to skill level and capability, letting each team member work efficiently on the tasks they are trained do. For example, medical assistants can provide patient education and medical scribes can take on the burden of patient documentation, EHR data entry, and even coding and billing. The team approach saves physicians’ time, improves doctor/patient interaction, and speeds the revenue cycle. In addition, care teams can actually save you money: using health coaches to provide patient education and support has been shown to reduce the cost of ER visits.
- Providing increased training support for resident physicians in the form of increased federal funding for residency spots in hospitals or community-based training is vital. Government and other public initiatives must aim to systematically increase physician numbers in shortage states if these trainee physicians are going to be allowed to remain where they are.
Despite the impending shortage, we have the resources and the skills from a variety of highly-trained people at all levels of the healthcare profession who are able to provide patients with the quality care that they deserve. Achieving the intended efficiencies requires that we mobilize technical and human resources to coordinate a working platform that supports physicians in providing the best care possible.