Combating the impending physician shortage

The U.S. population is aging dramatically, and with age comes the propensity to develop diseases. Due to the Affordable Care Act, nearly 32 million additional people have health coverage for the first time ever. This combination alone is putting tremendous pressure on the supply-and-demand of healthcare in the U.S.

A recent report released by the Association of American Medical Colleges forecasted that the U.S., will face a physician shortage of somewhere between 61,700 and 94,700 doctors over the next decade.

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Janis Orlowski, MD, AAMC’s chief healthcare officer, characterizes the problem as “critical” and notes the first step to fixing the problem was recognizing there was a shortage in the first place.

“We know it can take 8 to 10 years to train new physicians, so if we don’t start addressing the issue now, it will be too late,” she says. “We have asked medical schools to increase their class size, and if you compare 2001 to now, there’s been an increase in medical students of 26% and that has been done by increasing the number of medical schools in the U.S., as well as the number of medical schools increasing their class size.”

For further efforts to alleviate the shortage, the AAMC has instituted a multi-pronged approach that includes urging Congress to increase federal support to add at least 3,000 new residency positions annually during the next five years; improving technology use; and seeking innovations in care delivery.

“There has been a federal cap on residency programs frozen for more than 20 years, and that needs to be lifted and there needs to be more federal support for the training of physicians,” Orlowski says.

Next: A tech solution

A Tech Solution

The AAMC also believes that technology is going to help physicians become more efficient and can help with the impending shortage. “For example, telehealth and personal devices will help us in making medical care more efficient and hopefully let physicians see more people,” Orlowski says.

Talbot “Mac” McCormick, MD, CEO of Eagle Hospital Physicians, Atlanta, Ga., says in his work providing permanent and locum tenens physicians to hospitals—particularly to rural hospitals where the impact of the shortage is quite acute—and in the broader perspective as licensed internal medicine practitioners, he sees the shortage clearly changing the industry.

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The type of telemedicine Eagle offers—two-way audiovisual communication between a doctor “beamed in” from another location and a patient—has not yet gained widespread use, but that is changing rapidly.

“Telemedicine in its broadest definition is already integrated into health care today—through remote access EMRs, remote radiology reading, and pharmacy e-mail communication with doctors’ offices,” he says. “Telemedicine offers broad benefits to any rural hospital struggling with physician staffing and facing frequent transfer of patients to distant tertiary referral hospitals to get the care they need.”

Next: A team approach

A Team Approach

The AAMC’s third approach to handling the problem concerns a team approach to care.

“As physicians work with nurse practitioners, physician assistants, dieticians and pharmacists, there is some component of the care that can be transferred from the physician to the others who are appropriately trained,” Orlowski says. “They are a large part of increasing access to care for underserved populations in both urban and rural areas.”

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Dawn Morton-Rias, Ed.D, PA-C, president and CEO of the National Commission on Certification of Physician Assistants, notes the PA profession grew by approximately 35%, and agrees with the AAMC that PAs can assist with the physician shortage.

“Certified PAs routinely have their own panel of patients in busy primary care practices, allowing overloaded physicians to spend more time on the most complex patients,” she says. “What makes certified PAs increasingly valuable are their strengths in patient assessment, management and education, care coordination and continuity of care—time-consuming services that pay off in terms of patient adherence to treatment, reduced visits to the emergency room and even decreased hospital readmissions.”

Benjamin Reynolds, director of the office of advanced practice providers at UPMC, a 20-plus hospital system with more than 3,500 employed physicians located in Pittsburgh, Pa., says a patient doesn’t necessarily need to see a physician for most problems, and that having a physician see routine, low-complexity issues isn’t a good use of their time. 

“Promoting interprofessional team-based care, where all healthcare professionals are used at their maximum scope of practice carries the greatest promise of improving access to high-quality health care,” he says.

For internal medicine and family practitioners specifically, there has been an increase in providers employing nurse practitioners and physician assistants more extensively as a way to pick up some of the slack left from the physician shortage.