According to the Association of American Medical Colleges (AAMC), America may be short up to 90,000 physicians by 2025. A lack of Primary Care Physicians could account for as much as 1/3 of that.
Some of the factors contributing to the shortage, like population growth and an aging population, are outside of our control:
- Approximately 33,000 additional physicians will be needed in the next 10 years due to population growth alone
- For the next twenty years, an average of 10,000 people each day will reach age 65
Other factors are very much in our control. Let’s start with the way we’re treating our current and future physicians. CNBC’s Jake Novak believes this treatment is the real culprit behind the doctor shortages. Novak points out several key items:
- It’s hard to get into medical school — only 50% of the applicants accepted
- It takes a long time to complete training — an average of 14 years
- It’s expensive! Median debt for graduating med students is $170K (plus the salary they could’ve collected instead of going to school for 14 yrs)
- There’s not enough residencies — Medicare funding basically dictates the number of slots and its baseline has been in place since 1997
- Malpractice insurance costs $250K/yr
- Requirements to maintain certification — some with little tangible benefit
Beyond that we see daily articles and studies pointing out additional distractions and drawbacks on the profession:
- A recent HealthAffairs study pointed out that we spend $40K/yr/physician and 785.2 hrs/physician (staff and physician time) tracking and reporting quality measures
- A Texas research team estimated that the providers in their study spent more than 1-hr/day acknowledging alerts from their EMR.
Looking specifically at the PCP shortage, we can add a few more items onto the list. Most pressing is that our current reimbursement model makes primary care a very unattractive option for medical students. Generally speaking, its still damn-near impossible for providers to build a profitable, sustainable business by doing things that improve health and reduce care. Since Primary Care Physicians are in the business of doing just that, it stands to reason that it’s difficult for them to survive in our current system.
To put a bow on this, let’s look no further than the “Net Promoter Score” for becoming a physician:
How Do We Fix It?
According to the AAMC study cited above, there is no single solution (there never is). They add the following disclaimer:
The physician shortage will persist under every likely scenario, including increased use of advanced practice nurses (APRNs); greater use of alternate settings such as retail clinics; delayed physician retirement; rapid changes in payment and delivery (e.g., ACOs, bundled payments); and other modeled scenarios.
Addressing the shortage will require a multi-pronged approach, including innovation in delivery; greater use of technology; improved, efficient use of all health professionals on the care team; and an increase in federal support for residency training. The study’s results confirm that no single solution will be sufficient on its own to resolve physician shortages.
Because physician training can take up to a decade, a physician shortage in 2025 is a problem that needs to be addressed in 2015.
Wednesday, April 6th 2016
Q1: What are the key factors contributing to the predicted physician shortfall (up to 90K by 2025)?
Q2: What are the biggest contributors to physician dissatisfaction/burnout and what can we do about them?
Q3: What process or technology solutions can be employed to reduce the number of physicians needed to meet demand (or reduce demand)?
The #hcbiz Show! Episode 8