When you go to the internet or phone book today, there are hundreds of physicians listed in most urban areas. In the next two decades, you can expect more difficulty finding a physician in your hometown — a major physician shortage is looming.
In the last year, I have noted many mid-career physicians are leaving the practice of medicine. While the growth of mid-level hospital administrators has ballooned at nearly 3,000 percent, fewer students are entering medical school. In fact, according to Compdata Surveys, hospital administrators now account for a large proportion of the costs of health care.
The impending physician shortage will affect both primary care as well as numerous essential subspecialties. When I was in medical school, I was told that specialists — such as cardiologists — would be in abundance and I would not be able to get a job. I have been a practicing cardiologist for almost 17 years now. Based on the current report, it is expected that we will see a shortfall of nearly 100K doctors by the year 2030. A closer look at the predictions show that we will have a shortage of 40K physicians in the critical area of primary care as well as a shortage of nearly 60K physicians in specialties such as allergy and immunology, cardiology, gastroenterology, and infectious disease. In general surgery, the report predicts that there will be 30K fewer surgeons than are needed to provide care to those who need it.
Why are doctors leaving medicine?
A 2016 report by the Physicians Foundation found an alarming growth in burnout and dissatisfaction among practicing physicians — 47 percent of respondents in the survey indicated plans to “accelerate” their retirement and move into areas outside of clinical medicine. The most common reason for leaving medicine included regulatory burdens and electronic health records. Nearly 63 percent indicated that they have negative feelings about the future of healthcare and only half of all physicians would recommend a career in medicine to their children. Many of my colleagues feel that they have no voice and have no way to impact healthcare policy — even in their own institution. As regulatory requirements and nonclinical tasks continue to mount, physicians are finding themselves spending less and less time with patients. According to 2016 research from the Annals of Internal Medicine, most doctors only spend 25 percent of their day engaging with patients — the bulk of the time is spent on nonclinical electronic and regulatory paperwork. In fact, for every hour of direct patient contact, physicians have and additional two hours of electronic paperwork.
What is the solution?
These statistics should be incredibly troubling for all Americans seeking health care. With access already an issue in the U.S. health care system for many and more reforms on the way, we must do more to entice bright young minds to medicine — and retain those that are currently delivering care to millions of patients.
While the AAMC (Association of American Medical Colleges) argues that the answer to averting a shortage lies in creating more training spots and allowing advanced practice nurses and physician assistants to do the work of trained physicians — I would argue that the real answer to the pending physician shortage crisis — unfortunately lies in Washington, D.C. Congress must act to save health care.
1. Limit meaningless electronic paperwork. Currently, doctors spend far too much time with electronic medical records (EMR). The EMR, while touted to be a patient safety tool is nothing more than a way for hospitals and health care systems to ensure that they are billing patients at the highest levels — capturing all possible charges. Physicians are forced to click through a myriad of pathways in the record to document their care and work, and all of these pathways are carefully designed to maximize billing codes. Most doctors take home two or more hours of electronic documentation nightly to keep up with patient care loads. We must streamline paperwork and balance documentation with patient care. Doctors should not be billers and coders for the health care system.
2. Remove hospital administrators from the care equation. In some institutions, there are more mid-level managers than physicians. These executives are not physicians and are not trained in the practice of medicine. Their primary focus is to increase market share for the healthcare system and to “manage” health care professionals by creating algorithms of care and regulations.
Administrators will claim that their activities will help with quality improvement and patient safety. However, most of these individuals are highly compensated, and I am not aware of any data that suggests that their activities have ever been shown to improve patient outcomes. For most physicians, administrators are a mechanism for increasing cost of care. Physicians should be part of the decision-making process in any healthcare system and should have a voice — currently, there are very few physicians in the C-suite.
3. Remove barriers to patient care. Nothing frustrates doctors more than not being able to provide care to patients. We must make health care more accessible and provide physicians with the resources they need to efficiently provide high-quality, affordable care. We must promote the use of telemedicine and digital tools to enhance the doctor-patient interaction. We must allow physicians and patients to build long term relationships and facilitate and promote engagement. No longer can we allow networks and insurers to dictate which doctor a patient can see — if you like your doctor, you can keep him/her.
4. No longer allow insurance companies to dictate care. As a practicing physician, I spend a great deal of time battling with insurance companies over appropriate care for my patients. I find myself spending hours each week on the phone with an insurance company bureaucrat arguing that a particular test or therapy is indicated (even though these are supported by clinical guidelines) rather than caring for patients. We must not allow insurers to dictate how highly trained physicians should care for their patients. Insurers must abide by the practice guidelines and indications for tests and procedures that have been approved by major national organizations such as the American College of Cardiology, for example.
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