The Physician Shortage: Are Digital Health Solutions Addressing the Issue?
Hearing about "the physician shortage" is starting to feel reminiscent of constantly hearing about "clinician burnout". Everyone knows it's been going on for a long time and everyone knows it's a big problem. Many of us assume it's affecting us in some way, but very few can tell you if anything is being done to fix it, or whose responsibility it is to address it. In this article I'd like to review what has been driving the physician shortage, what has been done (if anything) to address it and explore what types of digital health solutions can truly help solve this problem.
The Physician Shortage Problem
You've seen the numbers, but I'll share them again here. The Association of American Medical Colleges (AAMC) estimates a shortage of between 37,800 and 124,000 Physicians by 2034. Of that number, 17,800 to 48,000 would be in primary care. Combine this with the mass exodus of physicians leaving the industry and we have an even bigger recipe for disaster. According to Definitive Healthcare, between 2021 and 2022, 71,309 physicians left the workforce with Internal medicine and family medicine impacted the most. So obviously we have a big problem here. Before we can look at the solutions of today and ask whether they are addressing this issue, however, we need to understand what's driving it.
Why there is a shortage and why it's getting worse.
The driving factors leading to the physician shortage are complex and multifaceted. Though each factor can be looked at in depth, for the sake of this article we will summarize the main themes. There are several things that come into play.
1) Aging population leading to increased demand for care
2) Aging workforce leading to increased physician retirement
3) Burnout (we will define this better in just a moment)
4) Financial constraints due to high debt burden
Burnout: It's worth taking a moment to briefly (if that's possible) discuss burnout. This term has arguably become overused and has its own myriad of causes. As a physician myself, the best article I have ever read on burnout was written by Dr. Amanda Rosen. You can check it out here. Burnout is a term that's been used a lot, and it has many different causes. It's when doctors like me start feeling exhausted and frustrated because we can't do our job the way we want to. I became a doctor to take care of patients the best I can, but things like a bad work-life balance, too much paperwork, or not enough time with patients can lead to me feeling like I'm not doing my best for my patients, and that goes against my duty as a doctor. Over time, it might make me want to quit to avoid putting myself and my patients at risk.
So, we understand why there is a physician shortage. But what are we doing to fix it?
Adding More Physicians to the Pool
In 2020 Congress voted to add 1,000 new Medicare supported graduate medical education (GME) positions over 5 years. That's something, but doesn't seem like it would make a dent. In 2021, the Resident Physician Shortage Reduction Act of 2021 was introduced in Congress. This would have added 2,000 federally supported medical residency positions annually for 7 years. This act has not been passed but was reintroduced in 2023 - so, it doesn't look like we are making much headway in adding physicians anytime soon. Not only that, but it might not matter. In 2023, 2,603 US Residency positions were left unfilled by graduating medical students. It might be that there just aren't enough students wanting to become doctors.
Dealing with Burnout
Since I haven't seen any cloning or "fountain of youth" digital health companies hit the market yet, I'm going to assume we can't do anything about the aging population and aging workforce. So, the next logical step in addressing the shortage is to attack physician burnout. This has become the focus of many digital health companies:
- Physician enablement platforms are focused on decreasing administrative tasks so that doctors can get back to patient care.
- Digital health managed service organizations are working to help primary care physicians move to value based care so that they can optimize billing and reimbursement.
- AI platforms are helping reduce the time it takes to document patient encounters.
These are all commendable endeavors, and hopefully these solutions will decrease physician burnout and increase the physician's ability to focus on patient care. But do these solutions help address the physician shortage issue? We need to take a step back and ask ourselves WHY we need to address the shortage. Is it that we want to see more white coats at our corner Starbucks? Or is it that we want to make sure that patients can get the care that they need?
We can all agree that Starbucks is crowded enough as it is. So, if the goal of addressing the shortage is to increase access to care, is solving physician burnout going to do that?
The ideal average patient load for a primary care physician is 1,000 patients, but most PCPs carry around 2,500 patients on average. We've already established that physician burnout comes from not being able to care for patients in the best way possible.
Our technology solutions of today are helping remove administrative burdens, optimize care delivery, and decrease physician burnout so that they can focus on patient care. But focusing on patient care doesn't mean seeing more patients. In fact, it should lead to physicians being able to see less. Don't get me wrong. This is a critical aspect of healthcare that needs to be addressed, but we must realize that this isn't addressing the shortage.
So what are we to do? If the physician shortage is worsening, and our current solutions aren't effective in increasing patient care delivery, then it might be time to start looking outside the physician workforce.
It's time to ask for help.
The role of the physician is evolving. Providing medical oversight is beginning to be a major focus for physicians in the workforce and will continue to become an integral part of the job. It's time to start accessing other pools of providers to deliver care and here, it seems, we might be making some progress.
The biggest group of non-physician healthcare professionals driving forward increased care delivery is Nurse Practitioners (NPs). NPs have become an integral part of patient care delivery both in and out of the hospital and more states are allowing for full practice authority for NPs to deliver care without any physician oversight. However, advanced providers may not be the only ones who can help solve the patient care delivery problem. In fact, there may be an opportunity to rely more heavily on other providers such as RNs, Pharmacists, Paramedics, and medical assistants.
In an article published by Elation Health, it was quoted that 77% of physician time is spent on preventative care that could be delegated to other providers and even non-clinical teams. 47% of time was spent on chronic care management which is another opportunity where care delivery could be shifted to RNs, pharmacists, paramedics etc. While speaking on virtual care, this quote from Key Care's CEO, Dr. Lyle Berkowitz sums up nicely what all care delivery systems need to realize; "We don't have a shortage of physicians as much as we have a shortage of using them efficiently…how can a virtualist manage 10, 20, or 100 patients an hour, not by doing 100 video visits, but by using asynchronous care automation, delegation to other staff, et cetera?"
Conclusion
It's time to start thinking outside the box of the physician provider pool. There might not be much we can do in the short term to address the physician shortage. Many digital platforms today are bringing tremendous value to the problem of burnout but ultimately these solutions won't solve the need for increased access to care.
There is a huge opportunity for digital health solutions that can help us access new pools of providers to address this issue, however. Companies that focus on helping physicians delegate care efficiently and compliantly, empower non-physician providers to deliver care safe and effectively and who focus their platforms on delivering care through the hands of non-physician providers will be able to finally address the physician shortage issue by increasing access to care through the hands of these healthcare professionals.
Ultimately it may be these types of solutions that drive forward every other aspect of care.
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