https://www.ajmc.com/contributor/dr-gary-mangiofico/2018/01/physician-shortage-requires-multiprong-solution
Physician Shortage Requires Multi-Prong Solution


There is a crisis looming, and it will be detrimental to patients’ health. A 2017 study released by the Association of American Medical Colleges (AAMC) predicts that the United States will face a shortage of up to 100,000 primary and specialty care physicians by 2030. Our population growth, especially the elderly population, coupled with the impending retirement of older doctors, is to blame

Part of this shortage is driven by the aging baby boomer population. According to data from the US Census Bureau, by 2030, all of the baby boomers will have moved into the ranks of the older population. This means that the number of adults aged 65 and over will go from 13.7% of the population in 2012 to 20.3% in 2030. According to a whitepaper from Merritt Hawkins that cites CDC data, patients aged 65 or older visit physicians 3 times more often than those 30 or younger. As the incidence of chronic diseases rises due to a growing elderly population, the demand for specialists will also increase.
 
The Merritt Hawkins whitepaper also cites an aging physician workforce as a major driver of staffing shortages. “Currently, 43% of physicians in the US are 55 years or older, which means along with the age wave, a retirement wave is looming. In addition, certain specialties have a higher percentage of physicians over the age of 55. Pulmonology has the highest number of physicians over 55-years-old (73%), followed by psychiatry (60%), non-invasive cardiology (54%) and orthopedic surgery (52%).”
 
The good news is that medical schools are on pace to increase enrollment by 30%. However, the 1997 cap on Medicare support for graduate medical education (GME) has stymied the necessary increases in residency training. Since it takes up to 10 years to train a doctor, projected shortages in 2030 need to be addressed now so that we will have enough physicians to treat our growing population.

Fixing the physician shortage requires a multi-pronged approach which includes: increasing funding for residency programs, increasing the use of physician extenders to maximize a physician’s reach, and embracing new and innovative technologies to increase medical coverage, especially in rural and underserved areas.

The AAMC and the American Medical Association support bipartisan legislation entitled, “Resident Physician Shortage Reduction Act of 2017,” which takes an important step toward alleviating the physician shortage by gradually providing 15,000 Medicare-supported GME residency positions over a 5-year period. This funding is critical to increase the number of residents and ensure that there is a steady influx of younger physicians entering our medical system. 

Another way to address the physician shortage is to increase the use of physician extenders. Physician’s assistants are an important part of this process, as are specialists such as anesthesiology assistants. Karen Sibert, MD, president of the California Society of Anesthesiologists and a professor at UCLA, was recently quoted in a Physician’s Practice article and said, “Certified anesthesiologist assistants (CAAs) are exactly analogous to what PAs are for a primary doctor or surgeon. They are trained in a medical, not nursing, model, and work directly under the supervision of physician anesthesiologists.” She goes on to say, “CAAs provide an opportunity for the physician anesthesiologist to focus on emergencies and saving lives, and not some of the lower level tasks such as initial screening and paperwork."

Increasing the use of telehealth can also help hospitals and health systems utilize the current supply of physicians more efficiently. Telemedicine can help physicians make use of unused time by treating more patients, connecting specialists to rural hospitals, and enabling patients to access a wider pool of physicians. Some uses of telemedicine are becoming more common, such as conducting pre-surgical interviews over the phone instead of in person.

One interesting innovation was a telehealth cabin that was developed by a French doctor and named the Consult Station. It is a standalone telemedicine booth that offers professional medical instruments, screens, and a video system for communication with qualified doctors. Guided by the doctor, a patient can use the equipment to self-administer a wide range of health checks, including: measurement of vital signs such as blood pressure, pulse rate, blood oxygen level, height, weight, and temperature; using an electrocardiogram, listening to the heart and lungs with a stethoscope, and testing the skin with a dermatoscope. These innovations can help patients in rural areas who may not have easy access to a seeing a physician in person.

There is not one silver bullet to solve the pervasive physician shortage problem. In order to tackle this enormous issue, there needs to be adequate funding from both the public and private sectors, as well as an increased willingness to adopt innovative models that support current primary care doctors and specialists, and attract the next generation of physicians who will care for us. 

About the Author

Gary Mangiofico, PhD, is an executive professor of organizational theory and management and academic director at the Pepperdine Graziadio Business School. Dr. Mangiofico has taught at the Pepperdine Graziadio School since 2002, and brings more than 20 years of experience leading strategic develoment, operations management and integration, and turnaround operations as CEO, COO, and a general management executive for both start-ups and Fortune 500 companies. He is a former vice president for Johnson & Johnson Health Care Services; COO and senior vice president (SVP) for Pathmakers, SVP for Apria Healthcare Group, and CEO for CPC Alhambra Hospital. Dr. Mangiofico was recently elected chair of the board of trustees of the Organizational Development Network, and is on the committee helping to plan the upcoming Pepperdine Graziadio Future of Healthcare Symposium on March 22. 



 
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