"If there is a workforce that wants to be on call once or twice a month," he says, "hospitals will not have enough doctors to cover obstetrics and we will need participation between obstetricians and nurse midwives."
He says powerful people, and hospital and health system senior executives count among that number, have to force a national dialogue about how to address the problem, because the lack of coordination between accrediting bodies and funders of physician graduate medical education means they can't seem to find common ground.
"None of these agencies talks to each other. It's like if the Orlando Magic players all practiced in different gyms and then showed up to play together for games," he says. "We haven't solved the shortage because we haven't wanted to."
Hospital and health system leaders have the power to change that dynamic. But, Klasko says, they need to decide whether they really want to solve the physician shortage or whether they want it to continue to be used as an agenda item for self-interested medical societies to lobby for more funding. He says
physicians have to get over themselves, in a way, in recognizing that ceding some responsibilities to allied medical providers doesn't have to mean a shrinking reimbursement pie for physicians.
"The knee-jerk reaction from medical societies is that this is bad, but they're thinking about it in their old guild mentality," Klasko says.
Instead, they should be having a clinical discussion about what's appropriate for physicians to do, and what others can do safely and effectively.
"Some of the medical societies are trying to block this," he says. "I've asked them, ‘What's your primary care strategy?' I'm often met with silence."
He says many hospitals that have never had a residency program could benefit by adding one, but that they face many issues in starting one, including the fact that their own physicians might not want to teach young doctors who will stay in the area to compete against them in the future. While having a residency program might differentiate a hospital, ensure a supply of future doctors, and improve its quality and safety record, establishing one is difficult, expensive, and potentially career-threatening.
"Part of the transition we're in requires that we all recognize there's a crisis and we have to transform," he says. "If you don't use residency to create a teamwork environment, don't be surprised when they get out and they don't act as a team."
This article appears in the October 2012 issue of HealthLeaders magazine.