What Physician Shortage?

HealthLeaders Media Staff, May 28, 2009

This argument may not go over well, but let me play devil's advocate for a moment.

What if there is no physician shortage? Or to be more specific, what if there is a hypothetical shortage, but we're considering all the wrong solutions? If experts are predicting a shortfall of doctors under the current workforce model, maybe it's the model, and not the number of doctors, that needs to be fixed.

This is an old debate that in many minds was settled when studies started projecting six-figure shortfalls in the number of doctors needed in the next couple of decades. But the counter-argument has been popping up again recently, most notably in an opinion piece on CNN by the authors of The Innovator's Prescription: A Disruptive Solution for Health Care.

The analysis goes like this: While there is a healthcare services shortage, that doesn't necessarily translate into a doctor shortage. There are a number of ways to meet that demand for services, and the mistake reformers of any industry often make is to look for answers from existing models and stakeholders, says Jason Hwang, MD, MBA, co-founder and executive director of healthcare at Innosight Institute and co-author of the article.

"The alternative is to ask what doctors are doing today that we could shift to other workers who may be more affordable, but could have very specific technical expertise in treating certain select conditions, and do it very well," says Hwang. "Sort of like outsourcing."

What Hwang is essentially talking about is shifting some of physicians' workloads onto nonphysician practitioners, such as nurses, physician assistants, and technicians, and shifting certain types of care to retail clinics and other settings outside of physician offices.

This is where the alarm bells usually start going off for physicians. Many will argue that there is no substitute for a physician with nearly a decade of advanced medical training.

Yes, it is ridiculous to assume that a technician can replace a physician's expertise. But isn't it also a little ridiculous to assume that nothing a physician currently does can be handled pretty well by someone else?

Healthcare services are already being provided outside of doctors' offices more frequently, according to recent reports. It's not just happening in retail clinics—over-the-counter at-home tests and medical devices now let patients diagnose, monitor, and treat conditions that were formerly the physician's domain.

To be clear, I'm not advocating replacing physicians or supporting the notion that physician shortages don't exist. But I recognize that if the shortage projections are accurate, increasing medical school enrollment and funneling more money into physician development aren't alone enough to meet the growing demand for medical services. So if we accept that there will not be enough physicians, we have to consider how to care for an aging population in that environment.

The key in all this is to enhance, not replace, physician services. If physicians view nonphysicians and retail care as threats, then care will continue to be disjointed and the strain on the system will grow. But if physicians recognize the opportunity for collaboration, they can work with new nonphysician providers to coordinate care and focus even more on the high-level services they're best at.

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