FutureDocs Workforce Model Factors in 'Plasticity'

Health policy researchers at the University of North Carolina are building an interactive computer model to attempt to empirically answer questions about patients-per-physician ratios by region and by specialty.

We've been reporting on this nation's physician shortage for years.

It's real and it's happening right now, as a quick chat with a physician recruiter or most hospital executives in most parts of the country will verify.

The shortage is expected to intensify in the coming years as more physicians retire, the general population grows and grays, and more people get health insurance under the Patient Protection and Affordable Care Act.

Still, there is something clunky about these projections. They may accurately reflect gross patients-per-physician ratios. That's easy to identify and track. These ratios don't, however, account for the more intuitive, subtle way that healthcare providers make their localized adjustments to provide access to care in their service areas.

If there is a shortage of cardiologists, for example, to what degree will primary care physicians alleviate that shortage by taking on the more routine monitoring of cardiac patients? Along those lines, how do we determine how many nurse practitioners or physician assistants will step in to alleviate a shortage of primary care physicians?

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I can't prove it, but from what I am hearing anecdotally, providers are already doing this informally on a patient-by-patient level in their service areas. When they see a need they find a way to meet it.

"We do it, but not officially," says Tim Putnam, CEO/President of Margaret Mary Health in Batesville, IN. "We look at what the specialist is doing that could be done by a family physician. Some specialists are seeing a lot of patients on maintenance that they really don't need to see."

Now health policy researchers are the University of North Carolina are building an interactive computer model to attempt to empirically answer those questions. Erin Fraher, team leader at UNC's Program on Health Workforce Research and Policy, says FutureDocs Forecasting Tool tries to factor in "plasticity."

"Past workforce models that have produced estimates of future shortages have said 'we are going to need X many primary care physicians or X many cardiologist or X many general surgeons.' That is not how healthcare is delivered on the front lines," Fraher says.

"We want to create a model that acknowledges that depending upon the community you are in and the models of care you have. For circulatory conditions you might use more internists and family physicians in a rural community and cardiologists in an urban community. Plasticity lets you think about who can deliver a set of services and allow different configurations in different communities for those services."

FutureDocs is granular to the level of Tertiary Service Areas so its usefulness might be limited for smaller hospitals that need greater local detail.

"If I were a health system or a hospital I would use this model to look at demand and what the workforce looks like, and using plasticity to see if I can use a less-expensive workforce. You can look at physician assistants and nurse practitioners in this model," she says.

"Look what happens when physicians retire and what if you increased physician (full-time equivalent) by 5%? Those seem like marginal changes, but in workforce models, two of the biggest drivers are FTEs and retirement. As a health system, just educating people about that could be a short-run way to solve a workforce shortage. The model allows you to educate yourself, your HR director, your local physician community, and your medical society or whomever you are collaborating with what the situation looks like under a set of scenarios and how it might change."

When plasticity is factored in, Fraher says, providers and hospital administrators might learn that the physician shortage, while real and immediate, is also manageable.

"Everyone is screaming 'physician shortage,' but most studies are written about national estimates," she says. "People love the big data numbers.'We are going to be short thousands of primary care physicians and thousands of specialists.'"

"FutureDocs has the ability to see that it may or may not be true depending upon the community you are in. In fact, overall, the model says the capacity of physicians to meet the demand for healthcare services is in balance and will continue to be in balance."

A bigger issue for local providers is not the national shortage of physicians, but the disparities in the numbers of physicians between different regions.

"Some places have severe shortages and other places actually look pretty good or even over capacity," Fraher says. "FutureDocs helps people see that your perception of this physician shortage depends upon where you are sitting geographically."

"Your demand for healthcare services for circulatory conditions are going to be much higher in Florida [where] you are going to have lower demand for OB/GYN. No brainer! This is a model that allows you to see those variations in utilization and surplus and shortage across communities."

"My hope," says Fraher, is that the model will provide a more nuanced picture that has been treated a bit more glibly at the national level."