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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Gone are the days when physicians would gather in the staff lounge and discuss various healthcare issues. Now, as the Internet has moved in, they don't even have to be in the same room or building to converse.
Social networking is part of the Web 2.0 trend, which is a combination of technologies and content that have helped transform the Internet from an information cache to numerous communities that allow people to connect with others anywhere in the world.
Online social networking continues to grow in popularity among physicians, says Joel Brill, MD, chief medical officer of Predictive Health, LLC, in Phoenix and chair of the Practice Management & Economics Committee at the American Gastroenterological Association. Social networks can play a critical role in a physician's daily life, assisting in accomplishing various goals and offering numerous advantages, including:
Meeting doctors with common interests
Communicating socially
Consulting peers
Finding a business partner
Promoting yourself, your practice, or your brand
Exchanging medical knowledge
Exchanging free flow of ideas
Social networking sites also give physicians the chance to get information—such as research, study tips and guides, healthcare-related articles, and others' experiences in the field—quickly, says Michael Tomblyn, MD, a radiation oncologist at the University of Minnesota.
Web site target: Physicians
Social networking has blossomed within the past several years, a trend that began with sites such as Facebook and LinkedIn. Facebook "appears to be gaining traction with professionals," including those in the healthcare industry, says Brill, adding that LinkedIn is also growing.
"LinkedIn is an excellent professional networking site, especially if the physician is considering new professional networking, recruiting, and business opportunities," Brill says.
In addition, there are several sites created for and used almost solely by physicians and others in healthcare, including:
Sermo.com
DoctorsHangout.com
StudentDoctor.net
DoctorNetworking.com
Relaxdoc.com
Tiromed.com
SocialMD.com
ClinicalVillage.com
MedicSpeak.com
iMedExchange.com
Ozmosis.com
Tomblyn said Sermo is a top site to look at, as it allows users to offer feedback on experiences they've had in the field, lessons they've learned, and questions or concerns they may have about issues relating to healthcare, all of which can ultimately help medical students, residents, and others who are just beginning their medical careers. This can also be very helpful to those just joining the social networking world.
Sermo is one of the largest physician-focused Web sites, due in large part to its affiliation with the AMA, Brill says. Sermo touts having more than 100,000 users, and the site continues to grow.
With the myriad social networking Web sites focused on physicians, it's easy to get bogged down in information that may not necessarily be useful, Tomblyn says. He cites the many online networking communities, from postings and blogs to mentoring and advice. But persevere, Tomblyn says. "You can't get discouraged."
Brill suggests physicians take time to research networking Web sites to become more familiar with how they work before joining. Begin by searching any or all of these sites for healthcare and related topics that you're interested in. Many sites are tailored to physicians' specific interests, Tomblyn says.
Joining a site "doesn't mean that you will be barraged by unwanted e-mails," Brill notes. "You can participate as little or as much as you wish."
This article was adapted from one that originally appeared in the May 2009 issue of The Doctor's Office, a HealthLeaders Media publication.
UnitedHealth Group, one of the nation's largest insurers, said in a working paper released Wednesday that if many of its currently used cost-saving programs and methods were adapted by Medicare over the next decade, roughly $540 billion could be saved by the federal program.
The new UnitedHealth paper provides "building blocks" that Medicare could build on to save money and promote quality, according to UnitedHealth Executive Vice President Simon Stevens, who heads the company's new Center for Health Reform.
The paper lists 15 suggestions for lowering the growth of health costs. "We do think that this is going to produce better health results" and generate savings, Simon said at a Washington briefing. The paper has been forwarded to congressional and White House officials.
The report comes just two weeks after an agreement among several health industry groups, including America's Health Insurance Plans, American Medical Association and American Hospital Association, to find ways to reduce cost growth in the health sector by $2 trillion over 10 years. The move had been seen by some as a way to head off a push by Congressional Democrats to create public plans that would compete against private insurers.
These savings are not made through squeezing hospital reimbursements or physician pay, Stevens said. "This is about improving the appropriateness of care delivered across the healthcare system."
Among the cost-saving proposals cited by UnitedHealth are:
$165.5 billion by providing skilled nurse practitioners at nursing homes to manage illnesses, coordinate primary care, and prevent avoidable hospitalizations.
$55.1 billion for transitional case management programs that provides a bridge between hospital inpatient admission and discharge.
$24.8 billion for disease management programs using predictive modeling to identify high-risk patients.
$23.8 for a physician compensation program that rewards medical groups for providing high quality and cost-effective care for patients. (The program focuses on primary care physicians, but can include specialists.)
$57.3 million by prospectively reviewing claims before they are made.
Anticipating questions that some would see their measures as rationing, UnitedHealth officials said that much of the current healthcare system is fragmented and has knowledge gaps—and it could therefore benefit by reducing unnecessary care.
This is "really a far cry from the 'R' word that’s often bandied about, said Lewis Sandy, MD, UnitedHealth’s senior vice president for clinical advancement, in reference to rationing.
New York City has agreed to pay $2 million to the family of a woman who died on the floor of the psychiatric ward at Kings County Hospital Center in June 2008 after waiting more than 24 hours to be treated. The city's Health and Hospitals Corporation accepted full responsibility for the death of the woman, and said it had taken steps to relieve crowding and increase the size of the staff to provide mental health services at the hospital.
President Obama's plan to overhaul the nation's healthcare system avoid one of the characteristics that felled Clinton-era reforms by maintaining an active and independent role for private insurance companies, congressional budget analysts said. In a report, the Congressional Budget Office said a government mandate requiring people to buy health insurance would not necessarily be considered a new form of federal taxation so long as people had a variety of private plans from which to choose and a government entity was not in charge of collecting their insurance premiums.
Soaring healthcare costs, combined with the recession, are threatening to undermine the gains from Massachusetts' 2006 healthcare overhaul, according to the third annual "Update on Health Reform in Massachusetts." The survey of roughly 4,000 adults found that, after seeing initial gains in affordability, an increasing percentage of residents are now reporting problems paying medical bills. It also found that a rising number of residents, especially those with lower incomes, are reporting that they did not get needed care because of costs that are rising faster than inflation.
A top spine surgeon at the University of California, Los Angeles failed to disclose payments from medical companies while he was researching their products' use in patients, according to records obtained by congressional investigators. Jeffrey Wang, chief of spine surgery at UCLA, didn't inform the school of $459,500 he was paid by companies from 2004 through 2007, according to a May 21 letter from Sen. Charles Grassley to the school's chancellor. State university researchers in California are required to disclose any financial ties to nongovernmental entities funding their work. Failure to report a financial interest can result in civil liability, including fines, as well as university discipline.
The federal government could save $540 billion in healthcare costs over the next decade through an assortment of "real- world" recommendations proposed by Minnetonka, MN-based UnitedHealth Group Inc. The savings prescriptions from UnitedHealth's new Center for Health Reform and Modernization represent the company's first foray into the discussion of President Obama's proposed healthcare overhaul.
With budget deficits soaring and President Obama pushing a trillion-dollar-plus expansion of health coverage, some Washington policymakers are taking a fresh look at a national sales tax. Common around the world, including in Europe, such a tax has not been seriously considered in the United States. But advocates say few other options can generate the kind of money the nation will need to avert fiscal calamity.
Marking the latest wrinkle in the ongoing saga over a proposed New Orleans teaching hospital, a House panel approved a bill that could slow Louisiana's acquisition of land where the complex is to be constructed. But state authorities say they are within weeks of securing much of the necessary land, with no intentions of altering course as the bill moves through the Legislature.
