Doctor Drain: A Risk and Quality Perspective on the Primary Physician Shortage

February 21, 2018 Heidi Chodorowicz

Healthcare is approaching a challenging crossroads. 

The gap between the number of healthcare providers and the projected needs of an aging population is only growing - leaving the healthcare industry to start preparing for what could be a major shift in the delivery and management of healthcare. 

What is the physician shortage? 

In it's simplest terms, the physician shortage is exactly what it sounds like: too few doctors meeting the demands of too many, increasingly complex patients.

Health workforce data obtained by the WHO Global Health Observatory from 165 countries suggests that the demand for healthcare will grow to 80 million workers by 20130, while the supply of healthcare workers is expected to reach 65 million in the same period. 

Some experts predict that this disproportionate growth will result in a worldwide net shortage of 15 million health workers over the next 12 years. The problem is further complicated by changing demographics; as Baby Boomers age, the population of individuals 65+ is expected to grow by 55 percent by 2030. (The demand for preventing and increasing chronic conditions associated with age, is expected to increase proportionately). 

Although this is primarily a supply and demand problem, there are some other contributing factors that have exacerbated the problem, including the distribution of skilled healthcare providers. 

When it comes to effectively managing population health, most healthcare professionals agree that having easy access to a family doctor is the best way to mitigate hospital admissions and spending and to improve patient outcomes. However, primary care data from US government statistics and the Canadian Institute for Health Information (CIHI), indicates that family doctors simply aren't distributed evenly throughout North America. 

A doctor can be a very long way away 

In an article shared by the Physician Retraining and Reentry Program, Dr. Richard Olds, CEO of the Caribbean medical school, St. George’s University, said: “The real problem is we don’t have enough doctors in the right places and in the right specialties.”

Indeed, data across North America indicates that doctors tend to cluster in large cities, making access to healthcare in rural areas and small communities particularly difficult. 

"There are many challenges to access. One of the challenges, certainly for the most remote communities, is that there is no local physician, and residents have to travel somewhere to receive care," Dr. Peter Hutten-Czapski, a family physician in northern Ontario, shared with Health Quality Ontario.

Health Quality Ontario found that people living in northern communities have a shorter life expectancy, are more likely to die preventable deaths and are less likely to see a care provider when they are sick, in part because the burden of simply getting to a doctor is much higher. 

Perceptions about "the best" career path 

Current payment models and the associated career preferences of young physicians are also having an impact. 

The fee-for-service model means that doctors are paid not according to their patient's outcomes, but for the amount and type of services they complete. Of course, top dollar services are delivered by specialists or in hospitals (a product of complexity and volume). 

Pay disparities encourage medical students to pursue specializations or roles in hospitals, while the overhead, risk, and costs of running a private practice dissuade young professionals from starting their own. The result? Specialty positions in the hospitals are the most desirable - and primary care is left by the wayside. 

How is the industry preparing for a potential shortage?

Healthcare has been anticipating the shortage for some time, and changes are already in the works. 

From a risk and quality perspective, we are likely to see a shift to community care models, changes in the healthcare and professional insurance industries and a focus on quality-based reimbursements. 

The emerging emphasis on community care will see healthcare organizations offer more services outside of their physician facilities to bring healthcare into the communities. One notable example, is the surge in homecare personal support workers. Delivery of care, patient privacy, patient safety and management of staff will need to be completely re-designed for the new model. 

Physicians are also opting out of running independent practices and are instead being incentivized to join umbrella coverage of large healthcare systems. It's an appealing option for physicians as it offers better premiums and job security. However, the influx of physicians into into umbrella coverage does come at a cost with potentially more risk to the organization.

A study that analyzed the National Practitioner Databank (NPDB), which is a federal database that tracks every case that US physicians have been named in. The study found that physicians who have been named in a case are more likely to be named in subsequent cases. Currently, 1 percent of physicians account for 32 percent of all paid claims. If a physician has been named in two paid claims, the risk for recurrence of a lawsuit doubles (with three paid claims it triples, and with six or paid claims, the risk increases 12-fold). 

This degree of risk is putting the pressure on healthcare organizations to be fully informed about their physicians' histories. 

How can we help?

In 6.7.2 we are introducing physician search in RL6:Claims to help quality and risk departments easily surface important information about their employed physicians, to help them anticipate future liabilities and facilitate immediate responses to re-credentialing requests. 

Increasingly, managing risks of future liabilities will require the ability to quickly surface physician case histories. RL6:Claims and RL6:PeerReview are just one of tools and strategies available to help administrators save up to six hours a day responding to physician re-credentialing requests. 

Perhaps one of the most critical realities associated with the physician shortage is the pressure on healthcare providers to work longer hours to meet the increasing workload. This, however, also increases the risk of burnout. Now more than every, physician wellness and satisfaction are key. You can learn how Lehigh Valley Health Network is leveraging RL6 to conduct mobile rounding for physician burnout

Peer reviews are an invaluable learning opportunity. Learn how Gundersen Health is closing the loop on peer review education items in our upcoming webinar. Register now!





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