Think You Are Overworked Now? Just Wait…

Anybody doing less work than they did a year ago? Two Years ago?

I frequently ask this question in my classes and no one, not one person that works in an active clinical practice could actually say yes.  America faces an increasing shortage of physicians. The multiple reasons for this shortage could fill several pages. The Annals of Family Medicines projects the shortage of primary care physicians at 52,000 by 2025. In Texas, there are 35 counties out of the 254 that have no physician at all and 80 more with 5 or fewer.

That should be enough to scare us without even addressing the retirement/age statistics. Thirty percent of Emergency Physicians are nearing retirement. Statistics tell us that 21% of the U.S. population lives in a rural area but only 12% of ED physicians choose to practice there. Add this to the burnout rate for ED docs and the workload gets larger.  Various factors cause physician burnout such as too much bureaucratic red tape and too many hours at work. Burnout rates as described by a 2015 Medscape survey were the highest among critical care (53 percent) and emergency medicine (52 percent)  Many other specialists also reported burnout issues.

Compounding the issues is at the same time the number of aging people 80 and older will increase, doubling in the same time period. For the first time in history, the people aged 65 and older will exceed the number of people under the age of 18.  It is a known fact that this population uses the medical system at two to three times more than the population under 65. Add the increasing technology providing more information and procedures and the work load continues to increase.

Medical schools have done their part to increase enrollment and new medical schools have been launched, but the cap on Medicare support for graduate medical education has stymied the necessary increases in residency positions. In 2014 more than 9,500 eligible physicians eligible to begin residency did not get a match and the estimate of those not bothering to apply was equal in number.

One idea that has gained traction is to change the requirements for foreign trained physicians to obtain a license to practice as a graduate assistant physician filling a gap between the nurse practitioner or physician assistant and the physician. Today about one in four physicians practicing in the United States was trained abroad including American citizens. Under a new Missouri Law, an assistant physician must initially pass at least the first two sections of the national licensing exam for medical practitioners.  Missouri will allow these graduate assistant physicians (GAPS) to work with a physician for 30 days and prescribe medications. They may then treat patients on their own if they practice within a 50 mile radius of their supervisor.  Missouri, Kansas, Arkansas, and Utah already offer provisional medical licenses to qualified medical school graduates that were not able to attain residency positions to work under the structured supervision of a collaborating physician. The average training time for physicians is 5 to 10 years. The time to fix the situation is now in order to have the physicians needed to match the increasing patient load.

A new report from the Association of American Medical Colleges (AAMC) includes an analysis of the needs and health care utilization of underserved populations, one of the primary visitors in our emergency departments. The data shows that if the barriers to utilization were removed for these patients, and if this population accessed health care at the same level as the insured, the shortage would be real today. The need would be much higher in our cities and metropolitan areas.  This highlights the need for a diverse health care workforce. Many of those who underutilize health care despite their needs are from racial and ethnic minority backgrounds.

Our physician workforce does not match our racial or ethnic minority populations. As demonstrated in the following graphics disparity fluctuates according to geographic region.

The answers require a multipronged approach including expanding residency positions including federal support, better use of technology, increasing class size or number of classes, and some innovation in health care delivery.

Change is a constant in the healthcare industry and our ability to adapt to the change in physician population will certainly be the mark of our ability to work through the challenges we will face.  In order to evenly distribute the work load we need to quickly and efficiently address the physician shortage and we need to do so now not in 5 or 10 years.


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