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Fact or Myth: Real Physician Shortage or a Broken System in the United States

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Charles Chen

on 22 April 2014

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Transcript of Fact or Myth: Real Physician Shortage or a Broken System in the United States

Fact or Myth: Real Physician Shortage or a Broken System in the United States
Background
Projected U.S. population at roughly 350 million individuals by 2025
A significant number of physicians, roughly one third are over the age of 55.
Basically:
Aging population and workforce
Increasing population
Aging physicians
Influx of newly insured
Maldistribution of physicians

Current Policies
18 new medical schools are being developed in the United States
According to AAMC, United States should increase medical school enrollment by 30%
Lift the Graduate Medical Education (GME) cap to accommodate the increased supply of future physicians
The federal government instituted a national incentive program to promote healthcare professionals to work in underserved areas in 1972
Mid-level providers have a limited scope of practice
Fee-for-service system leads to under-utilization of primary care physicians.
Medical Providers
Conclusion:
Future Recommendations

Make pay equitable between primary care physicians and subspecialists.
Remove Graduate Medical Education (GME) gap and increase residency spots to accomodate for future supply of physicians.
Change the model of health care system
Set-up a single buyer system, instead of FFS.
Increase scope of practice of mid-level providers
Objectives
Background and statistics
Current Policies
Implications of the Physician Shortage
Interview with Stakeholders
Recommendations in the Current Health System
Conclusion/Future Recommendations

Before we get started...
Statistics
More Statistics
Charles Chen
Adel Elkbuli
Martin Gutman
Andres Von Wachter
U.S. Health System Final Presentation

What about NPs?
More figures
State practice and licensure law restricts the ability of a nurse practitioner to engage in at least one element of NP practice. State requires supervision, delegation, or team management by an outside health discipline in order for the NP to provide patient care.
Implications of the Primary Care Physician Shortage
1. Decreased access to care
2. Sub-optimal delivery of care
3. Quality of care
4. Resource usage
Interview with Stakeholders
Health Care Executives
Patients
a) Primary Care Provider
Dr. Joan St. Onge
Dr. Olveen Carrasquillo

b) Mid-level Provider
Dr. Kimberly Elser

Dr. Pedro Jose Greer Jr.
Dr. Eleni Sfakianaki
Three patients were interviewed; names were kept confidential.
1. Decreased Access to Care
2. Sub-optimal Delivery of Care
3. Quality of Care
4. Resource Usage
Medical Providers
Perspectives of Primary Care Physicians
Yes! There is a primary care physician workforce shortage.
Shortage may be as high as 20,000 physicians in advent of the ACA.
Both interviewees answered that the academic medical centers may be to blame.
"Less than 5% of all doctors at the University of Miami are primary care doctors." - Dr. Carrasquillo
Perspectives of the Mid-Level Provider
Dr. Kimberly Elser DNP, ARNP, FNP-BC, CNM
Standpoint
Dr. Joan St. Onge M.D.,
Associate Dean for Graduate Medical Education at UM
Proposed Solutions
Health Professional Shortage Areas (HPSAs)
Improve infrastructure
Utilize tele-medicine
Loan-forgiveness programs
Increase scope of practice of NPs AND allow independent practice.
Recommendations for the Current Health Care System
It is really not that simple!
Shortage depends on what
thing
you are trying to resolve.
Health care vs. health
What about prevention?!
Change model of education

Dr. Olveen Carrasquillo M.D., MPH,
Associate Professor of Medicine,
Chief of the Division of General Internal Medicine at UM
Dr. St. Onge - Increase the number of residency spots, rather than the number of medical graduates.
Dr. Carrasquillo - Redistribute where primary care doctors are located (i.e. underserved rural AND urban areas)
Perspectives of Health Care Executives
Perspectives of the Patients
Even though people may have insurance, they may not have access to care due to the shortage of primary care physicians.
Residency Positions
Yes! There is a primary care physician workforce shortage.
Although there is a common consensus on the issue, the explanation differs.
Physicians are having fewer patients due to the reimbursement system and ACA.
In Florida, many nurses are physicians in their home countries.
Standpoint
Solutions
Allow nurses to practice independently because "by doing so, this will reduce the patient load on physicians and allow them to focus on more severe cases thereby reducing the demand for physicians." - Dr. Elser
Solution
Nurse Carla
Doctor Turk
Dr. Eleni Sfakianaki M.D., MSPH,
Former Medical Executive Director of MDC Health Department
Dr. Pedro Greer Jr. M.D.,
Founder of Camillus Health Concern
Founder of San Juan Bosco Clinic
Yes! There is a primary care physician workforce shortage.
Dr. Sfakianaki agrees that ARNPs should be able to practice independently, but only after testing for higher credentials and clinical training. However, a physician should still be readily available!
Dr. Greer states that in the current health care system, there will always be a shortage no matter what measures are taken.
Standpoint
Dr. Sfakianaki states that new medical schools need to be created with a focus on primary care, in which the medical school dean and associates encourages their medical students to go to primary care specialties in the future (i.e. FIU)
Dr. Greer states that the "vending machine" needs to be taken out.
More training in med schools for outpatient; little to none for inpatient.
Get rid of graduate residency specialty slots.
Solution
Patient 2
Patient 3
Stated he had to wait 2 months to see primary care physician because his diabetes was uncontrolled.
Says he cannot afford to go to the ER.
Standpoint: "I don't know if there is a shortage, but my insurance sucks."
Solution: "I need better insurance."
Patient 1
Stated he would rather just see a nurse since that's who he see's all the time.
He doesn't know why he always has to wait for a physician, unless it's an emergency.
Standpoint: "There might be a shortage, but I see plenty of nurses available."
Solution: "Just let me see a nurse."
Stated he had good insurance and never had a problem with getting immediate care.
Standpoint/Solution: "Everything seems fine to me."
Acknowledgments
Special thanks to all the participants of the interview:
Dr. St. Onge
Dr. Carrasquillo
Dr. Elser
Dr. Sfakianaki
Dr. Greer
Patients
Dr. King
References
Frisch, Suzy. (2013). The primary care physician shortage. BMJ: British Medical Journal, 347.
Dill, Michael J, & Salsberg, Edward S. (2008). The complexities of physician supply and demand: projections through 2025: Association of American Medical Colleges.
AAMC. (2010). Physician Shortages to Worsen Without Increases in Residency Training. Retrieved February 20,, 2014, from https://http://www.aamc.org/download/150584/data/physician_shortages_factsheet.pdf
Jolly, Paul, Erikson, Clese, & Garrison, Gwen. (2013). US graduate medical education and physician specialty choice. Academic Medicine, 88(4), 468-474.
Chen, Peggy Guey-Chi, Mehrotra, Ateev, & Auerbach, David I. (2014). Do We Really Need More Physicians? Responses to Predicted Primary Care Physician Shortages. Medical care, 52(2), 95-96.
Goodman, David C, & Fisher, Elliott S. (2008). Physician workforce crisis? Wrong diagnosis, wrong prescription. New England Journal of Medicine, 358(16), 1658-1661.
http://www.nationalfamilyplanning.org/document.doc?id=382
http://www.amnhealthcare.com/industry-research/2147484673/1033/
http://www.ahrq.gov/research/findings/nhqrdr/nhqr12/index.html
http://ppn.sagepub.com.medlib.med.miami.edu/content/13/2/81.full.pdf
Even more stats!
Number of Medical School Graduates
Full transcript