Unless We Act Now, The Wait To See Your Doctor Is About To Get a Whole Lot Worse.
By Gregg Nicandri, Chief Medical Information Officer, University of Rochester Medical Center
As Chief Medical Information Officer for UR Medicine, a mid-sized, 8 hospital system in the Finger Lakes region of New York State, my role is twofold: I help to ensure that we are purchasing technology that supports our mission, and I lead a team that drives the effective adoption of that technology by aligning configuration with clinical workflows. Before and during the COVID-19 pandemic, we have been primarily focused on updating our technologies and processes to support digital and mobile workflows, telehealth, and population health data and analytics. Those remain important; however, workforce shortages – already present in healthcare, but exacerbated by the pandemic, are now, in my opinion, the biggest challenge to our ability to provide high-quality, equitable care, to our community. I’d like to take this opportunity to focus on the physician workforce shortage and how health systems may partner with technology innovators to tackle this issue.
Even if we are successful in our efforts to keep physicians in practice from retiring or moving on, we will still face a shortage.
A Diminishing Provider Workforce
Prior to the pandemic, the Association of American Medical Colleges was projecting a physician shortage of up to 124,000 physicians by 20341. Recent evidence has pointed to the acceleration of this shortage. The Medical Group Management Association and physician recruitment firm Jackson Physician Search reported in an August 2022 survey that 51% of doctors are considering leaving for a different job in healthcare and that 41% are considering leaving the practice of medicine all together2. This mirrors my own personal experience where seemingly every provider I know is asking me how they can get a job in health tech or some other health-related space that does not involve direct patient care. Burnout is real, and it is a massive issue. Unfortunately, this is not likely a short-term, COVID-19 related problem. We are feeling the impacts of a physician shortage now and it is likely to get worse. Access for patients is challenged, and delays in care mean that we are missing opportunities to intervene at the point when optimal outcomes can be delivered. Over time, this will result in a higher disease burden, increased healthcare costs, and an even more stressful work environment for physicians. Like any crisis, this presents a significant opportunity for the re-design of a system that needs disruption. Health systems and technology innovators must work together now on efforts to increase physician supply and decrease physician demand that bring joy back to the practice of medicine and benefit all patients.
Increasing Physician Supply
Increasing the physician supply will require training and retaining more physicians. In the near term, the focus needs to be on retention. It currently takes more than 10 years to train a physician fully and though we are admitting more applicants to medical school, this will not address immediate and mid-term needs. We need to retain and extend our existing workforce. In the past, it was not uncommon to see doctors in their 70’s continuing to provide care while mentoring the next generation. This is becoming an anomaly. 35% of physicians are within 5 years of retirement age1, 36% indicate that they are considering early retirement, and 65% report they are experiencing burnout2. To me, this is a clear indicator that the practice of medicine is not as desirable and fulfilling as it once was. People who would have stuck around and filled needed gaps are now just leaving medicine. Technology innovation should focus on addressing the needs of this group. Motivations to stay in practice are varied, for some, it is the patients or their community, for others, it is the ability to innovate or do research, for others, it is to train the next generation, and for a few, it is the paycheck. Technology innovation needs to yield more time for these physicians to be flexible to do what they are passionate about. This means working with them to understand their needs, facilitating remote work, automating necessary but tedious processes, and for many, removing the computer and mouse from the exam room. Additionally, health systems need to reward these physicians for their years of experience and recognize the value they can still bring. They can do this by enabling more flexible schedules, thinking differently about what that work might look like, and removing technology barriers.
Decreasing Physician Demand
Even if we are successful in our efforts to keep physicians in practice from retiring or moving on, we will still face a shortage. We must also work to decrease the demand on our physician workforce by doing a better job with team-based care and ensuring all are working at the top of their license. We will need to automate or delete repetitive and non-cognitive processes, and we need to facilitate improved communication. This is key to ensuring important information is not missed when multiple individuals are involved in providing care to the patient. For technology innovators, this means it is a must to integrate with the electronic health record. Additionally, it is likely that it will become necessary to enable individuals with less training and expertise to perform higher levels of care and decision-making. It is imperative that our clinical decision support systems significantly improve in order for this to be successful. Augmented Intelligence platforms and algorithms must become trusted healthcare team partners. The reasoning behind their recommendations must be transparent, and allow for interaction (true partnership). It must provide value to the patient and the provider at the point of care in a way that influences behavior.
Technology has reached the point where these changes are possible, and despite a relatively bleak picture right now, I am very excited about the future of medicine. I look forward to continuing to work with my health system and our strategic technology partners on these initiatives. I have no doubt that our collective work will positively impact the lives of many.