Clinician Shortages: CMIOs and CNIOs Up on the Balance Beam

The June 2 press release issued by leaders at the Charlotte-based Premier healthcare alliance focused, not surprisingly, particularly strongly on levels of satisfaction and dissatisfaction with electronic health record (EHR) investments among hospital, medical group, and integrated health system leaders across the U.S. Indeed, the press release’s headline was “Providers increasingly dissatisfied with EHRs despite heavy investments, according to Premier, Inc. c-suite survey.” And we covered that press release and wrote about its implications.

But among the diverse findings in the Premier provider survey were also some concerning results regarding shortages of physicians and nurses. As the June 2 press release noted, “The survey also shows that three of four providers are experiencing physician or nurse shortages, with 42 percent experiencing shortages in more than one practice area. Among those experiencing shortages: almost four of five executives cited primary care physician shortages; 47 percent of respondents cited specialty physician shortages; 28 percent of respondents [cited] nurse shortages.”

Nurse shortages are nothing new, and indeed, previous nationwide surveys on that subject have found even more sever nurse shortages in past years. But the combination of ongoing nurse shortages and intensifying physician shortages, really is a combined trend that everyone needs to reflect on.

A number of factors are only going to intensify these clinician shortages, including, but not limited to:

• The aging of the nurse population in the U.S.
• The increasing clinical intensity of hospital care delivery, as health insurers push patients out of inpatient status as quickly as possible, leaving those patients who remain inpatients, more fragile than ever before
• The beginnings of an influx of newly insured patients, thanks to the passage of the Affordable Care Act, and including Medicaid program expansions in a number of states
• Emerging trends among practicing physicians, particularly among younger physicians choosing lifestyle considerations over maximizing billable patient care time
• The need for more clinicians to support population health management and care management work within accountable care organizations, patient-centered medical homes, and other care delivery and financing vehicles
• The trend involving both physicians and nurses leaving direct patient care to work in management, consulting, informatics, and other emerging areas

What’s more, it’s not just provider executives who are anticipating clinician shortages. As the American Association of Colleges of Nursing (AACN) noted earlier this year, “According to the Bureau of Labor Statistics’ Employment Projections 2012-2022 released in December 2013, Registered Nursing (RN) is listed among the top occupations in terms of job growth through 2022. The RN workforce is expected to grow from 2.71 million in 2012 to 3.24 million in 2022, an increase of 526,800 or 19%. The Bureau also projects the need for 525,000 replacements nurses in the workforce bringing the total number of job openings for nurses due to growth and replacements to 1.05 million by 2022.  Futher, the AACN noted, “According to the ‘United States Registered Nurse Workforce Report Card and Shortage Forecast’ published in the January 2012 issue of the American Journal of Medical Quality, a shortage of  registered nurses is projected to spread across the country between 2009 and 2030.”

—a number that is expected to grow to more than 130,600 by 2025. This shortage is equally distributed among primary care and medical specialties such as general surgery, cardiology, and oncology. To address this shortage,” the AAMC noted, “America’s medical schools are increasing their enrollments. However, in order to complete their training and begin seeing patients, new physicians must complete a residency training program, which are in shorter supply.” Yet at the same time, the association underscored, “The number of federally funded residency training positions was capped by Congress in 1997 by the Balanced Budget Act. The 26,000 residency positions available for first year trainees will not be enough to provide training for the students graduating from medical school as early as 2016. In addition, Medicare support of graduate medical education (GME) includes paying its share of the costs of training, as well as supporting the higher costs of critical care services, such as emergency rooms and burn units, on which communities rely. Without adequate support, the ability of teaching hospitals to provide essential patient care is threatened.”

Indeed, the AAMC reports on that same webpage that 250,000 U.S. physicians are likely to retire by 2020, creating a shortage of 90,000 doctors nationwide by that same year (just six years from now). Not only does the AAMC foresee a shortage of 45,000 primary care physicians by that year; it predicts a shortage of 46,000 surgeons and specialists as well by that year.

What’s more, all of this is playing out in an environment of increasingly straitened resources, with Medicare and other reimbursement cuts, value-based purchasing, and other payment and operational changes making simple abundance-driven hiring less likely than in the past.

Given all these developments, healthcare cognoscenti agree that clinical IT is going to have to make working physicians and nurses more effective and efficient than ever before. As we’ve reported in the pages of this magazine and online, that means, among other things, that physician documentation reform efforts are going to have to accelerate.

Most of all, CMIOS and CNIOs and their fellow medical informaticists and nurse informaticists are going to be pushed into the limelight as never before, as the need for hyper-efficient, hyper-effective clinical computing will become essential to the survival and good functioning of virtually all patient care organizations. In other words, as always, the opportunity to shine will come with intensified pressure. But isn’t that the balance beam that clinical informaticists are already getting used to?