How Can the Looming Physician Shortage Be Addressed?

What are your impressions of the key findings from the AAMC report?

The concept of staffing shortages is not news to us. It's been on the radar and has been coming for a long time. We see it day to day in terms of our ability to acquire talent, recruit talent, and retain talent. We see it across the entire healthcare spectrum.

Regarding nursing shortages, COVID-19 did no one any favors, particularly the healthcare workforce problem. It just exacerbated what was already a pretty acute problem and turned it into a raging fire.

The physician shortage, though, is not an easy problem to solve, and it's not a quick problem to solve. You have this supply-side constraint that is not something you can quickly fix. You can't just build more medical schools or bring in a lot more medical students quickly; that takes years. We've made some progress by adding new medical schools. But the challenge is that the need is growing probably faster than our supply.

What are your ideas on how this shortage can be addressed?

It's not completely hopeless. I think part of it is utilizing the resources we have to be as efficient as possible. Making the absolute most of the resources that we have is where technology becomes so important for us. Going forward, having other technologies, such as Artificial Intelligence (A.I.) and so forth, will make us more efficient.

It does make me a little nervous even bringing up the A.I. piece, but I think there are a lot of things that A.I. can bring to the table to make providers more efficient, whether it be charting, signing notes, or sending reply messages to patients. We just have to be careful with how we implement that technology and ensure that we're utilizing it in the best possible way.

How do you think A.I. can be part of addressing this shortage issue?

A.I. will not create more supply, but it will make the supply that we currently have more efficient. Instead of physicians spending two hours of the eight-hour day charting, they're going to spend 30 minutes of that time charting, reviewing charts that have been created or helped to create by A.I., which provides an additional hour and a half of patient care time.

I'm oversimplifying it, but that's one of the big tools. At the same time, you have to be careful with how you do that because you've got to make sure that the technology is mature and robust enough to handle the idiosyncrasies that come up in medicine.

What do you think health systems can do now to prepare?

There are tons of companies out there providing A.I. resources to aid physicians in their care. I think one of the things is being aware of what your opportunities are in that space and finding companies that will be around, have the right partnerships, and are well-funded. This isn't something to jump on the horse with somebody who has just gotten their first round of seed funding. Which is tough because sometimes that's where the innovation comes from. But if somebody has great ideas, they're going to find ways to get those to the marketplace.

In my current software life, on the QGenda side, I'm going to think of the things that we're doing, even using A.I. to make things as efficient as possible for providers, optimize their schedules, and simplify their credentialing stuff. Those things are along the same lines where we're trying to find ways to streamline all the tasks that providers have to do that are not taking care of patients and doing the things that you learn to do in medical school.

When we look at the shortage, it's expected to be geographically diverse and also specialty diverse. What do you think solutions could be?

I don't think anyone is going to be spared from that challenge. I think technology has the ability to provide services in areas that may have more challenges than other areas. Telehealth exploded during COVID-19, and our ability to do things and think outside the box has grown. I think stroke care is a great example. Now, you have these facilities that don't have a neurologist on site but can basically get a full specialty evaluation with the assistance of a nurse or physician from a neurologist who might be 250 miles away. They’re not procedure-based specialties because you're still going to have to be on-site for those.

A lot of the things that are more consultative, we're going to be able to use technology to speed up the turnaround time and be able to provide the service for the patients that otherwise would have to be transported. I think we're going to see that across a lot of those consultative specialties.

The other important thing is people working to the top of their license and being able to do so in areas where you have limited resources, making sure that the people who are there are operating at a high level.

From the health equity lens, what can be done regarding the underserved communities?

That's a challenge, but it’s not new. We've had that for probably as long as we've been providing medical care. I think the positive side that I see is that it's being recognized now more. We're beginning to look at basic research in which we're trying to be more diverse in the population of people that we're evaluating and applying studies to and realizing that all human beings are not exactly the same. They don't respond to things the same; there are, maybe, different treatment choices for different ethnic populations.

I think the biggest first step is recognizing that there's a problem, and I think we've done a pretty good job of doing that. Now, it's up to legislators and government health organizations to apply their understanding of where those needs are and put resources in place to address those.

Technology is going to allow us to do things a lot faster and more economically than we could have previously because, in the end, those organizations still have to break even to be able to continue to serve their mission. Finding ways to do it in the most economically efficient manner is going to be critical for their long-term success and being able to shrink some of that inequity that we see.

How were you able to address some of the nursing shortages in your organization?

We went to the point of helping to fund nursing education and working hard to get nurse educators in place. It wasn’t that we didn't have a lot of people who didn't want to go to nursing school, but we didn't have enough educators in place to provide the education.

There are organizations in our state that are partnered with nursing schools to help build facilities and provide training opportunities. I think we did some creative things internally. What was happening was nurses looking for an opportunity to say they could make more money to travel. Figuring out where the happy medium is, such as suggesting an internal resource pool, where they’re not going to have the same schedule as everybody else, but they’re going to get moved around, with a little more pay than when doing a regular eight-to-five shift.

I think hospitals and healthcare organizations did a pretty good job of trying to be creative and find ways to help those individuals where the dollar bill was the most important thing, finding ways to utilize them. The areas that had the highest need may not be the most pleasant areas, but they were willing to do it for the dollar.

I think many providers, especially in the last 10 or 15 years, have realized that the dollar is not the ultimate measuring stick. It is about lifestyle and happiness. We see that resonance today. It's just a cultural shift, and organizations have to move pretty quickly with that in order to retain talent.

Are there fewer people interested in pursuing a career as a physician than previously?

There are enough people that are interested in doing it. Medical schools still have way more applications than they have spots. It comes down to a funding issue. It's expensive to train physicians, and a lot of that funding doesn't come from the individual physicians themselves. There are governmental agencies that help provide some of that funding for those roles.

Schools have popped up that don't use as much outside funding, and the individuals who are going to the school are paying for it. They're paying very, very, very high tuition costs. They can make that up over a career of 30 years, but they go into massive debt. It's a challenge, too, because reimbursements go down and expenses go up. At some point in time, when those two cross, you hit the inflection point, and it may not be worth it to go to medical school anymore. For the vast majority of physicians, it's still a calling. You certainly can make more money doing something in the business world. You can, as a physician, make a great living, but you're not going to retire early.

What is your vision of what the landscape will look like five years from now?

My hope is that we continue to work hard on the supply side across the entire healthcare organization, including the nursing, advanced practice, and physician sides. Then, simultaneously, while working on that side, we do as much as we can to optimize our ability to get the most out of the providers that we do have, using technology to optimize the physician experience and the provider experience. That's everything from using A.I. tools for charting to optimizing schedules to simplifying credentialing, reducing all of the mundane tasks that providers have to do that are better served and done better with technology.

We have a disconnect with supply-side issues across the entire healthcare workforce. It's not going away; we really have to focus on utilizing technology immediately to optimize the providers that we do have. It even gets down to getting into middle and high schools and starting to encourage individuals at that young age that healthcare is a great profession for them to consider.