I am in San Francisco attending a meeting that is held in conjunction with the Association of American Medical Colleges (AAMC) and am attending some of the sessions today. One of the sessions was about the “State of the Physician Workforce” and, as the presenter, Clese Erickson, said, the state of the workforce is mixed.
On the half empty side, we only have 25% of our medical school attendees remain in a track to deliver primary care at the end of 4 years of medical school. Those who do primary care will not practice as hard as their predecessors (as a result of lifestyle tradeoffs). Consequently, what is a shortage of of between 40 and 60 thousand primary care providers (depending on the election on Tuesday) will be exacerbated as physicians adapt shortened work hours. Of the 18,000 enrollees in US Medical Schools this year, we have finally achieved over 3000 underserved minorities enrolled. This was only 12 years behind the target and at under 15% of the class does not reflect the changes in US demographics. An additional worry this year is that the number of residency positions (the first job after medical school, required for licensure in all states) is not increasing as fast as medical school slots, raising the specter of graduates driving cabs while waiting for a position to open up.
However, as Ms Erickson points out in her talk and her blog post, there is reason for optimism:
As a researcher, it’s hard not to get excited about the workforce implications of the increased focus on team-based care, recent announcements that some insurance companies are paying more for medical home models, the potential outcomes of the Pioneer Accountable Care Organizations (ACOs) , “hot spotting”high utilization areas and targeting resources to those communities, payment bundling efforts, and the thousands of applications for the CMMI Innovation Challenge awards.
All of these initiatives have the potential to increase care coordination, improve quality, and reduce hospitalizations and emergency room visits. Most rely heavily on rethinking the roles of existing care team members and ensuring that everyone is practicing at the top of their profession. Additionally, many practices are identifying new team members and integrating home health aides, case managers, and other care coordinators into their delivery models in new and exciting ways, such as coordinating with local community programs and providing home services, that will help patients gain better understanding of their treatment plans and medications, make community resources available to them, and help them receive better care coordination.
For several years I have become convinced that physicians are necessary but not sufficient to solving America’s health care. I am excited to see the governing body of our medical schools acknowledge this. Now if only we can keep on filling the glass from this tap.