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Emergency Medicine News:
doi: 10.1097/01.EEM.0000388465.52819.ba
Quality Matters

Quality Matters: The Physician Shortage is Real: How Are You Managing It?

Welch, Shari J. MD

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Though much has been made of the nursing shortage, the physician shortage will significantly affect U.S. emergency departments. Since the 1980s when the Association of American Medical Colleges predicted an oversupply of physicians, medical school graduation rates have been flat. Fast-forward 30 years, and we are in the middle of the perfect storm. The curves representing supply and demand suggest a crisis that will know no boundaries, crossing political and geographic borders and medical specialties.

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Demographics will fuel the mismatch. The population of the United States grows by 25 million each decade, and the number of those over 65 will double by 2030. (Adv Surg 2008;42:63.) As patients age, their utilization of health care goes up almost linearly. Patients over 65 will average six to seven health care encounters a year, while those 45 to 65 will average 5.4. Young adults have only 2.2 encounters per year, according to an article in the online magazine Physicians Practice. (www.physicianspractice.com/index/fuseaction/articles.details/articleID/888.htm; accessed 5/10/2010.)

At the same time, the number of physicians retiring is higher than was anticipated (JAMA 2009; 302[15]:1674), and younger physicians do not want to work the hours that physicians of previous generations have worked. This younger workforce has more female physicians, is smaller relative to the patient population, and the work hours being performed have been declining. (JAMA 2010;303[8]:747).

For emergency physicians, these trends will compound the existing shortage of trained emergency physicians. The shortages across other specialties will take the on-call crisis to a new level, and add to the already stressful work environment. Difficulties in seeking primary and preventive care will mean that patients will present to the ED later in the course of their diseases, and outcomes will suffer. Some have predicted that a three- to four-month wait to see a primary care physician is not that far off, considering all of these factors. (Forbes Magazine. Dec. 2, 2008; http://www.forbes.com/2008/12/02/health-doctor-shortage-forbeslife-cx_rr_1202health_slide.html?thisSpeed=30000).

For emergency medicine, are there strategies to help combat the profound shortage that looms? A two-pronged approach involving physician retention strategies and tactics that improve physician productivity is recommended. Forward-looking groups like EMP (Emergency Medicine Physicians) do everything possible to keep recruited physicians onboard and practicing. They offer assistance to help physicians manage stress and personal problems, and they offer financial counseling if needed and mentoring for physicians falling short in some parameter of clinical practice. Utah Emergency Physicians allows older physicians to opt out of night shifts, and offers incentive pay for covering the night shifts, making them more attractive to the younger members of the group. It also offers a part-time option for physicians nearing retirement, which has created a small pool of physicians to fill holes in the schedule, allowing increased flexibility in scheduling. Jody Crane of the Institute for Healthcare Improvement has heard favorable reports from departments experimenting with shorter night shifts, allowing for some prime sleep (9 p.m. to 3 a.m.), which older physicians find more manageable.

To improve physician productivity, the two big strategies are not new. Scribes are one of the sentinel strategies to improve physician productivity, and they can prolong the career of older physicians. Rick Bukata, MD, introduced a scribe program several years ago. This has helped retain older physicians, improved physician efficiency, and increased productivity to 2.7 patients per hour, with a 20 percent admit rate in a 24,000-visit ED that sees few patients after midnight. The other big idea, also introduced by Dr. Bukata, was to build out services that can be provided by midlevel providers. At Good Samaritan Hospital, a Banner Health facility in Phoenix, they ramped up their staffing of midlevel providers, and recently began staffing scribes for the midlevel providers to make them more efficient.

The point is this: The physician shortage is real. Your physician group and your hospital should begin exploring strategies to manage it.

Dr. Welch is a fello...
Dr. Welch is a fello...
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