Physician shortages may affect population health strategies

The possibility of a physician shortage in the near future could make it harder to deploy population health strategies, according to a report released in February 2017 by the Association of American Medical Colleges (AAMC).

The report looks at several population health strategies, including those that aim at reducing morbid obesity, controlling blood pressure and cholesterol, increasing blood glucose management, and smoking cessation.

The increased need for high-quality, low-cost healthcare for chronic care management initiatives (such as those mentioned above) is tied to workforce projections and the possibility that there won’t be enough physicians to lead care teams, the report says.

“We have goals to make populations healthier. If more people are living into their 90s or 100s, it won’t decrease the need for doctors,” says Janis Orlowski, MD, MACP, chief healthcare office for AAMC. “My experience tells me that our goals to decrease obesity and high blood pressure will make significant impacts on healthcare. But people will still need a doctor.”

Scope of the problem

By 2025, the United States could be facing a shortage ranging from 34,600 to 88,000 physicians in total. Physician shortages in specialty, nonprimary care areas such as surgical, psychiatry, and pathology could be between 33,500 and 61,800 by 2030, according to study. The projected shortages in the primary care field range from 7,300 to 43,100 by 2030. The study’s authors say that wide range is due to the possibility of rapid growth in nurse practitioner and physician assistants (PAs) joining the field.

”The ratio of physicians to advance practice registered nurses (APRNs) and PAs is projected to fall over time as the APRN and PA supplies grow at faster rates than physician supply,” the study’s authors say. The projections suggest that the physician to-PA ratio will fall from 7.2:1 in 2015 to 3.5:1 in 2030. The physician-to-APRN ratio will fall from 3.6:1 in 2015 to 1.9:1 in 2030. “It is unclear whether these decreasing ratios are sustainable as an increased number of APRNs and PAs continue to enter the market or to what extent these shifts will affect the demand for physicians.”

Next: Where pop health initiatives will suffer most

Where pop health initiatives will suffer most

The ramifications of this projected lack of physician leadership means that population health strategies that aim to reach out to patients in rural or non-metropolitan areas could suffer.

“If underserved populations had care utilization patterns similar to populations with fewer access barriers, demand for physicians could rise substantially,” the study’s authors said.

Physician need increases even more when healthcare equity is factored into the equation. According to the report, if healthcare were distributed to black and Hispanic populations at the same access as white, insured populations in metropolitan areas, an additional 98,000 physicians would be needed.

Key takeaway for  MCOs

”Additional doctors are needed for fairness and equity factors. Managed care organizations need to make sure they are planning the number of physicians that they need in the future based off their patients’ age and ethnicity,” Orlowski says. “If your patient population is more elderly, then you will need more cardiologists and gastrointestinal doctors. So it is important to think about the physician needs for today and the future.”

Orlowski says that all areas of the healthcare system need to work together to increase the numbers of doctors coming into the system. She says AAMC is developing advocacy around lifting the 1997 freeze on medical residencies funded by the federal government. “In 20 years, the United States population has grown, and the number of people living over the age of 65 has grown. It’s well past the time to reevaluate the number of funded residencies based on population projections of today.”