Will We Have Enough Physicians to Meet Demand?

With the upheld Affordable Care Act and the status quo election, the question that remains to be answered is how we, as a country, plan to meet patient demand in an already overwhelmed and inadequately staffed medical system?  With just over a year to go until the individual mandate is in full effect, the country is facing an explosive influx on an already taxed system that has many wondering how to meet both the supply and demand sides.

Supply and Demand Confounders:

The United States, as a whole, is already experiencing a Primary Care Physician (PCP) and nursing shortage.  In fact, some would say that it’s well beyond a shortage and well into a crisis. The Wall Street Journal reported that, at the start of 2010, the country was approximately 16,000 PCPs short of adequate levels.[i]  In its current state, by 2020 this shortage is expected to increase over 5 times to 90,000.[ii] Now, throw in an additional 31 million people on January 1, 2014 who will need a PCP and therein lays the problem. Further compounding the medical personnel shortage issue is that, currently, the U.S. graduates only 27,000 PCPs each year (a number that, in recent years, has steadily decreased).[iii]  In other words, we aren’t graduating enough medical staff to meet current needs nor are we prepared to meet future demand.

Combine these issues with an additional 79 million aging baby boomers who will tax the system with their increase medical demands, an aging and retiring medical workforce, concentration of medical staff in urban areas (instead of understaffed, rural areas), demand on providers to increase their patient load (both with the number of patients and increased treatment of chronic care) while lowering their reimbursement rates and you have the perfect storm.

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Supply Side Confounders

  • Workforce that is aging
  • Distribution of providers
  • Provider salary and benefits
  • Working conditions of providers
  • Lack-of teaching faculty
  • Departure rates of physicians

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Demand Side Confounders

  • Aging baby boomer populations
  • Population growth
  • Increased patient load
  • Increased chronic condition care
  • Higher poverty and uninsured rates

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Why Should You, as an Employer, Be Concerned?

There are a number of reasons why employers should be concerned.

  1. Access – The influx into the system may create insurer network access issues.  This will lead to employee and dependent complaints, which may result in marketing the overall program to meet employee needs.
  2. Cost – An alternate network or insurer may be more costly per capita.  Internally, there are additional costs to market, implement, and effectively communicate a new medical program.
  3. Absenteeism/Presenteeism – Employees will spend more company time researching doctors with patient capacity for themselves and their dependents.  Additionally, an employee may need to travel further to find a doctor during company business hours.

We need to create greater access points without provisioning for demand.  Until this happens, there are options that employers should review with their employee benefit consultants and/or HR team.

1. Alternative Funding Mechanisms – Self-funding provides an employer access to “rent” from a number of insurer networks.  With as few as 50 employees, employers are now granted greater flexibility in how they fund medical insurance and can choose a network that meets their business needs.

2. Leverage Technology – Technology could fill the gap by playing a much stronger role in medical care.  Most insurers have launched or are getting ready to launch online doctor services.  Similar to Skype or FaceTime, an employee has the convenience to speak with a credentialed doctor who has the ability to issue prescriptions.  This service is a convenience to employees and saves valuable company time for general urgent care.  Additionally, health diagnostic applications on smart phones are becoming much more accurate and sophisticated.

3. Concierge Services – Some employers have begun incorporating physician concierge services.  Concierge may mean an in-house clinic (for employers with large campuses) or mobile clinics for both basic medical and dental visits.  Doctors now travel to employer sites in stocked mobile clinics to conduct wellness biometric screenings or see patients with urgent care issues.   Additionally, for a price, employers may work with private practices to limit the number of patients they see annually and increase the time they spend with each patient.  Instead of the average of 3,000-4,000 patients a doctor typically consults annually, concierge doctors see between 100-1,000 patients annually.  The result is greater employee satisfaction resulting in increased capital retention and productivity and less absenteeism.

[i] Our New Healthcare Crisis.  (5 January 2011).  Available from: http://www.noinsuranceclub.com/blog/index.php/our-new-healthcare-crisis-primary-care-physician-shortage/.  (Accessed 8 March 2011).

[ii] Doctor Shortage Could Take Turn for the Worse.  (22 October 2012).  Available from: http://www.usatoday.com/story/money/business/2012/10/20/doctors-shortage-least-most/1644837/

[iii] Our New Healthcare Crisis.  (5 January 2011).  Available from: http://www.noinsuranceclub.com/blog/index.php/our-new-healthcare-crisis-primary-care-physician-shortage/.  (Accessed 8 March 2011).

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