Over the past several months, more and more healthcare analysts have started to raise concerns about an impending physician shortage. The argument is highlighted by the expected influx of new patients this year as Obamacare enables millions of people to obtain insurance and presumably begin accessing the healthcare system as never before. While ambulatory visits had already been increasing by an average of 2.1% per year since 2000, [i] this new demand is expected to push total outpatient visits to 812 million by 2020.
At the same time, the growth in physician supply has been – and is predicted to remain – relatively anemic. The U.S. Dept. of Health and Human Services estimates that the supply of medical specialists will increase by less than 10% in the next decade.[ii] When comparing this supply to patient demand, the Association of American Medical Colleges (“AAMC”) warns there will be a drastic shortage of over 46,000 surgeons and medical specialists by 2020, with nearly one-third of all physicians looking to retire in the next decade.[iii]
These factors have engendered vibrant discussion amongst healthcare leaders around how to cope and plan for this seemingly inevitable physician shortage. Many of the proposed solutions focus on longer-term strategy, such as increasing funding for residency training or relieving physicians of their medical school debt to make the profession more attractive to young students weighing their professional options. These strategies, while potentially effective, would require significant changes in well-crystalized medical education practices. Further, by the time these theoretical adjustments are made and their effects on the physician supply tangible, the nation will be several years into the shortfall crisis.
There is an alternative way of characterizing this challenge – that there is, in fact, an opportunity to improve the efficiency of the provider supply that exists today. As such, instead of focusing solely on increasing the traditionally-defined, physician supply side of the equation, we propose that patient access is best addressed through two complementary mechanisms:
- Physician efficiency – Far from having exhausted the available physician supply, patient access challenges (such as long appointment wait-times leading to patient out-migration) are often the result of poor supply-demand matching. The ability to get patients to the right doctor, the first time, is an essential step towards maximizing physician capacity and minimizing wasteful visits to physicians out-of-network of unqualified to manage a specific condition. As in other industries that have found ways to better arbitrage supply-demand, this initiative requires an information platform that can enable the real-time “matching” of resources. In the case of patient access, provider organizations must be able to connect patients with in-network providers that meet patient demographic preferences (geography and gender for example) while ensuring clinical competency for managing a specific condition. The urgency to do this in real-time, while challenging to many organizations today, is critical to optimizing the efficiency of their provider networks.
- Physician extenders – While information and work-flow solutions can help maximize the productivity of physicians, these solutions can also facilitate the incorporation of non-MD providers. Given the scarce nature of some specialist expertise, it is essential that physicians practice “at the top of their license” – seeing those cases for which they are uniquely trained to manage. While many organizations recognize this in theory, they have often struggled to incorporate physician extenders (like nurse practitioners) into the organization. Work-flow applications that can understand demand at the condition or diagnosis level are an important step in triaging patients to providers best suited for that need (for example, having nurse practitioners provide the first level assessment of a sports injury before escalating some of these to the busy orthopedic surgeon).
As demand for outpatient care continues to climb, already limited access to care will only intensify without profound changes in the efficiency of patient access operations. Access to care is increasingly correlated with organizational survival in competitive healthcare markets. While exploring mechanisms to increase the traditional supply of physicians, it is essential that organizations also implement ways to improve the efficiency of their existing provider network.
Is your system equipped to meet the challenge? Here are three fundamental questions for hospitals and health organizations to ask:Are your patients getting timely access to the right providers?
- What are average wait-times across the health system? Are any specialties booking out more than 10 days?
- What percent of referrals require re-referral to another subspecialist (for example interventional cardiology to electrophysiology) because the initial triage was incorrect?
- What percent of patients seek care outside the system because of long wait-times or insufficient knowledge of appropriate in-network providers?
- What is the average booking ratio of your providers across specialties? How many of your providers are scheduled < 75% of their potential clinical FTE time?
- Do you have varied booking density across specialists each qualified to care for the same kinds of cases (for example physicians with last names at the beginning of the alphabet are at 85% capacity while those at the end of the alphabet are < 50% booked)?
- Do your providers complain that they are sent the “wrong” types of patients by your call center or referring physician base?
- Do you track in-bound patient demand by condition and/or referring source in real-time?
- Can you quantify provider supply by condition or practice focus across your staff?
- Do you have mechanisms to identify and prioritize scheduling with providers who have historically low booking density (such as new staff members)?
- Do you have automated mechanisms for on-boarding and engaging physicians into your scheduling work-flow operations?