- Physician roles are changing as care teams grow and diversify, but this has intended and unintended consequences, Polly Pittman, professor of health policy and management at George Washington University, shared at a summit on the future of care delivery.
- EHRs — which are not going away anytime soon — have contributed to physician burnout but can be helpful and generate insight to help patient outcomes when configured properly, according to panelists on delivery system reform and its effects on the healthcare workforce. However, it can take work and time to get that optimal setup.
- The panel, which included experts from Novant Health and the Patient-Centered Primary Care Collaborative, added that quality improvement science and leadership needs to be taught in today's medical curriculum to keep up with the reality of current care delivery team expectations.
The Alliance for Health Policy hosted a half-day summit in Washington D.C. on Thursday covering the care delivery of the future and what role the healthcare workforce will play. The answer is no surprise: A lot.
The industry is bracing for the "silver tsunami" as baby boomers en masse age into needing more care services. The population of those age 65 and older will increase from 47.8 million in 2015 to 88 million in 2050, according to Leading Age. The Association of American Medical Colleges (AAMC) says the growth and aging of the population will increase demand for healthcare services.
But some experts worry the U.S. won't have enough physicians to meet the demand. AAMC estimates that physician demand is growing faster than supply, projecting a total physician shortfall between 40,800 and 104,900 physicians by 2030. In primary care, that number is between 7,300 and 43,100 physicians by 2030.
Pittman shared in her research as co-director of GW Health Workforce Institute that primary care is getting delivered with fewer physicians relative to other care delivery providers such as nurse practitioners. From 2007 to 2013, growth has been slower in physicians (34%) versus nurse practitioners/physician assistants (74%). In addition, the overall ratio of staff-to-patients in primary care community health centers in the same time period increased by 10.4%.
Pittman said that at hospitals, from 2010 to 2014, providers increasingly substituted high- and middle-skilled clinical non-licensed personnel with lower skilled staff.
Supply-and-demand concerns set aside, a great focus of Pittman's opening remarks and a panel on delivery system reform and its effects on the healthcare workforce was placed on technology, team-based care and physician burnout.
According to the panelists, the shift in the industry should be acknowledged by clinicians. Then, change can occur.
Dr. Tom Jenike, chief human experience officer at Novant Health, stated that the EHR has been one of the biggest shifts in the industry, but acknowledged it isn't going anywhere. Still, he believed the way discussions were framed in the Meaningful Use days skipped over how the tool would change the day-to-day workflow for everyone on a clinical team. Since 2009, EHRs have been shown to contribute to documentation overload and physician burnout.
Robert McNellis, senior advisor for primary care at the Agency for Healthcare Research and Quality (AHRQ), agreed EHRs have been a thorny issue for clinicians, but added when efforts go into retrofitting a tool for a practice, EHRs can work very well for practices. Unfortunately, this takes time and effort rather than the desired plug-and-play approach to implementing an EHR.
Jenike added EHRs and health technology have been beneficial for patients for things such as video visits and online scheduling. "We know consumerism is a big deal and the new generation wants healthcare....through a handheld device," he said, sorting why getting technology right for both the patient and clinician is critical for the future of care delivery.
Ann Greiner, president and CEO of the Patient-Centered Primary Care Collaborative, noted there are bright spots with the promise of technology care integration, but stated the large amount of change that comes with moving to value (reporting requirements, redesigning a practice, etc.) is stressful and equates to less time spent with patients.
The panelists agreed healthcare is always "at the crossroads." They cited health economist Uwe Reinhardt, who in the 1980s stated the American healthcare system was at a crossroads. This time, however, Jenike stated the high degree of change is unlike what's been seen before. The rapid changes "have been coming so fast people are losing focus on why they went into medicine," he said.
Jenike said that to prevent clinician burnout, Novant, a physician clinic network, advocates providers tamp down external factors that may contribute to overwork. In this, Novant asks the clinicians to look in the proverbial mirror and explore what is their own contribution to their burnout. Physicians are known for being perfectionists and A-type personalities. What Novant asks, according to Jenike, is for physicians to be versatile and not be in perfectionist mode at all times, like when they are on vacation.
Jenike shared the program has been transformation and has been expanded internally. "We find people get a new sense of meaning [and helps] recharge them," he said.
And the changes in the system are not being taught, according to the panel. Greiner stated that education has been allergic to change, as by and large health professional are trained in silos and then asked to work in a team-based environment. As the care delivery system moves to value and consumerism increases in healthcare, a focus on teamwork and the realities of the changing landscape will be imperative for incoming medical practitioners.