Talking Sense About the Physician Workforce

Physician workforce The November Health Affairs theme issue, Redesigning the Health Care Workforce, is especially good. Much of what I’ve seen written elsewhere on the topic focuses on alleviating a (purported) looming shortages of doctors or nurses by training more of them, or by having people with less training than doctors, e.g., NPs and PAs take on core physician tasks including diagnosis.

Expanding Primary Care Capacity By Reducing Waste And Improving The Efficiency Of Care by Scott Shipman and Christina Sinsky points out several opportunities for primary care physicians to increase their capacity by setting up more efficient workflows and pushing off administrative and clerical tasks and using better technology. They are right to point out that increasing compliance burdens are falling heavily on physicians. I for one would apply a very stringent test to any proposed regulation that adds burdens to primary care. The authors conclude that efficiency gains could provide capacity for an additional 30 to 40 million primary care visits per year. By way of contrast, the Affordable Care Act is expected to add 15 to 24 million primary care visits.

Accelerating Physician Workforce Transformation Through Competitive Graduate Medical Education Funding notes that GME has changed very little even though there is a consensus that change is long overdue. For example, training remains hospital-focused and highly-paid specialties like radiology continue to grow faster than primary care. Essentially, funding for GME is grandfathered, leading to excessive rigidity and lack of incentives to change. The authors, David Goodman and Russell Robertson propose making institutions compete for GME funding, adopting some of the best practices of the National Institutes of Health funding approach such as public guidance of programs, peer review, competition and long-term funding.