The Doctor Shortage

I spent about 15 minutes talking with a colleague last night. He's a family doc, a member of that holiest of holies among healthcare reformers and government types, the primary care physician. And not just any primary care physician: He works in an underserved semi-rural area where it's very hard to get doctors to come and just as hard to keep them there. And he's leaving.

There has been much ado about the looming shortage of physicians which has been estimated at close to 100,000 in the next 10 years. I can't be certain of just how solid that estimate is, however, as I think there are factors that have been left out of the equation. Factors such as mandatory use of electronic medical records-- not one, but one of the many that are out there, each a bit different from another, each requiring months, if not years, to become fluent, each designed to maximize billing potential while often times seriously compromising the actual presentation of information about the patient. Factors like a rising tide of patients with no insurance or poor insurance, patients who many times expect to be "fixed" rather than participating or taking responsibility for their health. Factors like scorecards that publicly measure a physician's patient satisfaction scores. Factors like being employed as a doc and, instead of finding freedom from the headaches of private practice walk into the nightmare of corporate hierarchy, "productivity" goals and measures, and the highest of customer service expectations while being provided with the leanest of resources. I won't even go into the omnipresent threat of malpractice litigation.

It's not all bad. Many of these measures may help drive improvements in patient care. Unfortunately, they will also drive many very fine physicians out of practice.

I don't worry about Los Angeles, Chicago, New York, Atlanta or any number of other substantial urban centers. I worry about the towns of 8, 10, 15, and 25,000 who have little to offer a highly trained professional other than a community filled with people in need. In our own little town we're up to 3 primary care and 2 specialists lost in the last 12 months.

The problem is larger than what we're hearing. Unfortunately, I don't think we've seen anything like the solution that's needed.