Facing the shortage of doctors

As the pandemic slowly turns into an endemic, its impact on primary care physicians continues to tug at the seams of an already frayed healthcare system. The looming shortage of doctors, predicted with growing urgency every year since the early 2000s, is now at the pinnacle of health care challenges in the United States. The Association of American Medical Colleges now estimates a shortage of 37,800 to 124,000 doctors by 2034, accelerated by a perfect storm of pandemic closures, physician retirements, an aging population and demand. increasing care. Simultaneously, the growing popularity and projected 10% annual growth of concierge medicine practices, characterized by intentionally small patient panels, appear to be intensifying the problem.

However, appearances can be deceiving and the reverse may be true: concierge medicine is not fueling the doctor shortage but may be one of the most viable potential solutions. By presenting a sustainable model that eliminates much of the burnout that eats away at the morale of our country’s health care providers, concierge medicine extends the years of active practice for experienced physicians, guarding the doors of nursing practices open primary schools and inspiring new generations to enter the field.

The dialogue about how to fix a broken healthcare system, which began long before the pandemic, has shifted to increased recognition of the value offered by concierge medicine. For example, Erin E. Sullivan, Ph.D., director of research and curriculum at the Harvard Medical School Center for Primary Care, said American scientist“(Before the) pandemic, I would have said, ‘We don’t have enough doctors who choose to practice primary care.’ And if doctors who choose primary care choose to practice in models like concierge, you could see how that would exacerbate a shortage.On the other hand, if those models turn out to be more attractive or sustainable ways for doctors to practice primary care, can we then increase the number of physicians choosing to practice primary care? And can we learn from these models to build something better and accessible to all patients?”

And when asked about the effect of concierge and direct primary care models on physician shortages, Reid B. Blackwelder, MD, former president of the American Academy of Family Physicians, said medical landscape“All of these models are ways to invest in primary care. With the pandemic, we have made changes in the way we interact with our patients which I think were exactly what we needed.

“Listen to your patient, he tells you the diagnosis.”The observation made in the 1890s by internal medicine pioneer William Osler, MD, CM, applies to physicians today, who have accurately diagnosed the primary cause of disease in our system: care based on the volume, with no regard for the practitioner trapped on the hamster. wheel. Doximity reports that more than 73% of doctors said they were overworked, and 55% of doctors surveyed by Medscape said they would take a pay cut to achieve a better work-life balance.

Failure to care for caregivers in a traditional fee-for-service model of practice or in a large group of the health care system is accelerating the exodus of dedicated physicians. The advisory board sounded the alarm earlier this year, writing: “There has never been a time when we believe doctors are more likely to quit. And even if they don’t quit, we question the quality of care provided, as burnout leads to poorer patient outcomes and increased medical errors.

In contrast, concierge physicians stay in practice longer than originally planned, driven by intense job satisfaction and the ability to balance work and personal life. Physician search expert Craig Fowler notes in his work on succession planning that physicians in a janitorial practice plan to retire at a significantly later age than those in a traditional model. “They can enjoy a good quality of work life and retire on their own schedule,” he says.

Not the retired type

At Specialdocs, we are privileged to work with many experienced physicians who remain more committed than ever to remaining in active clinical practice. Here are some highlights:

Dr. JW, Riverside, Connecticut:

“I am now entering my 41st year as a doctor and I have never enjoyed being a doctor so much.”

“Before I moved to Specialdocs in 2018, I was ready to retire early. My mind was completely shattered by a medical system focused on superficial care and a high volume of patients. As a concierge physician, I make a real difference in the lives of my patients, with the time to do a full history at each visit or to reduce bureaucracy and arrange an urgent consultation with a specialist.

Dr. WK, Chicago:

“The term ‘burnout’ is no longer part of my vocabulary.”

“In the mid-2000s, I felt like I was a few years away from retirement. The pace was such that I feared making mistakes that I would regret. Switching to the Specialdocs model took away the daily stress so well that it added years to my practice. I am in no rush to retire now and am truly grateful that I was able to continue caring for my patients throughout the pandemic.

Dr. EB, Wantagh, NY:

“I definitely would have left medicine sooner if I hadn’t changed to concierge medicine.”

“I was exhausted and at 68 felt my choices were limited to early retirement or joining a large local hospital group. Partnering with Specialdocs to start a concierge medicine practice offered a much better alternative, and I now plan to continue caring for patients for as long as possible.

Keep the doors open

Among the many heartbreaking statistics of the pandemic is this: In 2020 and 2021, more than 24,000 independent practices were reported permanently or temporarily closed. New data from the Physicians Advocacy Institute shows that nearly three-quarters of American physicians now work for hospitals, health systems or corporations, an increase of almost 20% since 2019.

We have long understood that the traditional fee-for-service model is unsustainable. Since 2001, Medicare payments to doctors have dropped 20%, adjusted for inflation, while the cost of running a doctor’s office has increased 39%. Becoming employed by a hospital system also doesn’t provide a perfectly packaged solution, as most physicians employed in hospitals earn 20% less than independent practitioners, according to Medscape.

Although a sense of normalcy is returning, for primary care physicians in traditional fee-for-service practices, the situation remains grim. According to the Primary Care Collaborative, nearly half of physicians say primary care is collapsing, more than 40% describe themselves as mentally and financially fragile, a third report that they are currently being denied and/or seriously behind payment by insurers and health plans and only 21% find the fee-for-service mode sufficient. More troubling, one in five physicians surveyed by the American Medical Association said they would likely leave their current practice within two years. It is an incalculable loss that will be felt for many years.

However, for concierge doctors, although the pandemic has been demanding, their professional survivability has never been in question. As many as 0% of janitorial medical practices have been closed during the pandemic, and they continue to thrive in 2022 on a solid foundation of dues revenue. Freed from financial worries and overburdened patient panels, concierge physicians not only keep their doors open, but their minds and hearts as well. As Dr. BB shares, in 2021 his longtime multi-physician cardiology practice in the Boston area was on the verge of closing due to the pandemic. “The shift to concierge medicine with Specialdocs has saved our entire organization with an approach that has benefited patients immensely and restored our joy in practicing medicine.”

Terry Bauer is CEO of Special Docs, a pioneer in concierge medicine that has transformed the professional lives of physicians since 2002.

Originally posted on our sister brand, Medical economics.

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