In a recent article, we discussed the physician workforce’s historic shortages. Analysts estimate that U.S. healthcare is short tens of thousands of doctors, with rural and low-income populations most affected.
But what if the physician shortage isn’t a supply problem?
This article explores a different explanation for the shortage: America’s physician workforce is sufficiently large, but we aren’t using doctors’ labor efficiently.
The standard physician shortage explanation: too few doctors
To be clear, many healthcare leaders believe the U.S. needs more doctors. The AMA President called the physician shortage an “urgent crisis” in a 2023 statement. And AAMC data projects the U.S. will face a shortage of up to 86,000 physicians by 2036.
This workforce ‘supply’ issue is the most common explanation of America’s healthcare problems. With too few doctors, Americans have trouble accessing primary care, leading many—especially marginalized and low-income patients—to seek expensive emergency care when their problem becomes critical. This is the least optimal method of providing care, and it’s driven by a shortage of doctors (especially PCPs).
That said, exploring counter-arguments can illuminate alternative solutions. It’s worth asking: what if the current physician workforce could provide enough primary care for all Americans?
What if the physician workforce is sufficient?
The ‘efficiency’ explanation proposes that there are currently enough practicing doctors to meet the nation’s healthcare needs. The actual problem is that we’re doing a bad job using the current physician workforce efficiently.
Framed this way, the critical question becomes: what can healthcare systems do to use the physician workforce more efficiently?
Authors of a recent Harvard Business Review article propose three solutions to the physician shortage:
- Better target PCP care at specific populations
- Use advanced practice professionals
- Deploy technology at scale to increase primary care access
Better target primary care for particular populations
Experience shows that focusing more physician resources on Medicare patients and those with high rates of chronic illness can reduce the use of more expensive care. This proactive primary care management approach helps reduce the need for costly specialist care for the sickest patients.
It’s true that addressing more patients’ healthcare needs through primary care may increase the need for PCPs. However, non-physician workers can help absorb that demand.
Use advanced practice professionals
Many healthcare employers are starting to use non-physician labor more effectively by implementing care models that empower the entire team to practice at the top of their license. For example, advanced practice professionals like nurse practitioners and physician assistants can handle many clinical tasks that MD providers perform.
To better incorporate the nurse practitioner and PA workforce, teams must delegate effectively, focus on skill development, and empower employees to advocate for their roles. No one in the clinic should routinely spend large portions of their time completing tasks that could be covered by a team member with less training.
Ensuring clinicians practice at the top of their license is a powerful way to efficiently meet the healthcare system’s needs while making the best use of the current physician workforce.
Deploy technology at scale
AI and other technologies offer myriad opportunities to better use providers’ time. For example, generative AI tools like ChatGPT have ushered in an era of AI medical scribes that can draft an accurate clinical note in seconds. Implementing technology to automate clinical documentation can be game-changing since physicians still average 10 hours per week on clinical documentation.
Technology can also improve patient care by reducing barriers to early doctor visits. Physicians can address many patient care needs via short telehealth visits, saving time and costs while lowering the likelihood of future intensive care visits for more severe needs.
Making better use of the doctors’ time
Neither explanation of the physician shortage—as a supply problem or an efficiency problem—is exclusively correct. Instead, both offer helpful suggestions for improving U.S. healthcare.
Educational institutions are working on essential reforms to graduate medical education to ensure that more trained doctors enter the workforce.
At the same time, there are known strategies that can help healthcare systems serve more patients with the same doctors. Targeted primary care for high-risk populations, a more multi-disciplinary care team, and deploying technology at scale can all help make care models, labor practices, and clinical processes more efficient.
Everyone wins when institutions make better use of physicians’ time. The strategies summarized here can save health systems costs, provide more patients access to quality primary care, and improve provider satisfaction by structuring clinical work so that doctors use more of their specialized training.