By Joy Robertson
KOLR-Springfield, Mo.
In the wake of health care reform more patients will go in search of medical care. Question is, will there be enough doctors to handle the need? If a Texas-based physician search firm is right, something has to happen, and happen soon.
"By the year 2016 we'll actually have, for the first time, more doctors retiring, passing away, than doctors coming out of our residency programs," said Kurt Mosley, vice president for strategic alliances at Dallas-based Merritt Hawkins & Associates.
Mosley joined other experts in a panel discussion at Health Journalism 2010, the Association of Health Care Journalists' annual conference, in Chicago on Friday. He said people are living longer and surviving cancer-related diseases and that's increasing the demand for access to physicians.
"So we'll have more water going out of the bathtub than coming in for the very first time," Mosley said. "There's going to be a quiz and it's called the future. And we need to get that right."
Is it a catastrophe or opportunity? Other panelists indicate doctor availability may not be so much a numbers issue as it is a distribution one.
Raymond Curry, M.D., of Northwestern University's Feinberg School says luring more students into medical school may seem the best way to fill the gap, but that just one of many moving parts to the equation. "It makes it difficult to hitch your wagon to something as simple as producing more medical students," Curry told the journalists.
Curry cited a surge in the number of medical schools and students in the 1960s and 1970s which was met by a plateau over the past 30 years. Another big issue, he said, is the geographic distribution of physicians and doctors in specialty practices. He said that, with students more attracted to desirable, densely-populated communities and high-paying specialties, manpower planning is key. "There really is none and there needs to be."
Curry advocates teaching a 'team' approach between physicians, nurse practitioners and physician assistants to encourage a continuum of safe care and better utilize personnel. To help control the cost of medical school – which he estimates to be about $1 million from entrance through training – he encourages the use of service corps to give back to underserved communities. He cites Mexico as an example, pointing out that students' sixth year is a learning year. "Everyone gives back," Curry says.
More physicians won't necessarily help improve the health of patients says David C. Goodman, M.D., director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice. "There is virtually no relationship between physician supply and health needs." He went on to say regions with a large physician supply tend to have greater unnecessary use of hospitals and more fragmented care.
Goodman agrees that doctors tend not to settle where the need is greatest. He suggests the need for enhanced rewards to primary care physicians to keep them from moving on to specialty roles. He also encourages a more patient-centered medical home, giving patients telephone access to doctors and having nurses work triage to help patient flow.
"We should invest in care that improves patient outcomes," he said. "Reward effective care and implement evidence-based medicine."
