Need to visit a doctor? You may be out of luck
In the United States, there are 266 active physicians per 100,000 people. These levels vary across the country, with Massachusetts boasting 432 doctors and Mississippi with only 185. Millions of new patients are entering our healthcare system through the ACA every year, and 10,000 baby boomers reach the age of 65 every day.
An aging and growing population leads to an increased demand for healthcare, and we many not have the supply for it. New models of care delivery are being thought about and tested here at the Business Innovation Factory; models that look to providers outside of physicians, and care beyond the clinic.
In 2008, the total number of office visits to a Primary Care Physician was 462 million; that number is expected to undergo a 25% increase to 565 million in 2025, requiring an additional 52,000 primary care physicians. However, the American Association of Medical Colleges predicts that the United States may be short 90,000 physicians by that year — a third of that consisting of primary care doctors
The looming provider shortage is the result of several factors, including the cost of medical education, the availability of positions, an increase in patients and an aging population of both providers and patients.
Not surprisingly it is pretty easy to guess where the doctors we do have chose to practice. The highest concentrations are in the Northeast of the United States, followed by the Pacific Northwest, and the northern portion of the midwest. While the lowest concentrations are the South, Southwest, and Gulf coast, all predominantly rural and socioeconomically depressed regions of the country.
Nearly half of rural areas in the United States, and 20% of all Americans are dealing with a shortage of primary care practitioners. 40% of the population of New Mexico has poor access to primary care, while more than 50% of the populations of both Louisiana and Mississippi do not have enough access to primary care physicians. And when access to care is low, health outcomes are worse.
Patients living in rural areas tend to be less educated and poorer, two things already associated with reduced health. Those without a general physician will often delay needed care, avoid preventative services, or seek care in the Emergency Department. Rates of disability, diabetes, heart disease, and suicide are all higher in rural areas, and the rate of death before the age of 75 is almost 40% higher than that in higher-income areas.
So what do we do now? Where do we get new doctors, and how can we get them to practice in underserved areas?
Almost 25% of active physicians practicing in the United States are International Medical Graduates (IMGs), meaning that they completed their medical training outside of the United States. According the the Journal of American Medicine, IMGs are 2x more likely to practice in medically underserved areas. They tend to work longer hours, and are disproportionately represented in areas with high-infant mortality, lower socioeconomic status, and a higher percent of non-white populations.
There are currently 260 doctors, all IMGs from the 7 predominantly muslim countries outlined in President Trumps travel ban that have applied for residency in the United States since the beginning of 2017, who may now not be able to practice or even enter the United States. Possible Implications for IMGs affected by the travel ban are ongoing and include clinical, research, and teaching opportunities.
“My concern is that any doctor or scientist from an Arab or Muslim country will now think twice about coming to the U.S. I am concerned that two months from now, the ban will extend to other countries in the middle east” — Dr. Peter Hotez
Now is not the time to be turning away anyone, let alone a skilled practitioner with a desire to work in an industry that is greatly in need of their services (almost 10% of U.S. Hospitals are considered IMG dependent). If the trend to limit entry into this country continues, our healthcare system may become the unintended victim.
“The volume of work is more than there are people to do , but I can’t envision a system where this doesn’t exist”- Dr. Kristen Miranda-Gaines
The Business model for healthcare delivery has remained relatively flat over the centuries. Patients visit a doctor, and the doctor treats the ailment. Wash, rinse, repeat. Here at the Business Innovation Factory (BIF), we have already begun to reevaluate this approach and work with leaders to transform the way providers and hospitals deliver care.
“Our assumptions about how care should be delivered might be impairing our ability to provide the best care and to do so with greater efficiency.” — Dr. Harlan Krumholz @HMKYALE
Continuous advances in tele-health, wearable technology, digital health tracking, and concierge medicine are all pushing the boundaries of what we had considered the only viable health care delivery model, and all seemed impractical at the onset. BIF is always looking for a new approach, a new trend, or new idea, and are willing and able to take those ideas to the next stage.
By using a human centered design approach, BIF is looking past the model of direct provider to patient care and exploring new models of care that can not only alleviate the problem of provider shortage, but provide better, more efficient, and more personal care.
