How to tackle America’s physician shortage

August 10, 2015, 9:26 PM UTC

Physician assistants

Duke University's Eugene Stead launched the first physician assistant's program in 1965 to address two problems. On the one hand, there was a shortage of primary care physicians across the country. On the other, men were leaving the military with medical training and no clear way to apply it to civilian life. In 1975, an independent organization called the National Commission on Certification of Physician Assistants was founded to oversee certification for the profession. In the '60s and '70s, most PA's were men, but the ratio has shifted. In 1983, the Bureau of Labor Statistics data says that about 35% of physician assistants in the country were women. Today, roughly 70% of PA's are women. Part of that might have to do with the fact that it is more lucrative, on average, for women to become PA's than doctors. A 2012 Yale study suggested that female PA's might end up earning more than women doctors, given the cost of education and the wage gap between male and female physicians.
Photo: Joe Raedle/Getty Images

Since the Affordable Care Act (ACA) was enacted in 2010, 16.4 million Americans have entered the healthcare system. This record number of insured individuals applies tremendous pressure on an already stretched system, but it also creates opportunities for innovation. The population of newly insured patients includes many who are living close to the poverty line. The rate of low-wealth Americans who are now insured increased by 13% while a Gallup poll found that low-wealth Americans were more likely to struggle with chronic conditions such as diabetes, obesity, depression, and high blood pressure.

In order to effectively meet the increased patient load, health centers must be prepared to manage the influx of new patients efficiently and cost-effectively. Complicating this is the Association of American Medical Colleges (AAMC) finding that the U.S. is headed towards a “doctor shortage.” The AAMC estimates that total physician demand will grow by up to 17%, which translates into a shortage of more than 31,000 primary care doctors and up to 63,700 other physicians by 2025.

Many health centers are responding to the pressure of serving more patients (including those with costly, chronic conditions) by engaging, training, and redeploying medical assistants (MAs) and other frontline health workers. With the right training, MAs can perform advanced tasks such as panel management, health coaching, scribing, and other clinical duties. This allows doctors and nurses to work at the top of their licensure by delegating clinical tasks to MAs and other frontline workers.

Instituting operational changes that better utilize the time and talent of healthcare personnel has proven to deliver better results for patients while lowering costs and increasing revenues for healthcare facilities. New Jersey’s Atlanticare Special Care Center reduced its union insurance payments by 12% and emergency room visits by 40%, using a medical home model that employs medical assistants as health coaches. New York’s Union Health Center implemented a career ladder that allows medical assistants to move into more advanced positions such as health coaches and floor coordinators. Health coaches often serve as the primary point of contact for patients with chronic conditions and provide intensive patient education. Floor coordinators, the most advanced role in the MA career ladder, manage the flow of patients within the health center and schedule provider time. A study showed that Union Health Center saved 17% per member per month in their capitated plan, and were able to reduce emergency room use by 50%.

As the country looks for ways to strengthen the workforce, it is worth noting that the ACA has also been a driver of healthcare jobs. The Bureau of Labor Statistics reports that healthcare added 40,000 jobs in June, with an average of 34,000 jobs added per month over the prior 12 months. Medical assistant (MA) jobs are among the most common and fastest growing occupations in primary care – projected to increase 29% from 2012 to 2022, much faster than the average for all occupations.

The confluence of major issues facing the system, from a shrinking pool of physicians, more patients, and an aging population with chronic diseases, should sound the alarm. U.S. health center leaders would be wise to increase their investment in the training and development of their support staff. A focus on effective ways to treat patients utilizing trained and certified medical staff will create new jobs and career advancement opportunities for frontline workers in the years ahead.

Barbara Dyer is president & CEO of The Hitachi Foundation and a senior lecturer at the MIT Sloan School of Management. Tom Strong co-leads the foundation’s Good Companies @ Work program, which focuses on how businesses can help low-wealth workers move up the economic ladder.

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