Back to the Cloud:
Their are many factors driving this shortage: Lack of new medical school development, absence of funding for new residency training programs, aging population, etc. For now, we will just concentrate on the demographics of the physicians.
The following graph (from a North Carolina Institute of Medicine study) is cannot be digested at a glance, but makes a few important points:
The figure compares two years -- 1980 and 2004. The "blue bar" histogram to the right is the number of physicians of every age during the year in question. The green histogram presents the same information for female physicians. There are a number of important take-aways from this figure.
First of all, the same "pig-in-the-python" dynamic at play in the general boomer population holds true for physicians as well. In 1980, the largest population of physicians were in there 30's and 40's. By 2004, practicing physicians tended to be in thier 40's and 50's. In another decade or so, the largest mass of practicing physicians will cross the threshold of 65, many becoming consumers rather than providers of healthcare. Demographic Issue One: physicians will be retiring.
Issue Two: What impact will the reform environment have on the timing of those retirements? In this age of uncertainty, it remains to be seen if physicians will retire at the historic norm, or if those who are able will opt out early rather than deal with the shifting sands.
The other obvious observation from the histogram is Issue Three: the younger workforce is now at least 50% female (probably slightly greater than 50%). The fact that women are so thoroughly integrated into the physician workforce is a desirable, necessary and long overdue. However, from a planning perspective this shift has a significant impact. Female physicians, in aggregate, over the course of a career, equate to between a 0.7 and 0.8 FTE. Female physicians as a group tend to drop in and out of the workforce, and are statistically more likely to work part-time. Now that the workforce is more than half female, the impact is of consequence.
Which brings us to Issue Four: the new generations -- Gen Xers, Gen Ys, Millennials. Much has been written about cultural differences in the ascending generations (e.g. less loyalty to organizations, more value on work-life balance). This generational change is probably real and of consequence on it's own. But we need to add to this meta trend the cultural changes occurring in medicine. For mostly good and appropriate reasons, medical students, interns and residents are mandated to limit their work hours. To most of society, establishing a work-hour limit of 80 hours per week does not seem like much of a limit. In medicine it is a seismic cultural change. Place the millennials, already predisposed to seeking "balance", in an environment that tells them it is their professional obligation to never work more than 80 hours a week, and we are invariably going to produce a different sort of physician -- hopefully one that is more humanistic and empathetic, but clearly not one who is going to work 100+ hours a week and take call every third night. This may be (probably is) good policy, but it has implications for a workforce already challenged to meet the pending demand.
How will healthcare meet the future workforce shortages? Expansion of medical schools is underway with a vengeance, but will not be enough. Residency training programs are not growing, due to lack of support, which undercuts all the great efforts of the schools. There will still be a gap to be filled, and we will need to look to fundamental redesign to meet the challenge. Non-traditional providers, advanced care practitioners, group visits, electronic visits will likely play a role, along with solutions not yet conceived.
Next: Disruptive Innovation
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