Several data points in the form of articles or news updates crossed my desk today. They resonated with the theme of my most recent HealthBlog post “Patientnado—the storm that’s about to hit healthcare”. In that blog post I discussed the likely impact Health Reform (Obamacare) will have as 30 million or so new patients, armed with freshly-minted health insurance, try to find doctors in an already-strained system.
A June 27th article by Yevgeniy Feymana and Paul Howard states that even before the enactment of health reform legislation, health-system researchers have reported that the US faces a growing shortage of physicians across all specialties. The shortfall is predicted to be 130,000 physicians by 2025. A new report by Feymana and Howard for the Manhattan Institute states that roughly a quarter of the doctor shortage will be among primary care physicians. This is worrisome since primary care is ideally the gateway or entry point for the millions of newly insured patients who will be hitting the healthcare system. This shortfall is already illustrated by some data coming from the state of Massachusetts which is often held up as an early model for health reform. According to the Massachusetts Medical Society, the percentage of family doctors accepting new patients in that state has dropped 19 percent over the last seven years. The percentage of internists taking new patients dropped 21 percent over the last 9 years. The number of pediatricians accepting new patients has fallen 10 percent over the last four years.
Another article that caught my attention today was one by Jen Wieczner of the Wall Street Journal titled, “The doctor won’t take your call”. In it, Ms. Wieczner explains the pain physicians are feeling over the spiraling increase in telephone calls to their practices. Answering all those calls (for some practices hundreds or thousands of calls a day) takes a toll on office staff, is a time sink for docs (for which they are seldom reimbursed) and is legal quicksand for malpractice if calls are ignored or the wrong information is conveyed. The problem will likely only get worse as more and more patients who are insured, but have high-deductible plans, seek care and advice without having to actually make an appointment thereby avoiding being charged for an office visit. As the Wall Street Journal article points out, doctors are increasingly wary of giving out free advice on the telephone. Although some insurers and health plans, including Medicare, are compensating doctors for time on the phone with some patients, this is the exception rather than the rule. As a result, many doctor practices are off-loading telephone responsibilities to call centers and a variety of companies that specialize in on-line, health information and triage solutions.
As I pointed out in my “Patientnado” post, the time has clearly arrived to start thinking in new ways about how we manage large populations of patients by applying exactly the most appropriate information and services in the most appropriate ways at the most appropriate time and place. In my own experience, I’m starting to see physician practices making use of communication/collaboration and customer relationship management tools that have become commonplace in other industries. Last December, I profiled a small family practice clinic that was making significant gains in patient satisfaction and medical assistant productivity by applying Microsoft’s cloud-based Office 365 and Lync unified communications solution to improve intra-office, care team communication. The lead physician in the group stated his practice would enjoy yearly savings of 30 days medical assistant time from that solution alone.
As a primary care physician, my heart goes out to colleagues who are struggling to stay afloat financially, let alone deal with the stress of these changing times and increasing patient demands. But physicians are a hearty, creative lot. Given more contemporary technologies and access to information on best practices, I believe they will adapt to meet the demands of health reform and whatever else comes at them in the future.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft
The real issue here is not one that can be solved by applying IT or even Physicians. The crux of the issue lies in your politicians, drug manufacturers and patent law surrounding pharmaceuticals. How else do you explain the US spending more per head on healthcare than any other country on earth, yet having healthcare that is on-par with some countries regarded as "third world"?
Jamie, thanks for your comment. Remember that one reason why pharmaceuticals are so expensive in the US is that our high prices subsidize drugs so they can be provided at lower cost in other parts of the world. There are also many other reasons why healthcare is expensive in the US. Yes, there is waste also high costs associated with billing, administration and regulation. Our physicians and nurses often earn more money than their counterparts in Europe or Asia. Although you are correct that by WHO criteria the US may lag behind other countries in certain KPIs, there are still lots of people who flock to the US from all over the world to receive medical care here for serious illnesses because our advanced care and treatments are superior to what is available in their own countries.
Bill Crounse, MD