WHAT IS THE FUTURE OF VALUE-BASED CARE?

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Research

How to prevent a primary care shortage

Let’s slow down a little on this idea of a physician shortage. Several recent analyses proclaim the US health care system will see a massive physician shortage in future. The basis of this hypothesis is demand for care will far outpace physician supply as the population continues to grow and age but the rate of physicians entering the workforce stays roughly the same. This shortage will worsen access to care and burden practicing physicians for years to come. And it seems inevitable. But is it?

We disagree. We respect other organizations’ models and analyses. But there is ample evidence the current physician workforce doesn’t practice anywhere close to its full clinical capacity because of immense administrative burden and inefficiencies in our systems. Especially in primary care, which is where we focused our analysis. What if PCPs could spend more time clinically and less administratively? Our hypothesis: there will be NO PCP shortage if leaders in the industry fix—or at least improve—the way physicians practice. We identified primary care workflow interventions with vetted data that increase physician capacity and allow them to spend more time clinically and less time administratively. Then we tested what impact those improvements could have on PCP supply.

The main takeaway:

Health care leaders CAN prevent a PCP shortage. We evaluated how interventions in four categories affect primary care visit supply (workflow optimization, care team redesign, telemedicine, and enabling technology). Even in our most conservative estimates, these interventions increased physician capacity to the point where there was not just no physician shortage but a visit surplus. Getting as tactical as possible, we found implementing just one intervention from each of the four types increased physician capacity enough to eliminate a PCP shortage.

 

Here's what we did

We analyzed PCP supply and demand by converting the number of providers and their hours worked into visit capacity. Physicians can’t work more hours—this was a guiding principle of our analysis. However, organizations can redistribute time spent on administrative tasks to clinical time through workflow interventions to increase visits.

  1. Projected visit demand: We estimated current annual demand by applying the average annual visit number per primary care provider from our Integrated Medical Group Benchmark Generator to the entire U.S. adult population. We then applied population growth projection to estimate future demand. Those estimates are in line with external analyses, such as from the AAMC.
  2. Projected visit supply: We considered both PCPs and advanced practice providers (APPs) in supply, accounting for departures and entrants to the workforce over the next decade. Then, we converted the number of providers into clinical hours and visits per year to get projected supply of visit capacity.
  3. Projected visit supply with workflow interventions: After segmenting current provider time worked into administrative or clinical, we identified several primary care workflow interventions with vetted data that reduce provider administrative burden or increase their visit capacity. Then, we determined how many visits (or fractions of a visit) each intervention could produce per provider. We calculated how much each intervention could increase visit supply at conservative, moderate, and aggressive levels.

We compared the three measures and got a clear-cut answer. If organizations can leverage these different workflow interventions—and therefore increase visits per provider per week without working more hours—we can completely eliminate the looming physician shortage.

 
Three findings from our analysis
 

What this means for you

Take models with a grain of salt: If the Covid-19 pandemic teaches us anything, it’s how quickly things change in health care. The future supply of physicians is impossible to accurately quantify no matter how perfect the data or calculations. Instead of focusing on the number of physicians, leaders should prioritize maximizing the capacity of the physicians they have.

Another goal should be to decrease PCP working hours: On average, PCPs around the nation work more than 50 hours per week. Much of their work happens after clinic hours. And we’re in the third calendar year of a global pandemic. How long will physicians tolerate these conditions? More than mitigating a long-term physician shortage, implementing these interventions makes current physician practice more sustainable. For physician leaders, a better work-life balance gives an organization an advantage when recruiting new physicians and retaining existing ones.

Act now—you have more agency than you might think: Our analysis shows there is a lot within a provider organization’s control to increase their primary care visit supply. Organizations can and should make these care model and technology changes now. Not just to offset a future shortage but to ease the burden on their current workforces.

Footnotes

1 See appendix for full intervention list.

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