As the U.S. population ages and the number of physicians fall, many argue the country will face a steep provider shortage.
There are several possible factors driving the physician shortage. The number of older Americans will double by 2039 at current rates. As people begin to live longer and require more medical care as they age, the number of physicians will need to increase to keep pace. The shortage spans across all specialties, and projected shortage numbers range from 45,000 to 90,000 physicians, according to the Association of American Medical Colleges.
Another potential factor is physician burnout contributing to the decline in physicians. The American Medical Association has sent multiple letters to CMS saying new federal technology requirements place a heavy burden on physicians. Many physicians say that their interaction time with patients is greatly reduced because of the documentation requirements of EHRs and other technologies in the exam room.
Nick van Terheyden, MD, CMIO of health IT company Nuance Communications, said many physicians are discouraged by the lack of patient contact because of current technology setups. Many physicians are facing away from patients in the exam room, which detracts from personal contact with patients, he said.
"If you take the whole process, workflow and user interface, it's focused on the screen and the need to capture information," Dr. van Terheyden said. "It's fundamentally flawed in most instances because the physician is facing away from the patient."
However, while technology may be contributing to elevated rates of physician burnout, the healthcare industry could also use technology to relieve those stresses.
Dr. van Terheyden said there are several technology measures in place that can improve physician engagement with patients while still meeting technological documentation needs. For example, many medical residents are now doing "rounds" on computers instead of physically going to patient rooms out of the need to view and monitor patient documents. Simply importing the records onto iPads or mobile devices so residents can physically go to patient rooms could contribute to interaction, he said.
The design of exam rooms in regards to technology could also be improved, Dr. van Terheyden said. Importing electronic medical records onto a tablet and turning it around to face a patient, documenting the interaction through dictation transcription software, may help physicians be more physically interactive with their patients, he said. Allowing the patient to view the document as information is being entered allows them to make corrections if something is incorrect as well, he said.
"If you consider in the room who has the biggest vested interest, it is the patient above the physician," Dr. van Terheyden said. "If they become part of that interaction, you get more patient engagement with better patient education."
Encouraging physician interaction with patients may encourage more students to go into medicine, helping to bridge the shortage, he said. Many older physicians feel overwhelmed or discouraged by their lack of engagement with their patients, which leads them to advise students not to go into medicine, he said.
The medical community needs to address the shortage soon by improving graduate programs and educational system for physicians because it takes years to train qualified physicians, according to the Association of American Medical Colleges. Dr. van Terheyden said the cost of training and medical school is also discouraging many students from going into medicine because they fear they will be unable to pay back the debt.
Several members of Congress launched an effort to provide more funding for graduate medical education and to improve access to more slots in medical schools, according to a statement from the AMA. Dr. van Terheyden said this is an important first step.
"We're always going to need physicians," Dr. van Terheyden said. "The impact of this is years away, and it will be very difficult to go back and fix it."