To understand American healthcare today doesn’t require mastery of CRISPR or mRNA vaccine technology or the latest minimally invasive cardiac procedure — although these are all wonderful and life-changing innovations. Instead, the topic currently guiding much of our understanding is basic economics. Starkly put, healthcare is facing a classic problem of supply and demand. The supply of physicians in the American workforce is simply not large enough to accommodate the massive – and growing – demand for our services by patients. A November 2024 projection by the National Center for Health Workforce Analysis put the issue in focus. It showed an expected physician shortage of 167,000 in 2032, growing to 187,000 by 2037. The American Association of Medical Colleges has a bit more conservative outlook, putting the expected physician shortage at 86,000 by 2036. But the fact remains that the significant challenges we’re experiencing in our clinics and hospitals today are only likely to get worse.
This is, of course, not news to anyone who works in healthcare. But patients keenly experience the physician shortage, too – and they feel it in their daily lives. They’re increasingly familiar with this unbalanced reality during those unfortunate times they must wait lengthy periods for an appointment with one of us – a situation no one wants. That said, solutions to the persistent physician shortage have received relatively little public attention.
At my institution, as at many others, we’re working this problem from both ends: We’re putting extra energy into recruiting the next generation of physicians to join our seasoned veterans, having added more than 50 surgeons and cardiologists in the last five years. That’s a significant influx of talent in an institute that employs 170 physicians. Our belief in creating and empowering multidisciplinary teams to better serve our patients’ diverse needs, rather than departments or divisions, is fueling this growth.
But that’s only part of solving the supply and demand equation. To keep our current physicians engaged, employed and seeing patients, we’re leveraging the strengths of different physician age cohorts to help troubleshoot emerging issues. Our recent implementation of a new electronic medical record, for example, frustrated some of our colleagues – a phenomenon of course not unique to us. But as a result, we now have a mentoring program where more tech-savvy physicians teach their colleagues how to use the system in the most time-efficient way. On the flip side, we’re also engaging some of our more experienced physicians from our regional hospitals academically, assigning them to be mentors to some of their younger colleagues. This engages them in a way that they may not have experienced in the past. Some are brought into teaching services, because the hospitals where they were practicing did not have residency or fellowship programs. While both interventions are wildly different, both harness the inherent collegiality of our profession to help build – and maintain – an engaged physician workforce.
It’s also important to note a growing number of American physicians are now employed by hospitals, health systems and corporate entities, as I am. A 2024 study by Avalere put the number at 77%. Given this trend, physicians in practices or hospitals that have been acquired may feel a certain loss of identity. That’s why it’s even more important for smaller divisions like services lines within health systems to create purpose, camaraderie and team culture. We’re seeing that efforts like these can make an appreciable difference in our physician engagement and retention.
Being on call is another pain point for physicians – and an increasingly common reason they cite for wanting to retire. Of course, we can never move totally away from being on call – it is an essential component of clinical work. But we can implement it in more creative ways. Our approach is to move away from a call team being assigned to just one of our many hospitals and instead employ a regional model, where three hospitals are covered by the same team. That’s significantly more manageable than being on call every other night. The bottom line? The burden of call is light and can be consolidated. We’ve found this is true even for serious cardiac emergencies like a ST-elevated myocardial infarction (STEMI) – known to most simply as a heart attack.
As a health system, we not only directly employ physicians, but we also have partnerships with many physicians who have their own independent practices. One important initiative we’ve undertaken with these colleagues is to maintain open dialog about their future. They appreciate it, and it’s certainly worth the effort. If you don’t have that collaborative relationship as a backdrop for important conversations about the trajectory of their practice, a sudden retirement could potentially put access to crucial services in doubt for patients.
The physician retention conundrum is a thorny one, and the headwinds are strong. A recent survey by McKinsey found that about 35% of responding physicians said they’re likely to leave their current roles in the next five years, with 60% of these saying they’re likely to leave clinical practice entirely. Physicians also know there are other outlets for their talents, with as many as half reporting even weekly job offers. Given these challenges, it will take the collective creativity of all of us who see patients to shore up our physician workforce. But one crucial factor seems to be respectful, frequent, communication. As leaders of service lines, we must do more to engage our physician colleagues to create purpose and camaraderie. Physician retirement is inevitable, but we want to help physicians retire for positive, not negative reasons.
I recently received notice from one of our physicians that he was planning to retire – in two years. He wrote that he had such affection for his team and for our institute that he wanted to be sure to give as much notice as possible to find his replacement. This is just one example, but it makes the point well: Cultivating that feeling of family really pays off, not only for our institutions, but for our patients. We should be using more creative approaches to bring it to life.
Mehdi Shishehbor, DO, MPH, PhD, is a practicing interventional cardiologist and President of University Hospitals Harrington Heart & Vascular Institute in Cleveland, Ohio. He also holds the Angela and James Hambrick Chair in Innovation.
