Three Perspectives on the Physician Shortage Crisis: An HCE Original Report (Part 1 of 3)

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healthcareix-itunes-artworkThe national physician-shortage crisis has been covered extensively by healthcare media, but this coverage is often limited to the latest projections about the severity of the crisis and speculation about how it will impact different regions of the country.

Recently, HCE decided to dig a little deeper into this subject by talking with three healthcare leaders across different areas of the industry in order to get their perspectives on the physician-shortage crisis.

In Part 1 of this article, we’ll look at how the crisis is affecting the academic medical center. On Wednesday, our second installment will examine the perspective of a contract management group. And finally, on Friday, we’ll tackle the subject of rural healthcare and the physician-shortage crisis.


Perspective #1: The Academic Medical Center

The Cleveland Clinic is world-renowned for its influential medical breakthroughs and provider innovations. In April alone, Cleveland Clinic made headlines for the success of its Chinese herbal-therapy ward; its opening of a 364-bed specialty hospital in Abu Dhabi; and the newly launched affiliation between Texas-based Doctors Hospital at Renaissance and the Clinic’s Bariatric and Metabolic Institute.

Therefore, it’s not a stretch to say whenever the Cleveland Clinic is mentioned among healthcare leaders, curiosity is piqued and initiatives are inspired.

However, the Cleveland Clinic is first and foremost a non-profit academic medical center. Its access to physicians is second-to-none, and therefore, the impact it is feeling from the national physician-shortage crisis is limited, Rob Coulton, executive director of professional affairs, said, at least in the short-term.

“More so it is felt in smaller regional and rural centers, so whether it’s Cleveland or Boston or Philadelphia, you’re not going to see that they can’t find certain types of doctors,” he explained. “Now, long-term, you do start to take a look at the growing population and the need for care and the number of providers.”

So, how does an organization prepare for the possibility of long-term shortages?

Coulton outlined five ways:

1.)  Training Doctors at an Increased Rate

The Cleveland Clinic has its own highly specialized medical school through which it trains approximately 36 doctors annually over a five-year program. During the course of their education, these doctors are exposed to the Cleveland Clinic model of medicine, and many of them serve out their residencies and fellowships at places affiliated with the organization.

By creating familiarity through training, Coulton said, Cleveland Clinic hopes that it becomes an attractive employment option for these young professionals in the future.

2.)  Forging Productive Partnerships

Recently, the organization established a partnership with an Ohio State University-affiliated medical school that will be based in one of its hospitals. According to Coulton, the goal is, once again, to bring quality physicians to northeastern Ohio and to ensure that they stay in that region.

3.)  Finding Strength Through Numbers

The idea of healthcare organizations finding strength through numbers will be a theme that will come up repeatedly in our three-part series, and such is the case with Cleveland Clinic.

The Cleveland Clinic manages a roughly 3,000-strong physician-group practice in addition to the numerous hospitals it owns. The organization views each and every physician as being part of the Cleveland Clinic family, Coulton said.

“That multi-strategy mode of both employed physicians and maintaining community hospitals further positions us as far as having a good number of people.”

4.)  Evolving the Role of Physician Extenders

Critical to Cleveland Clinic’s efforts to avoid a long-term physician-shortage crisis is its nurturing and development of the role of the physician extender. The first step in this process, Coulton explained, is to help physicians understand how integral extenders are to the care process.

“If a physician gets a physician extender and an advanced-practice nurse and treats them just as somebody who is assistive and is really not an integral, independent part of the care team, there’s little value, but when you see this done well, the physician extender can deal with post-operative care, can deal with primary-care concerns, can be the inquiry point in increasing patient communication [and] also assisting with patients in compliance,” he said.

In its child clinics, for example, two pediatricians and two advanced-practice nurses are usually down the hall from each other. For well-child visits, the advanced-practice nurse will see the family first, and if a referral to a pediatrician is needed, the Cleveland Clinic has structured its model in such a way that the specialist is simply down the hall.

“We find that the families are very happy with it…because they like the time and the attention provided by the advanced practitioner,” Coulton said.

The Cleveland Clinic has begun recruiting physician extenders with the same fervor that it approaches its recruitment of physicians, seeking the best and the brightest from the physician-extender realm.

The reason for this is simple, according to Colton. “They’re remarkable caregivers.”

5.)  Enhancing Population Management and Electronic Monitoring

“Quite honestly,” he said, “if we’re successful in our 20-year goal, we reduce the amount of doctoring patients need.”

That 20-year goal is to keep people out of the hospitals and to emphasize wellness over illness, he continued. In fact, he wonders if the physician-shortage crisis has been adequately examined in light of the “phenomenal efforts” that are being made in patient wellness.

For example, Coulton sees breakthroughs being made with electronic monitoring for a variety of chronic illnesses, such as monitoring the sugar levels of diabetics or people on Coumadin. Electronic monitoring has the potential to reduce the number of times these patients have to visit their doctors, he said.

“You don’t want to misrepresent that by saying we’ll just care for them less,” he added. “That’s not the plan. They will need less care… If we just stopped caring for them as much because of cost containment, that would be a bad outcome. If they don’t need me as a doctor as much, then that’s a good outcome.”

-by Pete Fernbaugh

Coming Wednesday: The Contract Management Group

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