Speaker 1 00:00:00 Let doctors be doctors. Don't overburden them with the distractions and keep them away from the patients. Let them focus on where they're good at doing and the growing shortage of physicians. It only makes sense to keep the ones that we already have.

Speaker 2 00:00:25 Welcome to Off the Chart, a business of medicine podcast, featuring lively and informative conversations with health care experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. I’m your host, Austin Littrell. In this episode, Medical Economics Editorial Director, Chris Mazzolini, is joined by Brian McKillop, president of the locum tenens division at AMN Healthcare. They're talking about the physician shortage, including projections, causes and solutions from AMN Healthcare's latest report, which you can find linked in the show notes down below. Now, onto the episode.

Speaker 3 00:01:05 Brian McKillop, thanks so much for joining me today.

Speaker 1 00:01:08 Pleasure to be here. Thanks for having me. I'm looking forward to this conversation.

Speaker 3 00:01:11 So yeah, today we're going to talk a bit about the physician shortage. And I know that Am and healthcare has put together a recent report that had a lot of really eye opening details about sort of the shortage and where this, this crisis is.

Speaker 3 00:01:25 So to start off, can you just provide an overview of what some of the recent projections are for the physician shortage? And, you know, sort of a follow up to that is, you know, what do these forecasts imply for the future of health care in the US?

Speaker 1 00:01:41 Yeah, yeah. Happy to. Yeah. Variety of organizations make projections on physician shortages certainly in recent years. The two most widely referenced and those that are periodically referenced by the Association of American Medical Colleges and by Health Resources and Health and Service Administration in 2024. The Aamc projected a shortage of 86,000. Physicians by 2036, in 2023. HRSa indicated that there currently is a shortage of over 57,000 physicians, which will grow to over 81,000 by 2036. So, as you can see, you're you're staring down the barrel of some some pretty heavy numbers there. Pretty heavy lifts when it comes to some shortages.

Speaker 3 00:02:23 What do they mean? You know, what is this like from a big picture standpoint? You know, what does this mean for patients for doctors in general?

Speaker 1 00:02:32 I mean, it's supply and demand, right? I mean, you look at it and you sort of start thinking through, and we'll talk about, you know, contributing factors here with the with this, the shortage, the demand continues to grow.

Speaker 1 00:02:46 as we look at patient population, we look at provider aging. And we'll go through this actually, we actually call it, we like taking complex, questions and simplifying it with some statements. We call it the seven P's. these are these are the contributing factors. One is population growth 2050. Population will grow by 90 million people. 90 million people. That's according to the Census Bureau. But in 25 years, the second one is the population continues to age. Of course. Right. In less than ten years, there'll be more people 65 years or older than 17 years or younger. That's for the first time ever in the US. And as you know, all older people see the doctor three times the rate of younger people, according to the CDC. So that's a huge factor driving that demand. the on the transverse, on the, on the provider side, providers are also aging, not just the population. So we're approaching a physician retirement cliff. 30% of active patient, you know, care physicians are 60 years of older, 23% are 65 or older.

Speaker 1 00:03:50 So we've got that. That is a potential problem, but we're also looking at other sides of the provider problem, such as burnout. I know that is a hot topic, and we'll probably go into a lot more based on some questions that we'll have here today. But many physicians are just simply dissatisfied with current medical practice conditions, seeking non-clinical jobs, changing jobs, or retiring. Last year, 44% of physician searches were replacement physicians who left. So, so big problems there, too. the the fifth p pervasive ill health. Six and ten US adults have chronic medical conditions, diabetes, high blood pressure. so we're comparatively sicker than other developed countries and have more doctors demand per capita because of it. And then as we continue to look at the the other contributing factors, definitely pipeline problems. The sixth p 97 Congress, capped the amount of money the federal government spends on training physicians. They added some one time funding during Covid, but certainly not enough to keep pace with the demand for doctors. So soon we'll have more water leaving the tub than coming in.

Speaker 1 00:05:00 And I would say the last predominant factor, and probably the one that's most fluid, is the practice styles that we're seeing. right. So, so most physicians, no longer own their own practices, right. Or they're working countless hours. They're employed, they work through groups or hospitals specifically, and they have set hours and they have set vacations. I mean, this is, you know, the new world we live in. And, so, you know, when one doctor is coming into the system doesn't necessarily replace one old doctor leaving. So sometimes it takes a new doctor with an app or EMP or PA or even two doctors to replace the old one. So several factors there. But like I said, we like to boil it down to a digestible seven, to help us kind of understand the dynamics around it.

Speaker 3 00:05:47 Yeah, no thanks for doing that. And we'll definitely share, you know, a link to the the full report, you know, on our website, Medical economics.com and in the show notes of this podcast.

Speaker 3 00:05:58 So you know, so physicians out there can can get a get a look at the actual, you know, report that you're mentioning in the seven P's. And so the, the one thing I wanted to kind of make note of, was, you know, you know, there's been always a lot of discussion about sort of underserved communities. So like where like in some ways, the physician shortage is already like a real thing, right? It's not like a projection in the future. And the report may note that, like, you would actually need like an additional like, you know, upwards of 200,000 physicians to get that actual equal access to care. So, you know what I guess, what are your thoughts in terms of, you know, strategies that can be implemented to sort of help address the disparity in access? You know, while we're also dealing with this, like looming national nationwide shortage.

Speaker 1 00:06:43 Yeah. And MSI did indicate that for all those Americans living in underserved areas to have access to physicians equal to, or enjoyed by people who live in places that are comparatively high.

Speaker 1 00:06:52 Number of physicians. We actually need over 200,000 physicians. so if you think about that, tells you even more about the projections of physician shortage ten years from now. Unfortunately, we know this has been a long standing, you know, problem for shortages of physicians in many areas, particularly rural. most physicians don't want to live on a medical island where there's no other specialist to consult or refer to. They want to have a work life balance, which is hard to achieve in those types of situations. They want cultural amenities. They want employment opportunities for their spouse and their kids. They want to go to the opera, you know, they want to do things that you really typically can't do in a in a rural community. We conduct a survey, for final year to drive the point home. if final year resident medical residents, that indicates only 2%, 2% of physicians in their last year training would actually prefer to live in a community of 10,000 people or fewer. So, yeah, it's a problem.

Speaker 1 00:07:48 so, what's happening continues to happen is that the gaps are being filled by advanced practice professionals such as MPs and Pas. on the permanent recruitment side of the business, we now recruit more MPs than we actually recruit family physicians or any other type of physician. we also rely on, to certain extent, international physicians who must practice in rural areas for visa reasons. So we're sort of bridging the gap from the MD standpoint, from that aspect. Ultimately, we need to expand rural residency programs. I think is a big component of that. Programs like the National Health Service Corps that allow physicians to pay off their medical debt, practicing in those areas and rural areas also need to grow their own physicians, right? Finding students from rural areas who understand the dynamic of living in that space where their family, where they grew up, to help, help them, help help them stay home. Right. And also help pay for their education. We can do more. but this is definitely an absolute ongoing challenge for us.

Speaker 4 00:08:48 Say, Keith. This is all well and good, but what if someone is looking for more clinical information? Oh.

Speaker 5 00:08:54 Then they want to check out our sister site, Patient Care Online. The leading clinical resource for primary care physicians. Again, that's patient care online. Com.

Speaker 3 00:09:06 So you know, you had mentioned, I think in a previous answer, burnout. And obviously it's always been a big issue, that physicians face and all health care workers really. can you discuss, like, some of the causes of burnout and some of the potential solutions, to sort of improve, you know, retention, you know, avoid those early retirements, perhaps that maybe, you know, dry, you know, with, you know, the feelings of burnout that sort of, you know, maybe drive a physician to, to call quits earlier.

Speaker 1 00:09:38 Yeah. It was really exacerbated when you think about the, pandemic. but now it's just continued, challenge that we're going to, have to answer for. Many physicians are tired of prevailing practice conditions, as I talked about.

Speaker 1 00:09:53 you know, if you think about what a doctor is trained to do, a lot of them now are asked to do non-clinical paperwork are, things like battle for reimbursement from third party payers, you know, the need to fight for pre authorizations. I mean, I personally have experience with my doctors going through that process. continued long hours. you know, that treadmill feeling that they have, you know, they worked hard to become a physician, and many times they're finding less time seeing patients than they are actually doing the paperwork, administrative functions of the job. you know, on, on a, a bit of the micro level, there are a variety of things that can be done to reduce that, that burnout, enhance that retention. Number one thing I would say is probably the daily work experience for the physician. So reduce that data entry through use of scribes. Use team based approach that allow physicians to practice at the top of their training and leave the more routine work to the other providers. Seek the inputs, particularly on clinical protocols.

Speaker 1 00:10:52 Ensure that they have efficient workplaces with easy use, up to date technologies to allow them to do things more efficiently. you know, do do what you can do to allow them to do what they want to do. And we're trained to do as to see the patients on the more of the macro level, it gets a little bit more complicated. it speaks to probably better management practices, I think about capacity planning and optimization, really understanding not just panel sizes, but really understanding the downstream implications of of who you hire, why you hire. If you need to hire an anesthesiologist, does it make more sense to hire to CNAS as an example? Or if you hire a surgeon, how many anesthesiologists do you need? Right. So understanding the flow of capacity and the impacts downstream to patient care. So those are I would say a couple of things, macro and micro that allow us to kind of help with that burnout component.

Speaker 3 00:11:43 You had mentioned the retirement cliff that's approaching, with physicians, right? Obviously, we have an aging population, which, like you said, includes both patients and physicians.

Speaker 3 00:11:53 And so, you know, it gets you thinking about, you know, sort of the next generation of doctors and, you know, sort of making sure that we have enough that are coming out of medical school, going into residency and all that. And, you know, anytime you start, you know, start talking or thinking about, you know, medical residency, you start think, you know, getting like kind of brushing up against all of these policy challenges, like how many residency slots there are and who funds those and all that. So, you know, obviously without spending, you know, 1000 hours, which we could talking about this, could you kind of discuss the role that sort of the medical residency, you know, caps and the funding mechanisms play on the physician supply issue.

Speaker 1 00:12:36 Yeah, sure. First we'll talk about that that, the senior component, because it's important to drive that piece home. Right. the CDC has reported that, about 15% of the population is, is our seniors, but they account for 35% of inpatient procedures, test treatments.

Speaker 1 00:12:55 Right. So you've got that component with the aging body parts that they have. If you think about the teams that that see those, individuals within those specialties, cardiologists, gastroenterologists or those pulmonologists, right. They're already in short supply. So you've got the primary care physicians that also need to coordinate that care. So you're seeing PCBs that are also in shortage, right. So you just think about think about that downstream implication of that. you know, our survey of patient appointment wait times is showing that the average wait to see a physician is getting longer, and it's grown by 43% since we started that survey, nine years ago. And so the role of the medical, you know, residency funding is an interesting one. medical training is the pipeline, obviously, that brings in the new physicians to our workforce. So I mentioned that as the £0.07, right. and the number of physicians we've trained since 97, when Congress put that cap on federal spending, is continue to be a bit burdensome for us and funding while it comes from states, and some from private sources, the number of residency positions has has increased slightly, but it doesn't keep pace with the demand for the reasons I just mentioned with the aging population.

Speaker 1 00:14:09 So the legislation would need to significantly increase for federal funding for GME. And, it's been introduced to Congress repeatedly in several years, but it's really never gained the right level of traction. So until we see increased funding in that area, we're going to reach a point where more physicians are leaving medicine that are entering while our population demand continues to climb. It's a it's a critical need that I know is is currently being addressed. It's a hot button in today's political landscape with the new administration. But we need to see immediate action coming from Congress on this one.

Speaker 5 00:14:46 Oh, you say you're a practice leader or administrator. We've got just the thing. Our sister site, Physicians Practice. Com your one stop shop for all the expert tips and tricks that will get your practice really humming again. That's physicians practice.

Speaker 3 00:15:03 What about the, the way doctors are practicing in terms of their employment now? You know, in the past, we had, you know, independent practice, right, was predominant. But like you, like you mentioned, we're moving towards an employed kind of status.

Speaker 3 00:15:15 Can you talk about that, the role of that in a little bit more detail?

Speaker 1 00:15:20 Yeah, I mean, they ran their own practices working 8000 hour workweeks. Right. So, it's interesting dynamic because we talk on one hand about retention and making sure that we don't have to burn out. So reducing that, it's an interesting thing because you're not going to have as much burnout if you're working less than 100 hours a week, right? You've got that work life balance. It's healthy and can be productive, but it does put a strain on the physician supply, because one physician coming out of training today does not necessarily equate to replacing an older one that's retiring. Sometimes it takes this to, as I mentioned before, so you've got a physician, a PA or an NP to replace that tiring FTE. Fortunately, we've got other flexible models, right. Telemedicine. We were seeing a complete uptick and rise in and and telemedicine which is great creates that flexibility that allows us to sort of have part time help, where you've got flexibility on both sides of the equation, on the, on the patient side as well as the physician side.

Speaker 1 00:16:16 And it's keeping physician in the workforce that might otherwise retire. Right. So it allows them to continue to see patients. In the same vein, we can look at locums, locum tenants, which I happen to be responsible for here at Amnh. Over 52,000 physicians in the US work low attendance jobs each year. That's tremendous. And we're expecting an 8 to 10% increase in that year over year. So again, as many older physicians might have potentially stepped away, they decide to work locums jobs instead because they still enjoy seeing patients and want to continue to have, you know, the ability to help and serve our communities there. You know, the one size fits all practice model just doesn't work in today's physicians. It's important to be flexible and tailor the practice to fit the physicians need. I mean, if you look at the supply and demand, the demand is there and the supply isn't. And when that happens, you have to I don't want to say acquiesce, but you have to be flexible with the physician.

Speaker 1 00:17:12 You have to go where the physicians taking you. And if they need that flexibility, then we have to cater to that to allow that to happen.

Speaker 3 00:17:21 So, you know, it's you know, we started off talking about like the projections in, you know, the 2030s and all that stuff, which obviously is important to future plan. But like what what should we do about it now? Like, you know, there are patients that need to be seen every year. There's a lot of, you know, boomers and stuff that are getting older as the doctors are getting older, like you mentioned. So what do we do about the physician shortage in the short term? Like, you know, what is something that that can be done to sort of help alleviate this? now.

Speaker 1 00:17:50 Chris, you're asking me for the silver bullet. I wish, I wish I had one for you, I don't. All right. it's it's a very difficult question to answer because, you know, the short term is a difficult thing because the journey to become a physician is so long.

Speaker 1 00:18:06 but there is a there is one thing that comes to mind. you know, Tennessee, for example, has passed a law allowing international medical graduates to practice in the state without having completed a US based residency. So we can we reduce those barriers for international medical graduates to come to states and allow that practice to happen. There's things like that. We've got opportunities. we just we just have to look at them through a different lens. Medical graduates, there's a desire and and capacity there for us to be more flexible, to allow that to happen. But the best thing we can do in the short term is to really work on that physician retention. It's really, really critical. Let doctors be doctors. Don't overburden them with the distractions and keep them away from the patients. Let them focus on where they're good at doing and the growing shortage of physicians. It only makes sense to keep the ones that we already have.

Speaker 3 00:19:01 Before we wrap up. could you say a little bit about Amen, Amen health, what you guys do and like what resources you have for physicians?

Speaker 1 00:19:11 Yeah, we're we're a digitally enabled workforce solutions partner.

Speaker 1 00:19:14 And we focus on the biggest challenges facing healthcare organizations today. And we just talked about a lot of them. Right. The, the the retention, the continued ongoing evolution of how physicians and providers can stay engaged. And those are things that are certainly near and dear to my heart personally. Aman, covers over 30 specialties. We've been doing what we've been doing in the space for over 40 years. we work in every type of community, from critical care to large ecosystem health care systems, and we run the gamut with regards to all types of solutions, including nursing to, permanent placement to interim roles, to locum tenens, even language services. So we run the full gamut of health care solutions, workforce solutions for our partners and for our providers.

Speaker 3 00:20:06 Brian McKillop, thanks so much for joining me and talking about this important issue. It was great talking to you.

Speaker 1 00:20:11 Chris. It was my pleasure. Thank you very much, sir.

Speaker 2 00:20:25 Once again, that was a conversation between Medical Economics Editorial Director Chris Mazzolini and Brian McKillop, president of the locum tenens division at AMN healthcare.

Speaker 2 00:20:34 My name is Austin Littrell, and on behalf of the whole Medical Economics and Physicians Practice teams, I’d like to thank you for listening to the show and ask that you please subscribe on Apple Podcasts, Spotify, or wherever you get your podcasts, so you don’t miss the next episode. Also, if you’d like the best stories Medical Economics and Physicians Practice publish delivered straight to your email six days of the week, subscribe to our newsletters at medicaleconomics.com and physicianspractice.com. Off the Chart: A Business of Medicine Podcast, is executive produced by Chris Mazzolini and Keith Reynolds, and produced by Austin Littrell. Medical Economics, Physicians Practice and Patient Care Online are all members of the MJH Life Sciences family. Thank you.