Having problems finding a doctor? If technology advocates have their way, it may not be as much of a problem as some are warning.
It was recently predicted that patient demand for physicians will drop between 4 and 9 percent by using health technology in community physicians’ offices, according to the November issue of Health Affairs.
The projection is based on the assumption technology would be used in slightly less than a third of US physicians’ offices.
“We estimate that if health IT were fully implemented in 30 percent of community-based physicians’ offices, the demand for physicians would be reduced by about 4–9 percent. Delegation of care to nurse practitioners and physician assistants supported by health IT could reduce the future demand for physicians by 4–7 percent. Similarly, IT-supported delegation from specialist physicians to generalists could reduce the demand for specialists by 2–5 percent. The use of health IT could also help address regional shortages of physicians by potentially enabling 12 percent of care to be delivered remotely or asynchronously. These estimated impacts could more than double if comprehensive health IT systems were adopted by 70 percent of US ambulatory care delivery settings,” according to a summary in the Health Affairs article.
Also, the National Center for Health Statistics claims electronic medical records give providers more use of patient records at the time of care, e-prescribing, and an easier time to retrieve lab results.
The recent journal essay projections come from Jonathan P. Weiner, who teachers at the Johns Hopkins Bloomberg School of Public Health in Baltimore, and his colleagues. Yet, Weiner said, according to Emrand EHR, use of health IT by even 30 percent of office-based doctors is between five years and 15 years in the future.
On the other hand, many doctors have already complained adopting new technology leads to lower productivity – especially at the start. There can be workflow challenges and difficulties in training, news reports said.
Recently, there have been concerns mounting about a current and future physician shortage. More patients are likely as Americans, who did not have insurance, sign up for the Affordable Care Act, which requires several preventative measures for patients under the plan. More than 30 million Americans are predicted to get medical care coverage over the next several years.
In addition, there is an aging of the US population. That means more medical needs. The number of Americans who are 65 and older will increase to 19 percent in 2030 from the current number of 12.9 percent.
Recently, Staff Care, a physician staffing company, also reported how hospitals and physician offices, were unable to find permanent physicians and opted for temporary employees.
“In a down economy, people don’t see the doctor unless they have to, either to avoid deductibles or because they are not insured – and there still are not enough physicians to go around,” Staff Care president Sean Ebner said in a statement quoted by Forbes.
In fact, the US will need 130,000 more doctors in about 10 years than medical schools are now producing, according to the Association of American Medical Colleges.
Use of more technology and better use of a health-care team may be able to help. For instance, there are sensors which provide remote monitoring of diseases and quicker interventions. They thus lessen the need for inpatient treatment, according to a recent Op-Ed in The New York Times by two prominent physicians, Scott Gottlieb and Ezekiel J. Emanuel. They two argue use of drugs and devices can lessen the need for more costly treatments. Minimally invasive procedures lead to lower expenses, too. Also, the use of nurse practitioners, health aides, pharmacists, dietitians, and psychologists will see less need of physicians by patients. Skilled health aides can follow patients at home, as well.
Not everyone agrees that better increased use of technology and other steps recommended by the two doctors can prevent the predicted physician shortage.
“It’s not that simple. Many of the changes mentioned, such as team approaches to medicine, are already being introduced, and shortages are increasing. Each medical professional is important in the care and treatment of the patient. Some physician responsibilities can be shifted to other trained medical professionals, and that is a critical part of the solution. But other medical duties cannot be shifted. We need to train more doctors,” Steven Corwin, CEO of New York-Presbyterian Hospital, wrote in a recent letter to The New York Times. He points out how the US government “arbitrarily caps the number of doctors who can be trained at approximately 17,000 residency positions a year. Those caps were imposed in 1997 when we believed that the country faced a doctor surplus and have remained in place despite the evidence of a growing doctor shortage.”
The resolution of this problem still rests with patient satisfaction with the provider. Will patients be satisfied seeing a nurse rather than a specialist? Many patients now do not even want to see generalists, even though they are qualified to treat many conditions. Will they have confidence that a monitoring device is a sufficient alternative to actually seeing a physician? Many patients are increasingly familiar with a specialist’s prior training and experience. They know which hospitals provide the best residency or fellowship, and look for top-quality medical schools in their doctors’ resumes. They want physicians who have extensive experience in treating a specific ailment, too. National rankings of hospitals in treating conditions are now widely available.
Technology cannot replace this bias, which many of us share. But it can help to treat patients, especially those who otherwise would not get care. Unfortunately, what appears to be developing – unless there are more medical schools producing more doctors on the horizon – is a two-tier medical system. The people in the know with the right insurance will get personalized service. The rest of us will get whatever can be dreamed up using technology and a division of labor among physicians, nurses, physician assistants and health aides, as well as remote diagnosis. This is the situation in the United States. The rest of the world, particularly where there is extensive poverty, still struggles with a third category: Little or no care at all.
Edited by
Cassandra Tucker
