AcuteCare Telemedicine Blog


Solving the Physician Shortage: Should it be Left to an Act of Congress?

Since 1997, the number of physicians entering the workforce each year has essentially been capped, while the demand for everything from hip replacements to treatments for diabetes to angioplasties has soared with our growing and aging population. Now, the Obama administrations newly proposed budget seeks to spend an additional $5.23 billion over the next decade to manufacture new physicians. While this sounds like a lot of money, given the magnitude of the doctor shortage issue, it won’t be nearly enough to solve the shortage problem on its own merits. The proposal is designed to swell the ranks of primary care doctors, those family physicians, general internists, and pediatricians that constitute the healthcare workforce that is predicted to experience the greatest shortage of all the medical disciplines.

But primary care is not the only medical care discipline that is facing future short falls.  According to a study by the American Academy of Neurology (AAN), by 2025 the demand for neurologists will far outnumber the supply, creating a 19 percent disparity in the number of doctors needed to adequately care for all patients. Those who suffer with neurodegenerative diseases like multiple sclerosis (MS), Parkinson’s, and Alzheimer’s will have to wait longer to see a specialist.

“The doctor shortage is worse than most people think,” says Steven Berk, M.D., dean of the School of Medicine at Texas Tech University. “The population is getting older, so there’s a greater need for physicians. At the same time, physicians are getting older, too, and they’re retiring earlier,” Berk says. And graying doctors, nearly half the nation’s 830,000 physicians are over age 50, are seeing fewer patients than they did four years ago.

The flow of doctors entering the market each year is determined by the number of U.S. residency positions, chiefly in teaching hospitals. Those positions are funded primarily by the program that oversees Medicare and Medicaid. In 1997, the federal government essentially froze spending on residency slots, limiting the number to around 100,000 over three-to-four years, and in turn freezing the number of newly licensed physicians available for hire each year to around 26,000. Over the past 17 years, a few hospitals have established new residency programs for primary care doctors, raising the number to around 27,000, or a less than 4% increase. Meanwhile, the U.S. population has risen by 50 million, or almost 20%. The American Association of Medical Colleges estimates that the U.S. will face a shortage of 46,000 primary care doctors by 2020, equivalent to one-quarter of everyone practicing in that category today.

The Affordable Care Act promises to magnify the problem but does attempt to address some of the issues to help stem its effect on the shortage by allocating an additional $1.5 billion in funding for the National Health Services Corps, which provides support to health care professionals in exchange for their service in areas with a more prevalent shortage. The law also puts more money toward training in hopes of increasing the primary care workforce and it offers more graduate positions for primary care doctors and more scholarships. It even offers a 10% bonus to primary care doctors who agree to see Medicare patients through 2015.

But many in the medical care industry do not see the solution reserved for government legislation alone. “Keep in mind the Affordable Care Act didn’t create this crisis,” said Dr. Reid Blackwelder, president of the American Academy of Family Physicians. “We’ve got an aging population that needs more care and a growing population.”

Many believe that new technologies will extend the reach of medicine in ways that will ameliorate the shortage problem. Health care professionals can serve more people by using telemedicine technologies to examine, treat and monitor patients remotely as well as providing patients increased access to advanced stroke care. These technologies are already keeping patients out of hospitals and doctors’ offices and providing improved recovery results. Creative new ways medicine is delivered, such as the use of “medical homes” and “accountable-care organizations” to better coordinate patient care, are also expected to improve efficiency and keep patients out of the hospital. Telemedicine enhances productivity and outreach while cutting costs, it improves diagnosis and care management in remote areas, and it reduces unnecessary care. The technology also strengthens partnerships between community based hospitals and advanced regional care centers.

“I understand there is a sense of worry, and change can be scary, but our present system is broken,” Dr. Blackwelder said. “We pay twice as much for our health in this country and have worse outcomes than other countries. Looking to government to fix a problem often harbors complexity, inefficiencies and long-term implementation of solutions. Dr. Blackwelder’s opinion reflects that of many other medical industry professionals, “We will have to start coming up with creative solutions to this problem, ones that won’t have to wait for an act from Congress.”



Study Confirms Predictions Of Telemedicine Benefits for ICU’s

Supporters of telemedicine have long predicted that the application of telemedicine services in Intensive Care Units (ICU’S) would have a beneficial effect on costs and patient outcomes and the first large-scale multi-center study of the effects of use of telemedicine in the intensive care unit for adult care is indicating significant improvements in patient care and lower costs.

The results of the study were released in the CHEST Journal Online First, a publication of the American College of Chest Physicians. The study, “A Multi-center  Study of Telemedicine Reengineering of Adult Critical Care,” looked at the impact of the program on 118,990 critical care patients, across 56 ICUs, 32 hospitals and 19 health systems over a five-year period, and demonstrated reductions in both mortality and length of stay.

Among the key findings were that, compared to patients receiving conventional ICU care, patients using the telemedicine ICU program were:

  • 26 percent more likely to survive the ICU;
  • Discharged from the ICU 20 percent faster;
  • 16 percent more likely to survive hospitalization and be discharged; and
  • Discharged from the hospital 15 percent faster.

Craig Lilly, M.D., professor of medicine, anesthesiology and surgery at the University of Massachusetts Medical School and director of the eICU program at UMass Memorial Medical Center, said, “The study demonstrates that if you use really high-quality tools and motivated and talented people, that you can shift the paradigm; you can save lives and you can save money at the same time.” He added that the study is large enough, that it provides some insights as to ICU telemedicine works, and where its use makes sense. He noted that not everybody that implemented the ICU telemedicine tools did it in the same way. By using the validated survey instrument, the researchers were able to identify factors that made a difference in better patient care.

“Today, personnel accounts for 56 percent of the $2.8 trillion healthcare spend in the U.S., and coupled with the current shortage of clinicians, many hospitals are unable to offer on-site intensivist physicians, 24 hours a day, seven days a week,” said Brian Rosenfeld, Vice President and Chief Medical Officer, Philips Healthcare Telehealth. “This study provides further evidence that health systems employing coordinated telehealth in their care models will increase provider productivity, while improving outcomes and reducing costs.”