Tag Archives: Medical Practice

Workforce Predictions and Horse Manure

The Association of American Medical Colleges (AAMC) recently released a new report detailing their predictions for the physician workforce of the future. The accompanying press release highlighted the key finding of the report: by 2030, the US “physician shortage” will be between 40,000 and roughly 105,000 physicians. The projection is based on a few assumptions, including that the 2015 physician workforce was “in balance” (enough doctors to meet demand); the aging of the population; retirement trends among physicians; and improvements in access to care for traditionally underserved populations.

Mostly the report made me think of horse manure. Specifically, it reminded me of frequently quoted predictions, made in the late 19th century, that cities such as New York and London would, by the early 20th century, be buried in mountains of it. This has been dubbed “The Great Horse Manure Crisis of 1894” which, of course, never came to pass.

In retrospect, it is easy to see that the 19th-century alarmists missed the technological revolution that was about to replace horses with vehicles powered by internal combustion engines, which averted the “crisis.”

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Burnout

Physician burnout has received a lot of well-deserved attention lately. Characterized by emotional exhaustion and professional frustration, it has been tied to array of bad outcomes, from physician suicide to poor patient outcomes. Organizations are waking up to the need to measure its prevalence and ameliorate its impact.

There seem to be two broad schools of thought about the causes – and by extension, the fixes – of physician burnout.

The first is focused on the inner life of the physician. Yes, the demands of medical practice are high, but if doctors were a little more “zen” about things, then life would be better for them and the people around them, including their patients. There is now a substantial cottage industry peddling retreats, wellness classes, yoga and more to help physicians find inner peace in our tumultuous times.

The second school of thought focuses on the externalities of physician practice. Increasing demands for productivity, economic stress, loss of control over scheduling, and higher “hassle-factors” associated with EMRs and regulations have made medical practice harder and less rewarding. Burnout is just the natural reaction of sane, well-adjusted, intelligent people put into an insane environment.

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The Future of Medical Practice

I had the opportunity last week to talk and learn about the future of office-based medical practice. The occasion was my participation in a panel discussion sponsored by a manufacturer of equipment for medical offices. A professional facilitator conducted a day-long interactive interview of 6 panelists, strategically selected from non-competing health care markets across the country. We talked about what was going on nationally, regionally and in our own organizations in order to provide a context for the sponsor’s strategic planning.

Much of what we talked about centered on the transition from “volume to value,” the catch-phrase for the movement away from fee-for-service to some form of quality-based payment system. The content of the discussion reminded me of the saying that “the future is already here, it’s just not distributed evenly yet.” Physician leaders from west-coast organizations described a landscape of capitated payments and “accountable care” that we talk a lot about but have not yet lived in a significant way. A representative of an institution in Boston spoke of a more highly consolidated provider community. Those stories were interesting, but not entirely novel. Here are a few things that were:

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