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July 5, 2022

4 ways to prevent a physician shortage

Daily Briefing

    There have been plenty of headlines sounding the alarm over a physician shortage, but how can health care leaders prevent one?

    Radio Advisory's, Rachel Woods sat down with Advisory Board's Daniel Kuzmanovich and Sebastian Beckmann to talk about the strategies health care leaders can employ to prevent a physician shortage.

    Read a lightly edited excerpt from the interview below and download the episode for the full conversation.

    Rachel Woods: What I'm hearing from both of you is actually a really hopeful message that there is something that leaders can do to solve for the misapplication of provider time and capacity. And that's not just going to help us avoid a shortage, but that's actually going to support provider practice. Let's get into what leaders actually need to do. How do you solve for that misapplication of physician time and capacity?

    Sebastian Beckmann: We looked at evidence from a host of different Advisory Board case studies in four categories, workflow optimization, care team redesign, telemedicine, and other capacity enabling technology. And then for each of those, we looked at the top intervention. And what kind of impact that has on the amount of visits a physician or an advanced practice practitioner is able to do over the course of a year.

    Woods: Can you give me an example of what some of those interventions might be in workflow, care teams, telemedicine, and other enabling technology?

    Daniel Kuzmanovich: Sure. To Sebastian's point, there are a number of things that have already been done in primary care to be innovative and effective. We looked at those four categories and we looked at specific interventions that actually make it better. For example, enabling technology, artificially intelligent scribes or natural language processing, documentation assistants. That's one such example of here's an enabling technology that supports primary care physicians.

    When it comes to care team redesign, we looked at things like more holistic care team redesign with maybe richer ratios, rather than, hey, here's your traditional number of people per physician benchmarked approach. Those are some of the interventions we considered.

    Beckmann: One thing I want to underscore there is these are all proven interventions. So these are not horizon technologies or things that are in Stage 2 venture capital funding. These are things that real practices are already doing and have been for several years.

    Woods: Do these interventions have equal impact or are some more impactful than others?

    Kuzmanovich: It's definitely not all exactly the same. So when we look at which ones actually make the biggest degree of difference, more robust medical assistant staffing ratios as part of a more holistic care team redesign, by far and away the most impactful intervention you could put out there to improve primary care capacity.

    Whereas things more about how do you actually train physicians to better navigate the workflow, that workflow optimization category, that's not as impactful, shall we say as the MA piece, but it's also got longer legs. It's more sustainable perhaps.

    Woods: I know I said that this message is overall pretty hopeful, but it's also a pretty wild departure from the familiar narrative about shortages today. And I imagine that our listeners are probably still a little bit skeptical. How attainable are these changes? Not just implementing the workflow intervention, but getting the results that we've modeled out on our end.

    Beckmann: Two thoughts: One is, we've picked the most conservative estimate. So there's actually several different interventions you could put in any one of these categories. We're looking at just the impact of one of those interventions. We're assuming that it's not going to have the full impact that we saw at some of the organizations that we interviewed and vetted. It's not going to work exactly the same way at every organization. So conservative estimate, only one intervention instead of a suite of interventions. Even with those assumptions, you still end up with the provider surplus instead of a provider deficit.

    Kuzmanovich: And what's really big there is what Sebastian pointed out earlier. We took stuff that's not magic, that's not in the future. Stuff that actually exists today in primary care capacity, ran the numbers, and then were very conservative about it. And still got, hey, not only do we have enough primary care physicians to provide the visits we need, but we have three times as many if we account for all of these elements of workflow and capacity and time management change.

    Woods: So what happens if an organization succeeds in one, but not all. Let's say they can really focus on holistic care team redesign. And they really expand the number of medical assistants that they have, but they're not really able to do asynchronous telehealth yet, or they can't spend the money to invest in documentation assistance, or EMR training or even a better EMR. What might that mean for that organization?

    Kuzmanovich: A little bit of something is worth a whole lot more than a whole lot of nothing. Just doing one of these things, right? We looked at four categories, broad suite of interventions, just doing one of these things can help drastically in terms of improving primary care visit capacity, primary care supply in a particular market or a particular organization. You don't have to do all four. Doing one thing well is a lot more sustainable than doing four things badly or doing nothing at all.

    Woods: Where do you want organizations to start?

    Kuzmanovich: By far in away the medical assistant opportunity, the holistic care team redesign opportunity, if you have one option, one place to throw your resources, time, and effort, that's probably the big one. It's got wins all around and it's the most impactful. But I can feel someone thinking, "Yeah, but there aren't a lot of medical assistants out there right now."

    Woods: Yeah, Daniel, you actually said at the beginning that there might be a shortage of medical assistants in parts of the country.

    Kuzmanovich: It's fair. And that's where we might need to look at technology.

    Beckmann: Yeah, and if you look at that increased MA staffing ratio, that comprises about half of the savings in provider time.

    But the other interventions together comprise the other half. So if you're able to get one of those right, you're still making a huge impact on provider capacity.

    Woods: Bottom line is we're not going to be seeing this shortage. And we've talked about what organizations can do to prevent a shortage from happening and perhaps even get to a surplus. Now I want to talk for a moment about how, especially when it comes to approaching these conversations with physicians themselves.

    Even though we're talking about things that can make their lives better, Daniel, you, and I know that it is not always that simple when you're going to a group of providers and saying, "I want to change the way that you practice medicine." Or, "I want to change the way that you go about your day." How do you suggest you approach those conversations with doctors?

    Beckmann: I think about the what's in it for me, for physicians. So what I mean by that is these are all interventions that increase the amount of time you have available to focus on direct patient care. So these are all things that reduce the amount of a documentation you have to work on, reduce the administrative burden. And hopefully in doing so, not only increase the number of visits available, but also reduce the burnout effect of all that administrative work.

    Daniel, how would you position that to a physician leader?

    Kuzmanovich: The way I'd approach this with a physician leader goes like this, "Your docs are working too long. Doing work that for a lot of the portion of primary care they don't actually like to do, that ultimately can have burnout and disengagement benefits."

    What we're doing with some of these things, I'll pick documentation assistance. I'm getting technology to take over some of the most frustrating parts of a physician's workflow so they can spend more time on patient care.

    So if I'm a physician leader, this makes a ton of sense. It reminds me of that Drucker-ism, there is nothing so useless as making someone more efficient at something they shouldn't be doing in the first place. I'm getting docs back to doing what they should be doing in the first place.

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