From the June 2017 issue of HealthCare Business News magazine
HCB News: Why are we facing a doctor shortage and how can we prepare for this growing crisis?
RB: The problem of doctor supply is very complex and has many dimensions. The number of new doctors entering the field is limited by the capacity of our medical schools. Of those entering practice, many choose to work in geographic locations or clinical specialties that don’t address the actual patient demand curves adequately. Many doctors leave the field because of economic pressures, liability concerns or simply the pursuit of more advantageous opportunities. Many doctors are baby boomers who will simply reach retirement over the next decade. All of these factors combine to cause the supply of doctors not to keep up with the ever-growing demand for care.
There are many opportunities to address this problem at the system level. Policy changes can reduce some of the burdens of being a doctor and cause more to stay in practice. Incentives can be designed to shift some practices to higher-demand specialties in underserved geographic areas. We can make it easier for immigrants to obtain medical licenses in states. These options represent system tinkering that can have a short- or medium-term effect, but won’t fix the problem long-term.
University of Central Florida
Systemically, we’re already addressing the problem in several ways. First, we’re rethinking the provision of care so that more of it can be provided by professionals not traditionally seen as doctors. This is one reason we use the term provider rather than physician (or doctor), because increasingly the person providing care isn’t a physician. This spreading of care across a broader sector that includes stakeholders outside of hospitals and physician practices dramatically increases the system’s capacity even though the number of doctors is declining.
Additionally, we’re working to engineer out waste. Unnecessary procedures take up valuable capacity without improving health outcomes. Reapplying that capacity can increase the yield of our system with the same supply. Ultimately, we make health information more broadly available so that patients make better life choices, further reducing the demand on doctors to provide care. A patient developing a disease that could have been prevented is even more wasteful to our system than a doctor ordering an extra blood test. Waste of any kind reduces useful capacity, and systems engineering looks at all of these dimensions.
HCB News: Why do we need to have health care systems engineers for all of this?
RB: Health care systems engineers are specialists, bringing knowledge, skills and tools to bear in distinct ways that are unlikely to be included in many organizational change initiatives otherwise. Many health care organizations include quality or process improvement activities that work to address many of the problems being encountered across the system. These initiatives can successfully improve efficiency and effectiveness in meaningful ways. The people conducting these activities are well-meaning and hardworking, but they often concentrate too easily on symptoms of problems rather than causes of problems. They fix components of systems, and problems often then pop out in other components. Systems engineers are educated and trained to focus on the system as a whole, and to implement changes in components that actually optimize the whole system. The people in the system need to be involved because they know their patients, processes and interfaces better than any engineer could. It’s the synthesis of all of that knowledge with systems thinking that will improve our health care system for the future.
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