Dr. Corey Scurlock MD, MBA is the CEO & Founder of Equum Medical.
It may not match the scale of the exodus of nurses from the healthcare workforce, but a growing shortage of physicians is no less of a threat to patient care. A recent survey found that one in five doctors plan on leaving the profession in the next two years, hastening a projected shortfall of as many as 124,000 doctors by 2034. This has reached such a concerning level that the U.S. Department of Health and Human Services and U.S. Surgeon General Dr. Vivek Murthy have launched a strategic advisory to mitigate clinical burnout.
Covid-19 and longstanding concerns about changes in the business of healthcare have left many physicians burned out. Older doctors are seeking early retirement, and younger doctors seek a more balanced work/life ratio. Many aren’t interested in some of the all-consuming specialties such as critical care, neurology, oncology and psychiatry.
As with everything else in our world right now, supply is not meeting demand. Action is required, but it can’t just rely on yesterday’s solutions. Opening up more slots in medical schools won’t fill the immediate need for experienced, board-certified physicians. Buying up physician practices is largely played out, as most doctors are already employed.
I would argue that we can’t wait for a new MD pipeline to open up. Instead, we need to fix the broken practice of medicine. Doctors are burned out because they are locked into 15-minute appointment cycles wrapped around the exigencies of electronic health records systems that demand complete documentation of each step, leaving little time for the “How are you, Ms. Jones?” moments. Patients are unhappy with eight-month waits for new patient appointments to confirm diagnoses of serious diseases.
Within the hospital, a lack of staff and available expertise meets up with broken processes to choke off patient flow from the emergency department to laboratories to medical floors. Staff personnel stand around waiting for paperwork. Patients wait on gurneys for everything. By the time things are straightened out, the original order might no longer be appropriate for a patient. Discharge alone has become a major headache.
One antidote to this is to create a hybrid model of care as I have done with my company and as my business helps other companies do. It relies on points in the care process being actively managed remotely by specialist physicians who also have a background in telehealth. These veterans should understand where timely intervention can unblock patient flow at “hot spots” in a patient’s journey caused by delays in care, inappropriate care transitions or potential patient harm.
Telehealth-enabled monitoring can reduce transfers by accurately assessing patient acuity and overseeing the work of less-experienced hospital staff. Through these interactions, the goal is to see reduced patient readmissions and ED visits, shorter hospital stays and better utilization of resources.
Of course, all of this begs the question: If the hospital can’t find enough specialists, how can virtual care physicians fill these roles? The answer is pretty simple, in my opinion. You bring back the joy of being a doctor. These telehealth doctors work from home, linked to pods of multi-specialists who work with the same hospitals, getting to know the staff. They can work when they like and as much as they like. They access the medical record but are called upon to solve problems, full stop. You can also make sure their work is always varied. Doctors want to heal, not master the intricacies of Epic’s latest software.
With the tailwind of favorable policy and reimbursement the telehealth industry is experiencing right now, it might be an opportune time to consider this type of strategy. But as one explores telehealth as a business venture, it’s important to recognize that all such business is still highly regulated, as it is in the field of care delivery. The core components of an end-to-end telehealth solution include people, process and technology. Here are some thoughts on each.
• Technology: Audio-video providers have matured significantly, and increasing interoperability has enabled new entrants. Health systems have sought to standardize enterprise platforms versus best-of-breed applications. Clinical analytics tools can be overlaid on the EMR leading to simpler clinical insight gathering. While not mandatory, such systems target quality or performance metrics to support ROI.
• Process: Efforts to virtualize care can be disruptive to care delivery. Consider what technology platforms to purchase, KPIs to measure and clinical workflow to create.
• People: Delivering telehealth-enabled care will place the highest regulatory burden on an organization. Malpractice, state licensing and credentialing, and HIPAA, to name a few, are considerations that need to be tackled first. Secondly, your attention to provider experience is paramount to ensure a healthy and sustainable workforce to attract talent.
As Covid-19 wanes, we are facing unprecedented change in the provisioning of care. New care models will emerge. Telehealth is not the only solution, but it is clear that it will be a primary one. A recent survey (registration required) of health system CEOs by the University of Colorado’s Health Administration Research Consortium put virtual care as the No. 1 strategy for future growth.
For those looking for solutions to today’s healthcare challenges, here are three points to remember:
• Telehealth is here to stay: It could be the great equalizer for care access and equity.
• Patient flow is key: By focusing on the patient journey across the continuum, hot spots can be identified and targeted.
• Clinical and operational alignment are needed: People, processes and technology can combine as a force multiplier to return greater value, but only if everyone has agreed on a care road map.
As telehealth goes, we are not battling efficacy anymore; we are battling inaction and the cost such inaction creates. I believe unlocking the potential of all our nation’s providers can deliver better care everywhere. It’s time to imagine what the design of the next-generation, digitally-enabled clinical workforce looks like, and it’s all about access and equity in care delivery.