- The Washington Times - Sunday, March 26, 2017

Dr. Ezekiel Emanuel is outraged over reports of a massive physician shortage expected by 2030 — because he doesn’t believe it.

In a wide-ranging recent report, the Association of American Medical Colleges predicts that by 2030 the U.S. will suffer a shortage of 40,800 to 104,900 physicians.

The report highlights that the U.S. population is expected to increase by 12 percent, to 359 million people, and that the population most in need of health care, those aged 65 and older, is expected to grow by 55 percent.

A shortage is predicted in primary care physicians, surgeons, psychiatrists and pathologists.

But Dr. Emanuel, chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, doesn’t see it this way. “If you look at the numbers, we have enough of them,” he said in an interview Friday.

It’s not a lack of physicians, but poor management and distribution of resources that account for a perceived physician shortage, Dr. Emanuel said. He outlined this argument along with co-author’s Emily Gudbranson and Aaron Glickman, in a recent article for the Journal of the American Medical Association (JAMA).

“All I did was take the general numbers that are out there and did basic math,” Dr. Emanuel said.

The article states that if there are 388,000 primary care physicians in the U.S. and if each doctor can see about 1,500 patients, a population of 583 million could see a doctor. The current U.S. population is about 320 million.

While Dr. Emanuel relents that some specialties are lacking the appropriate human resources, like psychiatry and pediatrics, in terms of primary care physicians, the U.S. has a surplus.

What Dr. Emanuel prescribes is taking away the appointment book from the physicians. He outlines his vision for a more structured, properly managed health care system in his upcoming book, “Prescription for the Future.”

“One thing that is obvious about the American health system is we have a lot of bricks and mortar, big physician offices with big waiting rooms. Is that an efficient way to spend money?” he said.

His suggestion is to create what he calls “open access scheduling,” reserving 20 percent to 50 percent of appointments for walk-ins and same-day treatment. He also recommends cutting down on unnecessary visits and using digital tools such as video chats and text messaging.

His solution for treating a growing, aging population calls for investing in and employing nurse practitioners, care coordinators and medical assistants for services that don’t require a physician.

Yearly “wellness examinations, follow-up visits, closing of care gaps, and support for medication adherence — could be provided by nurse practitioners, care coordinators, and medical assistants. By reorganizing clinicians’ responsibilities, physician time could be used more effectively,” the authors wrote in the JAMA article.

Dr. Emanuel emphasized that his argument is on the macro level, not taking into account patient preferences and access to services.

“It is true some patients might have preferences for a green-haired, purple-eyed physician,” he said, “you don’t decide building more medical schools on personal preferences. It’s big numbers and evaluations.”

Last week, the National Resident Matching Program, which helps match medical school students with hospital residency programs, announced it had it’s highest acceptance rate, with 30,000 new physicians assigned to residency programs throughout the country.

“It was a very successful match,” said spokeswoman Mona Signer. “We matched more applicants than ever before because there were more positions than ever before.”

She attributes this to increases in class size, residency programs and medical schools, especially those for osteopathic and allopathic treatment.

But while the number of resident physicians is increasing, the distribution of medical professionals among the country’s neediest communities remains a problem.

“There are always issues with shortages of rural areas,” Ms. Signer said, adding that most medical programs tend to be located on the coasts, with less opportunity in the center of the country.

Dr. Emanuel touched on this in the JAMA article: “Nearly a fifth of U.S. residents live in rural areas, yet less than a tenth of primary care physicians practice there. Training more physicians will not solve this issue. Instead it will be important to consider how physicians are incentivized to encourage more to pursue underserved areas, such as in rural health care.”

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