Where Are The Doctors?

12 Innovative Mobile Healthcare Apps

With physician shortages looming in 2014--which is when the healthcare reform law starts expanding insurance coverage--The Physicians Foundation is providing a $750,000 grant to University of North Carolina researchers to build a Web-based model that will show the distribution of physicians across the country and how many doctors may be needed in the future.

The money is going to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill (UNC). The funds will be used to develop a dynamic projection model that can be continually updated with new data to track physician workforce needs across the country.

The Bureau of Health Professions in the Health Resources and Services Administration (HRSA) includes a National Center for Health Workforce Analysis that does similar research. In addition, HRSA publishes a list of "health professional shortage areas." And the Dartmouth Atlas of Healthcare, published by a group of researchers at Dartmouth Medical School, shows the numbers of physicians, primary care doctors, specialists and surgeons in various hospital referral regions.

Nevertheless, The Physicians Foundation—a non-profit group funded by the settlement of a class action suit between medical societies and health insurers--believes that the current data is inadequate. "We don't feel the data collected by the government or by private sources gives us the accurate picture of what the physician population is or what the future holds in terms of shortages or excesses," said Alan Plummer, MD, a foundation board member and chair of the grants committee. "We feel there is a physician shortage now and that it's only going to get worse."

"Most experts agree that the nation is facing a shortage of physicians, but we don't know how many, in what specialties, and in which geographies we will fall short," said Erin P. Fraher, PhD, who heads the project at the University of North Carolina. "This model represents an important step in fostering quality healthcare delivery to all patients across America."

Intended for use by workforce experts, policy makers, and others, the model will draw upon data from the American Medical Association, the Centers for Medicare and Medicaid Services, and other sources. UNC, The Physicians Foundation, and a clinical advisory group comprised of practicing physicians will utilize this data to develop a model that will enable users to estimate physician supply and demand within a geographical region and/or specialty.

A multitude of factors affect workforce needs, Plummer noted. For example, the researchers will look at the availability of nurse practitioners and physician assistants, which can mitigate the demand for physicians. Moreover, the model must take into account the number of new doctors going into various specialties and the number of doctors who are retiring or leaving practice.

Based on the current data and their health policy orientation, workforce experts have divergent views about the number of physicians that will be needed and the correct proportion of primary care doctors and specialists in the workforce. The new model will incorporate a multitude of scenarios to evaluate physician workforce needs. "And once the model is established, it can be modified by the researchers as new data is found," Plummer noted.

Jonathan Weiner, a Johns Hopkins University professor who is an expert on physician workforce, managed care, and health IT issues, commended the project and said the UNC researchers are leaders in the field. Nevertheless, he said there are limits to what the model will be able to do.

"The idea that you can come to full agreement on how many clinicians you need in an area may be pushing it a bit," he pointed out. "There's also some controversy about whether more providers alone is the answer. In most major American cities, there are huge numbers of doctors, but they're inaccessible to people who don't have access to them."

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