The Occasional Perspective - 11/151/22

Opinions and Reflections 

The Immediate Looming Crisis – The recruitment demand for physicians and advanced practice providers is increasing at an exponential rate according to a recent report from the Association for Advancing Physician and Provider Recruitment. Why? In large measure to replace departing (i.e., retiring) physicians. The placement of such physicians has increased 16% for the period 2018 to 2021. From an overall perspective, the number of clinical searches reached 47% for physicians and 32% for APPs. The shortage is especially acute in the primary care (i.e. frontline) areas of health care with the specialties of family medicine, internal medicine, and hospital medicine represented as the highest need areas. Furthermore, for many health care organizations – the recruitment of clinicians is their #1 problem!! So, why is the turnover occurring? The reasons among the health care systems with 300 to 1000 provides included:

                                                                                           MDs                      APPs

• Leaving for a similar position                                   74.6%                   91.7%
• Retirement                                                                67.3%                   12.5%
• Geography                                                                50.9%                   43.8%
• Burnout                                                                      34.6%                   33.3%
• Compensation                                                            30.9%                   68.8%

As a “rural health advocate” it’s also clear that the rural communities are the hardest hit by the problems of clinician shortage. Furthermore, the “thinning” of specialty availability is exacerbating the “burnout” issue. It’s been estimated that 1:5 physicians will retire or leave practice over the next five years or, 20%! And, it could be higher. Some studies show that the number of physicians who will reach retirement age is more than 35% of the workforce over the next five years. That’s huge. In fact, I predict that over the next five – yes FIVE – years, we are going to see a massive shortage of primary care providers due to the retirement and burnout of primary care providers of the Boomer Generation. The overall shortage by some studies is predicted to be over 120,000 physicians not even considering the APPs (for which I do not have any good numbers at this point) But, it’s not just clinicians leaving – it’s also a lack of entry by the next generation of clinical providers into the primary care fold. Finally, one more stake in the heart of primary care is that they are among the lowest compensated of the providers and yet, primary care is one of the most important areas for offering sustained quality with the best outcomes over the longer haul at the lowest overall cost. Hmmm. It’s time for a “rethink.” I personally believe that a move toward “value-based care delivery models” is a major component of the “rethink.”  

But, There’s A Bigger Looming Crisis Needing Our Advocacy – Now, while I believe that the shortage of clinicians (physicians and advanced practice providers) is a big issue (SEE above commentary) that requires our attention – I think we also need to be cognizant of the (dare I say) much bigger crisis of climate change. From National Geographic this horrific crisis has been exacerbated by the opening question of “climate injustice”. What’s that? It’s where the least responsible nations for climate change are experiencing the worst burdens at the present time. The results of the recent United Nations Climate Conference or, COP27 held in Egypt point in this direction by offering fair warning from a large contingent of frustrated developing countries on “who” is going to pay for the “loss and damages” due to global emissions. The question is raised because the least developed nations are contributing the leastest of the least amount toward emissions responsible for global climate change. For example, the United States is responsible for 20+% of all historical global emissions of gases (e.g. methane, carbon dioxide) that cause climate change. What’s a world to do? Evidence that “not enough” might be the answer came in the form of plans for resolving the problem. About five years ago the global community of 190+ nations agreed that each country should put together a plan within five years on their intent for helping to solve the problem. The reports from the COP27 meeting revealed that only 25+ reports have been received AND NONE OF THEM were from the leading contributors to the problem = the United States, Europe, China, Russia, etc. It makes the shortage of clinician providers seem like a minor problem…