Last year, I had a PCP appointment scheduled for March. At the time, I had just switched jobs, so my health insurance did not start until the next month. Rather than pay for the cost out-of-pocket, I rescheduled it. When I called the doctor’s office to reschedule, the earliest appointment was in March 2024, a year later. This was inconvenient, but I didn’t worry about it because I am someone who regularly goes to the doctor for annual checkups, is in good health, and comes from a family of medical professionals. I just put myself on the cancellation list and hoped I would get lucky with an earlier appointment.
The US has a doctor shortage, and it’s getting worse
According to the American Medical Association, my experience was not unique. It’s estimated that more than 83 million people live in areas without adequate access to a primary care physician. This doctor shortage highlights that my experience of not having ready access to a PCP is common, particularly for those in rural and urban locations. And it may get a lot worse. The Association of American Medical Colleges estimates there will be a shortage of up to 124,000 doctors across all specialties in 2034.
There are many reasons for the doctor shortage, including the growing population, aging population, aging of the physician workforce, a limited number of medical schools and residency programs, physician burnout, and more. We can’t do anything about many of these issues, such as the growing and aging population. But we can address the issues leading physicians to want to retire, burnout, and the limited number of spots in medical schools and residency programs. This blog will focus on the first two.
In 2021, a national survey of US physicians showed 62.8% of physicians experienced burnout. This is a 38% increase from the previous year. And due to burnout, many physicians may retire early. In order to address the issue of physician burnout, we need a systemic approach that starts with medical schools and how medicine is taught and practiced.
One approach to address this burnout is incorporating physician wellness into medical school curriculums. Innovative entities such as the Alice L. Walton School of Medicine are doing this by teaching medical students how to practice and prioritize self care.
Second, this culture of wellbeing must be incorporated into the health organizations where physicians will practice medicine. This evolution will take time. However, while medical schools are evolving, health care entities can use an emergent strategy to improve physician wellbeing in the near-term.
An emergent strategy could help provide a solution to physician burnout
An emergent strategy is the cumulative effect of day-to-day, tactical operating decisions used to solve immediate, unforeseen problems. Emergent strategies prioritize and invest in decisions made by staff who are not in a visionary, futuristic, or strategic position. With emergent strategies, these individuals identify potential approaches to address situations or problems that occur in their day-to-day work. Think of emergent strategy as an approach akin to trial and error. It can adapt, improve, and evolve. It is not a fixed and well-established method. This type of strategy is used when there isn’t a clear solution to a problem or the future is unknown. Addressing physician burnout is a good fit for this type of strategy because the problem doesn’t have a clear solution health care entities can just plug into their existing business models.
If health care entities want to decrease burnout and doctors’ retirement due to burnout , they could test an emergent strategy approach. For example, organizations could run a test focused on altering practices to better support doctors’ wellbeing and improve their working conditions. Specifically, they could leverage practices that have demonstrated effectiveness at reducing burnout, and that physicians note their organizations are not currently employing. Below are a few examples of changes that could be tested.
The Physicians Foundation’s 2023 Survey of America’s Current and Future Physicians found “[o]nly 31% of physicians agree that their workplace culture prioritizes physician wellbeing, declining from 36% a year ago.” In addition, at least half of physicians surveyed responded that their employer rarely or never incorporates 8 of the 16 evidence-based wellbeing solutions identified to support physicians. The physican percentages ranged from 63% to 33%. A few of these wellbeing solutions include:
- Using validated tools to regularly assess and respond to occupational burnout;
- Being encouraged to take paid leave, sick leave, and rest breaks;
- Having wellbeing metrics included as organizational key performance indicators;
- Designating an executive with operational authority to oversee and align all clinician well-being efforts; and
- Normalizing conversation about the use of mental health care.
These wellbeing solutions are simple changes that could improve working conditions and combat burnout. By using an emergent strategy approach to test and implement some of them, health care organizations could help address the doctor shortage thus benefiting both doctors and patients alike without completely overhauling their organization.
The doctor shortage will continue to affect us all, and industry leaders must take action to address it. Complete evolution is a long-term solution, but in the near-term, health care leaders can leverage an emergent strategy to improve physician wellbeing.
