Question

What are some of the major changes in the market for physicians’ services that are affecting both physician incomes and their practices?
What measure is commonly used to indicate a shortage?

Answer 1

Major changes in the market for physicians’ services affecting both physician incomes and their practices

Market place trends and healthcare reform have clear implications for physicians. This will depend on specific market dynamics, private payer initiatives , degree of physician organization , physician-hospital integration and government action.

1.      Traditional payment will decline. tMedicare fees may notl increase in future. Since many private payers link their fee schedules to Medicare rates, this means no increase in the payment.

2. Changing health delivery services:- Medicare/Medicaid may be Innovated to provide grants and lead demonstration projects to identify new delivery models and/or payment models. The hope is that through incentivizing discovery, new care delivery models such as the patient-centered medical home (“PCMH”) or payment models such as bundled payment will evolve to reduce program expenditures while preserving or enhancing quality of care. Alert physician organizations, large and small, can participate in these demonstration projects to be at the leading edge of innovation and seize opportunities to lead the market.

3. Accessibility to health care delivery :- Approximately 32 million or more currently uninsured individuals with have access to health insurance. These will likely create issues for medical care. Patients already have difficulty obtaining physician appointments .Access to primary care is likely to be the first to be affected. Redesigning care delivery models, implementing electronic visits (e-visits) and other electronic tools such as telemedicine, effectively utilizing a broad array of healthcare practitioners and support staff, and empowering patients to play an active role in their health will an access “meltdown” be avoided. Patients are already increasingly expecting ready access (defined by the patient) to their healthcare providers through e-mail, portals, and, when necessary, the face-to–face visit at home. Physicians who cling to the traditional office visit as the only venue for care will risk declining patient preference and declining patient revenue.

4.     Increasing Patient expectations:- A combination of factors will result in an increase in patient expectations for healthcare services+:

• The newly insured will expect to have access like others
• Those with insurance may face increased cost-sharing,
• The young generation wants to avoid looking or feeling older, and will expect their healthcare provider to provide the solution(s).
• There will be an increasing demand for the ability to communicate via text, social networking, or web portal with healthcare providers.
• Disruptive innovators and innovations can change the competitive landscape (e.g. Google, Walmart).
• Exploding wealth of data and health information will appear online for the worried well, chronically ill, or recently diagnosed patient.

These factors will result in an increasingly consumer who expects that their physician is responsive to their expectations.

5.    Reframing the clinical workforce. Funds are given to increase training positions for primary care and general surgery, training in preventive medicine and public health, support training for medical homes and team management of chronic disease, among other initiatives. But these will likely fall short of filling the gap of demand/capacity in many key specialties .

    6.Hospital relationships :- A care delivery system is being developed that is based on collaboration between physicians, hospitals, and other healthcare providers. To achieve optimal performance under any of the proposed payment models requires collaborative physician-hospital relationships. This will require both hospitals and physicians to put aside old frameworks that assume one entity “controls” the other .

Measure commonly used to indicate a shortage

Physician Supply Model produces national projections of physician supply for 36 medical specialties through 2020, which are aggregated into 18 specialties . The PSM is an inventory model that tracks the supply of physicians by age, sex, country of medical education (whether United States medical graduates [USMG] or international medical graduates [IMG]), type of degree (i.e., Medical Doctor [MD] or Doctor of Osteopathy [DO]), 2 medical specialty, and primary activity (e.g., patient care or non-patient care).

The PSM produces two measures of physician supply:

(1) the number of active physicians

(2) the number of full-time equivalent (FTE) physicians. One FTE is defined as the average annual hours worked in patient care per physician in 2000 Women and older physicians have worked fewer patient care hours compared to male and younger physicians, and because a growing proportion of the physician workforce is female and older the FTE supply of physicians is growing slightly slower than the number of active physicians.