Question: How do you anticipate the physician workforce changing over the next five years?
Editor’s note: This response was edited lightly for clarity and length.
Dr. Harry Severance: With the ongoing workplace abuses toward doctors, multiple overloading factors will lead to disenfranchisement and marginalization — including reduction to employee status, accelerating workplace assaults and violence, (now making healthcare the most dangerous of all U.S. workplace jobs), and multiple other disruptive factors, now with fewer bright young minds considering healthcare as a career option.
Here are a few of the trend scenarios that I see likely evolving over the next several years:
1. ‘Doctor AI:’ With the accelerating exodus out of ‘hands-on’ healthcare by current doctors, and fewer bright young minds choosing healthcare careers, we will rapidly reach truly unsustainable shortages.
Recruitment of advanced practice providers to replace physicians will ultimately, in large measure, fail — if they are left to face the same abusive challenges — and consumer discontent will further escalate.
‘Industry’ will then attempt to fill in severe shortfall areas with AI-driven (non-human) systems, especially with venues such as local telemedicine, and in rural and other evolving underserved areas, where these evolving exodus shortages are already significantly impacting healthcare delivery (or, increasingly, an evolution of entirely non-served areas).
Their argument will be one of ‘no other choice’ – except to have NO access to healthcare!
2. Unionization: Those physicians who choose to stick it out in healthcare (now overwhelmingly working under employee status) will increasingly migrate into unions in order to gain some workplace protections and to regain some semblance of a seat at the table to advocate for the safety and function of their workplaces, and to be able to advocate for their patients and patient outcomes.
3. ‘Seller’s market’ for physicians: As physicians become a rarer and rarer commodity and the industry increasingly faces such dire options — no physicians, ‘doctor-AI’, prevalent unionization, with continued worsening in consumer hostility and discontent — some healthcare systems may then be motivated to improve workplace conditions in order to competitively attract this now increasingly rare commodity.
4. Political upheavals: A fourth possible trend — how the current political upheaval/unrest in Washington will affect physician workforce — is yet to be seen. There is already concern expressed about recession, increasing overall national unemployment and loss of domestic and economic wellbeing, as these massive changes are rolled out and move forward.
Healthcare has historically been seen as a ‘hedge’ against and ‘safe haven’ from recessions, upheavals, and other disruptions for those working in healthcare. So will the exodus of doctors and other healthcare workers slow, at least temporarily, while this current political upheaval plays out?
But, now that healthcare is increasingly becoming big business (poised to become the country’s fifth largest economic market sector) and increasingly entangled within and owned as a part of corporate ‘mega-businesses,’ can it now suffer the same financial winds of change that affect other marker sectors, and suffer similar critical downturns?
5. Clinical practice niches downsizing efforts will expand: As the amount of medical knowledge continues to exponentially increase, we will see expanding migration by those physicians who remain in the system away from overall generalist positions and into smaller and smaller (often self-created) clinical specialization niches, where they have some chance of keeping up with medical knowledge for the patient populations they have ‘staked out.’ This trend will continue until AI systems become generally available as an accurate consultative, referral and knowledge-expanding tool, malpractice systems acknowledge that physicians cannot possibly know everything, and healthcare consumer hostility decreases
This increasing segmentation of healthcare could make consumer access issues even more difficult, and is an added incentive for doctor-AI systems development.