The healthcare trends scaring physicians

From consolidation to physician shortages, seven physicians recently spoke with Becker's to discuss the healthcare trends they're wary of in 2023. 

Question: What healthcare trends are you wary of in 2023?

Editor's note: Responses were edited lightly for brevity and clarity. 

Robert Chavez, MD. Internal Medicine Specialist at NYU Langone Health (New York City): The other trends that are concerning are poor payer behavior, predatory large emergency room groups, horrendous No Surprises Act process, artificially low Medicare and Medicaid payments and Kaiser Permanente cutting reimbursement between 40 and 70 percent.

Eric Eskioglu, MD. Neurosurgeon based in Charlotte, N.C.: Currently half of practicing physicians are over the age of 55 and getting ready for retirement. With an increasing elderly population and demand for more complex medical issues, I see the physician supply versus demand coming to a head soon. I worry that the same trends which have become permanent in "traveling nurses" are emerging in physicians, especially with the millennials and Gen Zs. I expect to see more temporary physician demands with people opting for higher pay, more time spent with family and different geographical venues to combat physician burnout. I truly believe machine learning and artificial intelligence will be the way to overcome these issues. With medical knowledge doubling every 72 days, we need to relegate memorization and patient data search to artificial intelligence, lessen the cognitive burden on physicians thereby increasing the amount they spend on higher judgment problem-solving skills on their patients' healthcare.

Marsha Haley, MD. Clinical Assistant Professor of Radiation Oncology at University of Pittsburgh School of Medicine: The physician and bedside nursing shortages have worsened since the pandemic. Some politicians use "quick fixes" for these issues instead of investing in long-term solutions such as increasing residency positions and investing in quality nursing education and nurse retention. One trend over the past several years has been to increase the scope of practice for non-physicians, resulting in the replacement of physicians. 

Taif Mukhdomi, MD. Interventional Pain Physician at Pain Zero (Columbus, Ohio): The healthcare trend I am most wary of in 2023 is that there may be less options for care for patients. With the growing trend of consolidating care under hospital systems, health insurance-owned care teams and private equity-backed provider groups, the future of healthcare continues to change. While the overarching goal of the healthcare system remains maximizing efficiency and outputs, not every aspect of healthcare can be managed as a business. Healthcare isn't and shouldn't be viewed as an "efficient" endeavor, since the human condition isn't always predictable. Declining reimbursements for private practitioners encourages formation of groups and consolidation to help providers sustain their practice models, but I fear consolidation leads to less competition: Certain sectors of healthcare don't face the challenge of healthy competition. This leaves patients with fewer options for care. With that being said, this poses a great opportunity for new private practice groups to take advantage of being nimble and thriving in the changing healthcare climate.

Thomas Sweet, MD. Hematology and Oncology Physician at Southern California Permanente Medical Group (San Diego): I am wary of accelerating wages for healthcare workers except for physicians further exacerbating income prospects. In my field, I am also concerned about rapidly accelerating cost of treatments sometimes for marginal benefits.

Kerry Willis, MD. Family Practice Physician (Beaufort, N.C.): Medicine has become too complicated by design to allow corporate raids on the federal treasury that provide little value to the healthcare system or patients by design. I look for 2023 to be the year of the rebellion starting as the public and practicing physicians leave the insurance system and make the crisis in access that is already problematic. The primary care system has to be decoupled and simplified to allow universal access at a reasonable price for all Americans. I see no will or ability for the government to accomplish that task, but employers will tire of their money going to corporate bonus programs for medical millionaires' salaries and benefits and lead the change with direct primary care like models and changes. 

Lance Wobus, MD. Psychiatry Resident at Richmond University Medical Center (New York City): First, as a psychiatrist, I fully support telemedicine. If post-COVID-19 policies reinstate regulations on restricting telemedicine, this would have a detrimental effect on patients seeking mental healthcare.

Second, I am an activist in opposing the expansion of independent practice for nurse practitioners and physician assistants. The NPs and PAs I work with (and have seen as a patient) have been very capable, but it is just not the case that after four years of med school, including two in clinical work, and four years as a practicing (but supervised) psychiatrist, the clinical care I provide is equivalent to that of an NP/PA. I think this trend will also be detrimental to healthcare.

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