Question: How do you anticipate the physician workforce changing over the next five years?
Editor’s note: Responses were edited lightly for clarity and length.
Bernard Boulanger, MD. CEO of Provider Enterprise and Executive Vice President of Tower Health (West Reading, Pa.): The physician workforce is likely to shift further to an employment model, particularly among physicians just entering the workforce. Further, there will be large numbers of physicians retiring over the next five years. As a result, the role of advanced practice providers and pharmacists in medical practice are certain to increase in number and in their scope of duties. In five years, will AI result in such efficiencies that fewer physicians are required? That is hard to know at this point, but it is possible that some specialties, such as radiology, will be significantly impacted. Productivity pressures will continue for physicians, whether in employed or private practice, as reimbursement is further constrained. Finally, as unionized residents and fellows complete their training and enter the workforce over the next five years, one could surmise that unionization will achieve a greater foothold in the physician workforce.
Quentin Durward, MD. Neurosurgeon at the Center for Neurosciences, Orthopaedics & Spine (Dakota Dunes, S.D.): In my opinion, there is going to be a progressive worsening of the neurosurgeon manpower numbers in the near term. There is an unstoppable movement amongst my colleagues to earlier retirement and reduced work hours, and I see it across the country. I am 71-years-old this month and in addition to still being in practice, I take my full share of calls at a level 2 trauma center. But my case is somewhat of an exception. I know of none from my cohort of neurosurgeons I know who trained 40-50 years ago who are still in full-time practice.
The number of neurosurgical residents completing training has changed little over the last 30 years, and there’s been a change in the culture and expectations of many neurosurgical residents, in my opinion. Increased length of training, work-life balance expectations, more non-traditional applicants have contributed to a reduction in the amount of work produced by the average neurosurgeon and this trend will continue going forward.
There is a sea-change I see occurring in neurosurgery practice as neurosurgeons move from physician-owned private practices to various forms of employment. The inability to cover the overhead in private practice and still make a living is the fundamental driver that has led to this migration of neurosurgeons. All physicians are assigned payment for their work based on the RVU’s calculated for the work done, multiplied by the Medicare conversion factor, which is currently $33.29. In most employment models, the employing entity is able to recruit and retain their physicians by paying them based on a much higher conversion factor, often-times double or more. The employing entity, whether it be an ASC, a hospital or a healthcare system, is able to pay this embellished amount by utilizing some of the profit it is generating from its well-reimbursed surgical services, and its ancillary services such as MRI and X-ray imaging and physical therapy. This begs the question, is this system of money transfer from hospitals and other employing entities to employed physicians sustainable? Will the government allow this system of pay embellishment to physicians to continue?
The way things are going, sooner or later we all may be forced into an employment model that is seen in many countries with government controlled healthcare, where we are all salaried. In our country this model is personified by the physicians who work for the VA system.
Sean Gipson. CEO and ASC Division President of Remedy Surgery Centers (Hurston, Texas): I believe that the physician workforce will undergo several significant changes over the next five years. The changes will be driven by evolving healthcare needs, technological advancements and demographic shifts.
Aging population and increased demand for healthcare: As our population ages, especially with the baby boomer generation reaching retirement age, there will be a significant increased demand for healthcare services. This will likely lead to a greater need for physicians, particularly in specialties related to geriatrics, chronic disease management and long-term care.
Physician shortages: There has been an ongoing concern about physician shortages, especially in rural and underserved areas throughout the United States. Although more medical schools and residency slots are being added, the growing demand for healthcare professionals, combined with existing physician burnout and physicians leaving the workforce earlier than expected, may contribute to continued shortages. It’s expected that these shortages will become more acute in certain specialties, such as primary care and psychiatry.
Shift toward primary care and preventative health: As healthcare systems increasingly emphasize value-based care (focusing on prevention and overall health management rather than just treatment), there will be more demand for primary care physicians. However, fewer medical students are entering primary care specialties, which could create a gap in meeting this growing demand. This shift may also contribute to the growth of multidisciplinary teams, including nurse practitioners and physician assistants, to fill the void.
Expansion of telemedicine and digital health: The COVID-19 pandemic accelerated the adoption of telemedicine, and this trend is expected to continue over the next five years. Physicians may spend more time using digital health tools to interact with patients remotely, monitor chronic conditions, and provide follow-up care. Telehealth will likely improve access to care, especially in rural areas, but may also alter the traditional face-to-face patient-physician interaction and how physicians manage their time.
Increased focus on physician well-being: Burnout among physicians has been a growing issue, and efforts to address this are expected to intensify. In the next five years, there may be more systemic changes aimed at reducing burnout, such as improvements in work-life balance, better administrative support, and enhanced mental health resources. Additionally, changes in practice management, with the integration of artificial intelligence and automation, could help reduce some of the administrative burdens physicians face.
Technological integration and AI: AI and machine learning tools are increasingly being used in healthcare for diagnostics, treatment planning, and administrative tasks. As a result, physicians may spend more time collaborating with AI tools to provide better care while reducing their administrative workload. However, the integration of AI may also lead to a shift in the types of skills physicians need, requiring them to adapt to new technologies and workflows.
Diversity and inclusion: The physician workforce is becoming more diverse, with increasing numbers of women and underrepresented minorities entering medical school. Over the next five years, this trend will continue, leading to a more diverse workforce that is better equipped to meet the needs of a diverse patient population. Medical schools and health systems are likely to focus more on creating inclusive environments that support this diversity.
Changes in work settings: The traditional physician practice model may continue to evolve, with more physicians working in group practices, urgent care centers, or telehealth-based practices. There may also be a shift toward more independent practice or entrepreneurial opportunities for physicians as they look for more flexibility and control over their careers.
Very few of us like change, however, the next five years I anticipate our physician workforce will likely experience a combination of increased demand, changing practice models, technological integration, and a focus on physician well-being. These changes will reshape how physicians deliver care, their professional roles, and the overall structure of the healthcare system.
Michael Gomez, MD. NICU Medical Director of Pediatrix Medical Group (Long Branch, N.J.): The physician workforce will have to expand because the different expectations contemporary physicians have as compared to those with more seniority but given the volume of medical school and residency graduates and the maldistribution of physicians across the country, new models care models that include different team members and different tools will have to be developed for some areas of the country most affected by this maldistribution, that can manage complexity, yet maintain an adequate standard of care. You’ll begin to see this change in five years, but it will take a generation at least to develop successful models.
Shadi Jarjous, MD. Chief of the Division of Hospital Medicine at Lehigh Valley Health Network (Allentown, Pa.): I believe that the physician shortage we are experiencing currently will continue to be a major challenge for the foreseeable future. The ever-compounding complexity of healthcare delivery, increasingly limited resources, and laser-thin margins of healthcare systems are placing mounting pressure on practicing physicians to increase productivity and efficiency while simultaneously decreasing the cost of care to ensure sustainability. This escalating demand has led some physicians to seek an exit strategy from clinical medicine. Unfortunately, it has also made a career in medicine less attractive for the newer generations, especially post the recent pandemic. Newer generations are choosing other career options that have comparable career fulfillment, equivalent financial outlook, and more favorable work-life balance. Other members of the care team including physician assistants and nurse practitioners will continue to help fill some of the void created by physician shortage but will not be sufficient to completely close the gap. Advanced practice clinicians are invaluable members of the patient care team, and they will certainly play a bigger role in the delivery of healthcare in the U.S.. However, differences related to the scope of training, practice and experience of these clinicians will make it very challenging to use them as substitutes for physicians in many areas. A potential countermeasure is expanding physicians’ reach and reconfiguring their roles by creating physicians-led teams with advanced practice clinicians and other healthcare workers built on a collaborative relationship where everyone works to the top of their licenses to strike the right balance between autonomy and experience that is needed for success. Another important essential intervention is working on decreasing physicians’ burnout by creating a better work life balance for them, shedding non-value-added administrative tasks, and optimizing their work environment. Finally, an intriguing development to follow that will certainly have an impact on physicians’ workforce is the rise of artificial intelligence and how it is going to influence physicians’ training, work experience and ultimately patient care.
Ira Kornbluth, MD. President of Clearway Pain Solutions (Annapolis, Md.): There is an estimated shortfall of physicians in the coming years. While technological advances including AI and physician extenders can help supplement physicians, physicians will still be in high demand. Baby boomers are aging and there are rising rates of many chronic illnesses, which will increase demand for physician services. Physicians will remain essential for technical skills and complex decision-making pertaining to chronic illnesses. Declining relative reimbursement, erosion in physician autonomy, high debt and administrative burdens have made it less appealing to be a physician. More foreign medical grads and physician extenders can bridge the gap between physician workforce needs and supply. Physicians in health systems may opt to join unions to enhance bargaining positioning.
Matt Mazurek, MD. Assistant Professor of Anesthesiology at Yale School of Medicine (New Haven, Conn.): The most dramatic workforce change will be the impact of retirements. Nearly half of the physician population over 55 is male and 30% of female physicians are over 55. A good portion of these physicians are seeking retirement, and this will place an enormous strain on the younger physician workforce. I predict, too, that in five years, 90% of physicians will be employed. This, along with the changing demographic of the physician workforce, will force healthcare systems and other large physician groups to become more flexible and adaptable with schedules and workload. Parallel to these developments will be increased union organizing and participation and a push for more agency and autonomy.
My biggest concern is the number of medical students who do not intend to practice. Recent surveys have found that nearly 25% intend to use the MD degree for other pursuits such as consulting. Additionally, medical students are reporting a burnout rate of 50%. These numbers are setting off alarm bells with the Association of American Medical Colleges and the American Council of Graduate Medical Education. Burnout, for example, remains a problem for attending physicians as well. Collectively, we need to solve this problem. Finally, it is impossible to predict how physician payments from CMS and Medicaid will impact physician’s salaries. If there is continued decline, I predict accelerated retirements of older physicians.
These opinions are solely my opinion and not those of Yale School of Medicine or Yale New Haven Health.
Pradnya Mitroo, MD. President of Fresno (Calif.) Digestive Health: As the data show, I think there will be significant physician shortages in many areas especially primary care as medical students choose specialties over primary care in increasing numbers. Medical students are choosing specialties rather than primary care because of poor reimbursement for office visits as compared to procedures and as most graduate with significant loans to pay back. Compensation will become a significant factor in the specialty they choose. As reimbursement continues to drop we will see more non physician providers (NPs and PAs) filling these gaps in primary care.
In that same vein, we will see more subspecialists spending more of their time in procedures and less time in the office. There will be an increased reliance on NPS and PAs to see follow-ups in the office while physicians see only the most complicated patients.
Barry Sagraves. Partner at ArchGate Partners (Chicago): There are several interconnecting trends affecting the physician workforce, and almost none of them are positive in addressing the acute shortage and mix of physician talent available. The result will be a continuing shortage of physicians and a mismatch of specialties to need, and an overall situation not much different from today. The first trend is the social/generational change of younger people seeking work/life balance, which discourages wanting to endure the slog of medical school and advanced training. This is related to the widespread social disaffection with higher ed in general, with increasing numbers not believing the benefits are worth the enormous cost of both undergraduate and graduate training. Much is being made of artificial intelligence creating improved efficiency, but adoption of these tools is likely to be slower than the optimists predict. Finally, the regulatory burden might ease slightly in the short run under the new administration, but any reductions are likely to be reversed in the future.
So what might improve this rather gloomy outlook? Continuing to get care provided in the most-appropriate setting would help address cost, quality and capacity. An increase in the use of physician assistants and pharmacists in primary care is underway and could accelerate. Revisions to immigration rules would help, but are probably unlikely in the current environment. And revisions to the education process to reduce cost and time would encourage more to enter the field.
Sheldon Taub, MD. Gastroenterologist at Jupiter (Fla.) Medical Center: Several factors will influence the physician workforce over the next five years. An aging physician population especially in primary care will have an effect. This, in conjunction with physician burnout, is very important. We are dealing with an aging population, requiring more geriatric care, chronic disease management and oncology. The growth of AI driven technology and telehealth will allow for more remote care and have an effect on in person physician services. Changes in Medicare and Medicaid reimbursement may have a negative impact on career choices and practice viability. I am anticipating visa restrictions on foreign medical graduates will have an impact on them coming to the United States, thus decreasing medical resources. and finally, mergers between hospitals and healthcare systems may reduce physician autonomy and impact on job satisfaction.
Eric Tower. Healthcare Advisor at Blank Rome (Chicago): There is a bulge of experienced doctors that is on the cusp of retirement, increasing burnout, growing demand for care with an aging population and an identified shortage of physicians entering the workforce. There is also a continued focus on value-based care, but many elements of that care are not directly reimbursable under the predominant RVU model. The net result: the workforce will increasingly transition to allow doctors to practice at the top of their licenses (e.g., the most complicated matters), while increasingly relying on AI and using ancillary providers to handle routine communications, “wellness,” some chronic care management and simpler procedures, which will hopefully help with burnout. Expect continued growth in alternative sites of practice (telehealth, workforce clinics, etc.) and a continued movement of services to environments that are less intensive than hospitals (ASCs, physician offices, etc.).
Frank Vrionis, MD. Neurosurgeon at Baptist Health South Florida (Boca Raton): Due to unrelenting Medicare cuts to physicians forcing early retirement, aging population demographics and work-lifestyle changes that promote shift work for new physicians, one would expect a shortage in physician workforce over the next five years. The shortage will be more pronounced in certain specialties that deal with chronic illnesses and in rural areas where it is hard to recruit new physician talent.
