6.04.2008

Doctor Imbalances: Not What the Customer Needs

The healthcare profession is facing serious issues of supply and demand for doctors. I regard this as a lean issue because lean is all about providing value to the customer. And if you are not producing what the customer wants or needs, then something is wrong.

These thoughts are prompted, in part, by a
recent article in the journal Academic Medicine, published by the Association of American Medical Colleges. The article describes the results of a study by three doctors and a research assistant of six medical school programs specifically designed to train doctors to work in rural areas.

Rural areas, the article explains, face a significant shortage of doctors.

Although one of every five Americans (20%) lives in a rural area, only 9% of physicians practice there. The scope of this problem is substantial, because more than 20 million of the 60 million people residing in rural areas live in federally designated Health Professional Shortage Areas (HSPAs).

This rural physician shortage has existed for more than 80 years, despite the fact that, in general, people living in rural areas have a greater need for medical care, being older, sicker, and poorer than their nonrural peers.

Of greater concern, the future rural physician workforce is likely to decline even further, with only 3% of recent medical students planning to practice in small towns and rural areas. Factors associated with this decline include the decreasing number of physicians entering family medicine and primary care, the increasing number of women in medicine, the changing lifestyle preferences of younger physicians, and the increasing level of medical student debt.

The study found that the six medical school programs, for a variety of reasons, are extremely successful in channeling more doctors into rural areas. The authors then developed a projection:

Initiating new programs in every medical school would be expected to result in 1,139 rural physicians yearly, more than twice the number produced if there were no such programs (513). During the next decade, this is projected to result in 6,260 additional rural physicians. Considering the multiplicative effect of increased long-term retention of these graduates, the impact of these programs would likely be even greater.

The geographic imbalance described here is just one supply-and-demand issue involving doctors. Another was highlighted in a
recent article in The New York Times, which described how medical school graduates have to compete fiercely to obtain residencies in dermatology or plastic surgery while relatively few graduates are entering fields like family medicine.

The result is too many doctors in some specialties, and not enough in others.

This has a lot to do with the fact that some specialties lead to better compensation and a better lifestyle than others.

There is also an
interesting commentary in the Boston Globe by Dr. Joseph Martin, professor of neurobiology and former dean of Harvard Medical School, and chairman of the New England Healthcare Institute. Its title is “Where have all the doctors gone?”

Medical schools are not manufacturers, and doctors are not products, but people who can choose what they want to do.

Adjusting market forces to provide incentives that will help address these imbalances of supply and demand won’t be easy. But a dose of lean thinking, focusing on the customer (patient), might help.

1 comments:

Dean Bliss said...

As you mentioned, one of the key problems with rural physicians is compensation, not just the difference between urban and rural, but the declining Medicare and Medicaid reimbursement. Many physicians are not accepting new Medicare patients since they are barely covering their expenses. A wholesale change in reimbursement methods is necessary to start to reverse this trend.