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60 Clinical Integration & ACOs A ccording to projections by the Association of American Medical Colleges, the nation will be short more than 90,000 total physicians by 2020 and 130,000 physicians by 2025. The physician shortage has the potential to affect our present and threaten our future; however, some argue that the impending physician shortage is overblown. Here are 15 things to know about the physician shortage from both perspectives. 1. There are reports of a shrinking supply of physicians. One in three prac- ticing physicians in the U.S. is over the age of 65 and close to retirement. Furthermore, six in 10 say it is likely many colleagues will retire in the next one to three years. 2. Physician shortages will impact primary care more than other special- ties. In the wake of some specialties reporting more acute physician shortag- es, a report in the Annals of Family Medicine projects that the United States will need 52,000 more primary care physicians by 2025. 3. A significant shortage of surgeons and oncologists is also anticipat- ed. The country's demand for oncologists is slated to nearly double and lead to a shortage of nearly 1,500 cancer specialists by 2025. The number of new cancer cases in the United States is projected to increase by as much as 42 percent by 2025, but the number of oncologists will likely grow by only 28 percent. Oncologists are already in short supply in many rural communi- ties, and more than 70 percent of U.S. counties have no medical oncologists at all. Furthermore, according to the AAMC, general surgery is predicted to be among the hardest hit, with a shortage of 21,400 surgeons by 2020. The number of practicing general surgeons is expected to fall to 30,800 by 2020 from 39,100 in 2000. 4. Population growth and the aging population drive the impending physi- cian shortage. Approximately 33,000 additional physicians will be needed in the next ten years due to population growth alone. Additionally, in the next ten years, 10,000 physicians will be needed to serve the aging population. By age 65, about two-thirds of senior citizens have at least one chronic disease. Twenty percent of Americans older than 65 see 14 or more physicians and average 40 physician visits each year. 5. Medical residencies are in short supply. Funding for the Teaching Health Center Graduate Medical Education Payment Program, which was created by the Patient Protection and Affordable Care Act, is set to expire at the end of federal fiscal year 2015. Through the program, the Health Resourc- es and Services Administration awarded $83.4 million in funding to sup- port primary care residency programs at 60 teaching health centers. These awards are helping support the training of more than 550 residents in fam- ily and internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and general and pediatric dentistry during the 2014-2015 academic year. If not extended, the program's expiration is projected to cut the number of new residents being funded by 8,000 by the year 2025. Moreover, the number of Medicare-sponsored residency slots has been capped since 1997, making it financially challenging for health systems to expand residency capacity. Thus, medical school graduates will most likely exceed the number of residency positions by 2015, according to a report by the AAMC. 6. Legislation for increased residency availability is in the works. According to The New York Times, bills currently in Congress could increase the number of residency slots for new physicians by 15,000 over a five-year-period. At this point, it is difficult to say whether or not Congress will choose to pass those bills in addition to rehabilitating veterans' healthcare. 7. Telemedicine increases overall physician efficiency and specialist availabil- ity to rural areas. Telemedicine can help hospitals and health systems utilize the current supply of physicians more efficiently. Telemedicine can also help physi- cians make use of unused time by treating more patients, can connect specialists to rural hospitals and enables patient access to a wider pool of physicians. 8. Mid-levels may alleviate projected shortages. Mid-levels can enhance many aspects of primary care and can help lessen physician workloads. Depending on scope-of-practice laws, nurse practitioners and physician as- sistants are taking over some of the load of primary care demand. As a re- sult, some analysts see the predicted physician shortages as exaggerated. The AAMC disputes that claim citing scope-of-practice and reimbursement is- sues as reasons why team-based care will not close the care gap. Only 18 states allow NPs to diagnose, treat and prescribe without some degree of supervi- sion by a physician, which limits their impact as part of a care team. 9. Nurse practitioners have a positive effect on outpatient management of chronic conditions. A team approach that utilizes nurse-managed protocols can have positive effects on outpatient management of adults with chronic conditions such as diabetes, hypertension and hyperlipidemia. This approach can help lighten the load of some physicians and ensure quality care. 10. Currently, physician supply vs. demand is very dependent on geo- graphic location. According to a Kaiser Health News report, the nation's pri- mary care system is generally holding up fine (at least at present) with few shortages, even with the addition of patients who gained insurance for the first time under the PPACA. This is contrary to many other reports and to what many experts predicted would happen with the passage of the PPACA. For more information, call 425-657-0494 or visit our website at www.eveia.com Eveia's Clients: · Ambulatory Surgery Centers · Surgical Hospitals · Health Systems with ASC Relationships · Physician Practices · Anesthesiologists ASC Operations Compliance & Consulting Services Preparing for excellence Provider Business Services Optimizing opportunity Provider Contracting Services Reimbursement experts 15 Things to Know About the Physician Shortage By Dani Gordon