Medicine as a Job and Not as a Career — Recruiting and Retaining an Evolving Physician Workforce

The need for healthcare services in the United States is increasing. An aging Baby Boomer population, accompanied by chronic disease, has augmented the demand for a robust primary and longitudinal care workforce.

Unfortunately, the Association of American Medical Colleges forecasts by 2034 a national physician shortage of between 37,800 and 124,000 physicians required to deliver the 2019 level of care (more than double the current shortage of 19,900–21,800). Extending the current level of care enjoyed by non-underserved Americans to the entire country would require an additional 102,000–180,000 physicians.(1)

An aging physician workforce in the midst of significant corporate and technological changes in healthcare and a global pandemic is also contributing to the shortage of available doctors. More than 40% of active physicians are projected to be 65 or older by 2030.(1) Older physicians have witnessed the evolution of medicine away from independent, entrepreneurial practices that kept paper medical records. EHRs, clinical information systems, and administrative requirements are increasingly complex and specialized. Health systems and medical groups are consolidating and becoming larger to manage the complexity. Physicians thus increasingly practice as groups or as employees of large healthcare organizations rather than as independent professionals.(2)

All of this, combined with COVID’s impact on vulnerable populations and with the recent rise in asset values, such as residential real estate, and it is not surprising that there is accelerated retirement among older physicians.(3) According to a report by Doximity, more than 1% of the physician workforce retired earlier than expected due to the pandemic.(4) Considering the number of physicians in the United States and the high estimated costs of physician turnover, this has significant impact on our healthcare system.

Provider Supply Side Response

Several solutions have emerged to address an aging physician workforce, though even these ideas don’t fully address the current forecasted shortfall of projected need. Applications for medical schools are at an all-time high, more students are matriculating to medical programs, and gains are being made in terms of enrolling more racially and ethnically diverse medical school classes.(5-6)

Legislatively, the Resident Physician Shortage Reduction Act has been introduced. This bill aims to increase the number of residency slots by 3,000 positions per fiscal year for five years with particular focus on what the Health Resources and Services Administration consider shortage specialties.(7)

Medical education and physician pipelines are not the only ways to address projected physician shortages. Over the next decade, job growth for advanced practice clinicians (APCs), such as nurse practitioners and physician assistants, is expected to far eclipse physician growth (46% and 31% versus 3%, respectively).(1) Legislation provides these clinicians a growing scope of practice in many states, including providing more patient care through collaborative and alternative practice agreements.

Additionally, machine learning and artificial intelligence show considerable promise for streamlining and automating simple patient care decisions and tasks. While these technologies have been more theoretical than impactful in terms of providing healthcare to date, such solutions continue to attract record levels of venture funding.(8)

The Evolving Healthcare Market

The result of the aforementioned societal changes and market forces is a healthcare system that is quickly becoming characterized by an older, more middle-class patient population. The workforce caring for these patients is in a state of evolution, becoming younger, more automated, with a broader range of medical licenses. Their collective challenge is to deliver effective, patient-centered care in a healthcare system brimming with change.

For healthcare delivery organizations, this has created competition that goes beyond patients, members, and lives. Now, firms are tasked with competing for provider talent with a different approach to a career in medicine. Further complicating matters is pervasive burnout and employee turnover, to which millennial physicians and trainees do not appear to be immune.(10)

Competing for Workforce Market Share

Successful, sustainable organizations must determine how to leverage equity and belonging among its workforce to increase care delivery supply and meet patient needs. We propose three strategies on how best to attract and retain providers as consumers.

1. Compete for talent with inclusion and co-creation.

Every generation is unsettled when the succeeding generation challenges its beliefs.(9) In healthcare, lack of cultural diversity and generational interprofessional hierarchy exacerbate this dynamic. Health system leaders should counterbalance this tension by involving early-career clinicians in executive leadership.

Early-career executive advisory groups or positions on established clinical and leadership governance councils are ways to incorporate the ideas and values of younger providers in strategic organizational decisions. Similarly, the voice of APCs should be incorporated into leadership decisions and initiatives. Organizations should also rethink clinical practice as the predominant factor when considering clinicians for chair, medical director, and other executive leadership positions.

Exhibited executive decision-making through committee and society leadership; advanced education, such as MBAs, and leadership development training; and experience leading healthcare start-ups or non-clinical firms are additional factors to consider. The weighting attributed to these factors should be assigned and adjusted, based on organizational needs.

2. Cultivate sustainable, long-term relationships.

Novel, team-based models of care and the reality of physician workforce turnover are sure to disrupt the longtime relationships once associated between patients and physicians. This creates an opportunity for healthcare delivery organizations to bridge the gap and develop brand equity and loyalty among patients and consumers through sustainable value propositions.

While meaningful, continuous relationships between patients and providers should remain ideal and aspirational, the role of healthcare organizations in facilitating those relationships and rebuilding them in the midst of change will become imperative. Such action will insulate against patient attrition and dissatisfaction in the event of provider turnover.

Similarly, there is a need for organizations to develop provider-level brand equity and loyalty among providers by establishing a culture and identity that are consistent with their care delivery model(s).

Young people certainly are not shying away from a career in medicine, as evidenced by medical school applications and enrollment. Yet, trends related to burnout and turnover suggest that they have different ideals and preferences related to job-seeking and employment. This is an opportunity for healthcare firms looking to attract and retain providers, as those ideals and preferences should be prioritized in establishing the healthcare culture of the future.(10)

In summary, creating a strong consumer brand for both patients and physicians through culture and experience can diminish personnel turnover and attrition.

3. Invest in simple, human-centered technology.

Much of the technological innovation over the past 20 years in healthcare has supported better documentation, billing, and coding, but this has not aided in reducing burnout or creating capacity. One exception was the leap forward in adopting telehealth during the COVID-19 pandemic, a rapid response to an emerging need. In that circumstance, regulation was simplified, and barriers were minimized to connect patients and providers.

Such an approach is important as we consider future technologies aimed at improving patient care. Solutions should reduce physician and provider tasks towards better care as opposed to adding to the myriad of clinical information system options providers must use to care for patients.

Health system leaders who can make wise, human-centered investments in technology ahead of crises to encourage patient engagement, accelerate clinical documentation, provide cognitive decision support, and reduce physician between-visit work will create an advantage in retaining satisfied physicians.

Conclusion

Health system leaders are facing a rapidly evolving workforce supply-demand problem in healthcare delivery. It is thus imperative for firms to leverage inclusion and belonging as strategies to navigate this change.

Doing so will require current healthcare leaders to develop nontraditional leadership teams that include younger physicians and APCs; re-evaluate their brand relationships; and to invest in human-centered technology.

References

1. AAMC. The Complexities of Physician Supply and Demand: Projections from 2019 to 2034. Association of American Medical Colleges. Published online June 2021. www.aamc.org/media/54681/download

2. Najmabadi S, Honda T, Hooker R. Collaborative Practice Trends in US Physician Office Visits: An Analysis of the National Ambulatory Medical Care Survey (NAMCS), 2007-2016. BMJ Open. 2020;10(6):e035414. doi:10.1136/bmjopen-2019-035414

3. Castro M R. The COVID Retirement Boom. Economic Synopses. 2021;25. doi:10.20955/es.2021.25

4. Doximity. Doximity Compensation Report 2021. Accessed January 13, 2022. https://c8y.doxcdn.com/image/upload/v1/Press%20Blog/Research%20Reports/Doximity-Compensation-Report-2021.pdf

5. Weiner S. Applications to Medical School Are at an All-Time High. What Does This Mean for Applicants and Schools? Association of American Medical Colleges. October 22, 2020. Accessed January 13, 2022. www.aamc.org/news-insights/applications-medical-school-are-all-time-high-what-does-mean-applicants-and-schools

6. Boyle P. Medical School Applicants and Enrollments Hit Record Highs; Underrepresented Minorities Lead the Surge. Association of American Medical Colleges. December 8, 2021. Accessed January 13, 2022. www.aamc.org/news-insights/medical-school-applicants-and-enrollments-hit-record-highs-underrepresented-minorities-lead-surge

7. Menendez R. S.834 - 117th Congress (2021-2022): Resident Physician Shortage Reduction Act of 2021. March 18, 2021. Accessed January 18, 2022. www.congress.gov/bill/117th-congress/senate-bill/834

8. Healthcare AI Trends To Watch. CB Insights. www.cbinsights.com/research/report/ai-trends-healthcare/

9. Goldberg E. The 37-Year-Olds Are Afraid of the 23-Year-Olds Who Work for Them. The New York Times. October 28, 2021. Accessed January 13, 2022. www.nytimes.com/2021/10/28/business/gen-z-workplace-culture.html .

10. Clancy M. Understanding Millennial Physician Jobseekers. Recruiting Physicians Today. 2019;27(5):4.