Blog | Monday, May 1, 2017

Workforce predictions and horse manure


The Association of American Medical Colleges (AAMC) recently released a new report detailing their predictions for the physician workforce of the future. The accompanying press release highlighted the key finding of the report: by 2030, the U.S. “physician shortage” will be between 40,000 and roughly 105,000 physicians. The projection is based on a few assumptions, including that the 2015 physician workforce was “in balance” (enough doctors to meet demand); the aging of the population; retirement trends among physicians; and improvements in access to care for traditionally underserved populations.

Mostly the report made me think of horse manure. Specifically, it reminded me of frequently quoted predictions, made in the late 19th century, that cities such as New York and London would, by the early 20th century, be buried in mountains of it. This has been dubbed “The Great Horse Manure Crisis of 1894“ which, of course, never came to pass.

In retrospect, it is easy to see that the 19th-century alarmists missed the technological revolution that was about to replace horses with vehicles powered by internal combustion engines, which averted the “crisis.”

What is striking about the AAMC report is that it fails to consider the impact of the technologies that are poised to revolutionize medical practice. In fact, the report assumes that we will be practicing medicine in 2030 more or less the same way we are practicing now, which is not only depressing to contemplate but extremely unlikely.

Here are just a few things that we already know about, which seem destined to change medical practice, separate and apart from any unanticipated technological or organizational breakthroughs:

• virtual care, enabling providers and patients to connect without physical contact,

artificial intelligence, replacing expert (human) interpretation with (machine) algorithms,

• consumerism and self-care, supported by online communities of patients with similar complaints or conditions, leading to care outside of current delivery models,

• more effective treatments, leading to more “cures” that will replace chronic “management”,

• innovative care models less dependent on physicians, and relying more on other health care professionals,

• more targeted therapies based on precision medicine, leading to less wasted care, fewer side effects and better outcomes, all of which lower the need for more conventional treatment, and

• more effective public health strategies, lowering the burden of complications of smoking, or diabetes or coronary heart disease.

The list goes on, but the point is pretty clear. I think the AAMC badly missed the mark with this report. In fact, it reminds me of horse manure in more ways than one.

What do you think?

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.