Updated: Sep 17, 2019
Of all the problems with our current healthcare system that get discussed in the media, there is one that receives relatively little attention – we don’t have enough doctors. According to a report published by the Association of American Medical Colleges (AAMC) in April of 2019, we are already about 30,000 physicians short of what we need to provide healthcare for all Americans. With our aging population, the AAMC report projects that this shortage may grow to as much as 122,000 physicians by 2032. How did we end up in this position? For starters, a federal cap on support for graduate medical education (GME, i.e. residency) creates a bottleneck in physician training – a cap that has not changed since 1997. For those of us that made it through the bottleneck, there is the looming threat of burnout – a state of feeling overwhelmed, cynical and detached from the job due to protracted, unresolvable job stress. As administrative burdens increase, doctors are increasingly looking to cut back hours or, in some cases, leave medicine altogether. A study by the Mayo Clinic in 2015 estimated that 54% of all physicians reported burnout in the previous year, so it’s not a problem isolated to a minority of doctors. As doctors succumb to burnout, it only compounds the problem of not having enough physicians in the first place.
What can we do about the shortage? The obvious answer is to increase funding to train more doctors. Legislation has been proposed in 2019 to use Medicare funding to open up 15,000 additional residency positions over 5 years. Even if it passes, however, it would be at least 7 years before the healthcare system sees the benefit, as it requires 4 years of medical school and a minimum of 3 years of post-graduate training for a physician to practice independently. We could try legislation aimed at reducing administrative burdens in healthcare, but, unlike the funding cap on GME, there are many, many targets here with a lot of powerful interested parties who are unlikely to agree quickly on issues like prior authorizations or claims and appeal rules. We need more physician coverage ASAP, but training more doctors and changing the rules of medicine could take years to achieve. In my mind, that leaves the option of expanding the coverage provided by our current physician pool.
Unfortunately, in recent years, the means of expanding coverage has consisted largely of asking doctors to see more patients with the same amount of resources. This approach, of course, requires sacrifice in the form of less time with individual patients and less time documenting to lay out your thoughts and plans clearly. Some measure of brevity is going to be necessary to get all of the patients seen by an inadequate number of doctors, but where could we be more efficient in a way that doesn’t detract from patient care? This is one of the key questions that led me to pursue a telemedicine delivery model. I started examining the parts of my day that were not patient care and not enjoyable – a lot of these are not easily modified, like completing documentation in the electronic record or completing paperwork required by insurance to get patients necessary care. One aspect that can be modified, however, is travel time. I have spent countless hours in transit between patient rooms, hospital floors and different healthcare facilities – often with redundant trips where I think I’m done at one facility only to be consulted on a new patient there later in the day and retrace my steps before the workday is over. This time spent meandering can become highly inefficient, particularly when you cover multiple facilities that are miles apart across a major metropolitan area, as many of my colleagues in Denver do. So, why not just cut out the travel time?
Granted, this approach may not work for every physician in every situation. For now, surgeons still need to be physically present in the room to operate (although robotic surgery may soon change this), and specialists who perform endoscopic procedures and insert various types of catheters still need to show up in person to make it happen. For cognitive specialties (those that do not involve many, if any, invasive procedures), however, telemedicine offers an opportunity to expand our reach in ways previously unimagined. Rather than walking and driving miles every day just to move between patients, I could stay at one workstation and take seconds, rather than minutes, to transition from one case to the next. It may not seem like much, but multiply those few minutes walking between patients and driving between hospitals by about 20 patients per day and then by the number of working days in a year, and it adds up quickly. Also, we specialists tend to cluster around urban areas, so, historically, patients had to drive for hours to see us at our home offices or else we had to drive for hours to see them at outreach clinics. Why not arrange patient encounters so that neither party has to leave home? With the proper telemedicine setup, I could see all the same patients at the hospitals where I now work in proximity to my home and still have time left over to check on a patient in Delta, Colorado – a 4.5-hour drive from Denver with good traffic. If I felt so inclined, I could even see a patient in another state at a facility with no local Infectious Disease doctor, all without leaving my chair (hypothetically…since we all now know that prolonged sitting is bad for your health…so maybe I have one of those standing desks, or even a treadmill desk, but you get the point…).
When it comes to reforming the healthcare system, I believe broader implementation of telemedicine is a step in the right direction. Not only does it expand the reach of our limited supply of physicians – it also provides more equitable delivery of healthcare. Let’s face it – rural hospitals in the US are not able to provide the same level of care as their urban counterparts, and much of the problem stems from not being able to retain medical specialists. But what if specialty expertise were available to the rural facilities on demand without having to entice the doctors to move out of urban areas with higher-than-average salaries? More patients receive quality care in their own communities. Patient families are not burdened with travel expenses. Smaller, remote healthcare facilities struggle less financially because they retain more patients. The system as a whole saves money. Internet access, webcams and remote logins to electronic record systems are already widely available, so we could remove a lot of geographic limits to excellent healthcare with minimal investment. This is a part of the vision of AirborneID, because Infectious Disease, in particular, is a field short on physicians at a time when “superbugs” are on the rise. Changing the paradigm of care delivery could improve outcomes for more patients and local healthcare facilities while staving off physician burnout and maximizing the impact of a limited number of doctors. It’s time to rethink how we deliver healthcare in the US, and I hope that AirborneID is just part of a wave of change that harnesses technology to accomplish the task.