"As the healthcare system shifts to do more preventive care, that will be the area of most concern," Garza says. "Physician training needs to be multidisciplinary, needs to feature a team approach, and nurses and others will have to work at a higher level. We'll need to stretch our human resources."
Extended roles of nonphysicians is a direction toward which many hospitals and health systems are moving, says Clese Erikson, director for the Center for Workforce Studies at the Association of American Medical Colleges, a medical school trade organization.
"You can see that with the increased number of ACOs and efforts with ‘hot-spotting' [aggressive primary care intervention on the sickest patients]." Bringing nurse practitioners into the communities where the highest utilization patients
are, for example, can help prevent unnecessary utilization, she says.
Such efforts, if successful, might bring much-needed nuance into the discussion of the physician shortage, including disruptions in the types of physicians needed in the future.
Erikson says such efforts might mean healthcare in the medium-term future might be more primary care intensive and may change demand for specialists, but that such efforts—despite the fact that they appear to improve quality of care and seem to reduce downstream utilization of expensive healthcare services—are in such an early stage that it's difficult to define their workforce implications.
"It's too early to say, but I would be surprised if it could eliminate all the shortages," she says.
Changing expectations about work-life balance
Another piece of the shortage puzzle involves the importance many young medical school graduates have placed on leisure and family time. Where in the past a physician might find a 60- or 80-hour workweek common and expected, not so today's graduates.
"This generation of physicians views that person as a caricature," says USF's Klasko. "We are creating a group of physicians with more of a shift mentality, which will increase both the need for numbers and being creative."
Klasko, an OB-GYN, says for example that many in his specialty do not want to be as available to patients as their predecessors were and cites statistics that show that almost 60% of OB-GYNs are practicing part-time.