If you could gaze into a crystal ball to define the outlook for Emergency Medicine (EM) and Hospital Medicine (HM) physicians over the next five-to-fifteen years, what would you see?
Certainly, the physician shortage and the way patients access and experience care would emerge as central themes, but those aren't the only two things you would notice
You would likely also see the need for improved efficiencies, willingness to accept a team approach to care that includes NPs and PAs, acquiring more critical care skills to treat the increase in higher acuity patients, facing challenging healthcare paradigms outside their current scope of practice, and providing quality care in rural areas.
We’ve examined each of these important issues to see if we can make some evidence-based predictions regarding what EM and HM physician practice will look like in the months and years ahead.
Physician Shortage Will Continue to Grow
The physician shortage is a core theme in our predictive narrative because it has a bearing on nearly all the others mentioned above.
For the past several years, the Association of American Medical Colleges (AAMC) has warned that the United States is experiencing a worsening physician shortage. Its latest report predicts that the country could see the deficit rise to 122,000 physicians by 2032 as demand outpaces supply.
The primary factor driving demand for physicians: a growing, aging population.
"The nation's population is growing and aging, and as we continue to address population health goals like reducing obesity and tobacco use, more Americans will live longer lives," said AAMC President and CEO Darrell Kirch. "These factors and others mean we will need more doctors."
Need for Increased Efficiencies Will Extend Beyond Cost Alone
The physician shortage brings with it the need for increased efficiencies to provide quality care to the highest number of people possible.
When you think about efficiency, the allocation of funds is likely the first thing that comes to mind, but efficiency also involves discovering innovative ways to maximize the value of available resources through resourceful processes, people, and technology.
One of the ways such efficiency is evidenced is through telemedicine: the remote diagnosis and treatment of the patient employing telecommunications technology.
Use of telemedicine is particularly important in rural areas where the physician shortage is more intensely felt and where access to quality care is becoming more limited.
A 2018 study from the University of Iowa found that rural Emergency Departments (ED) using telemedicine save money and have an easier time recruiting new physicians. ED physicians in rural areas can use telemedicine to consult with specialists in larger facilities, which may let the patient be treated in place or be transferred to the appropriate facility, the study said.
At SCP Health, we have implemented telemedicine with small-to-medium-sized facilities, enabling them to provide quality diagnostic and treatment services in a cost-effective, timely manner that they would be unable to otherwise.
Alternative Healthcare Delivery Trends Will Continue to Emerge
Telemedicine is just one of many healthcare delivery trends that will emerge in the future. The fact that healthcare is becoming more consumer-based thanks to high-deductible health plans and competition for patients has opened the door to alternatives, such as mobile care, remote monitoring, acute care clinics, stand-alone ERs, and high-end outpatient clinics.
In 2017, President Trump issued an executive order designed to increase choice and competition across the healthcare market. According to HHS Secretary Alex Azar, this move was made to empower consumers, and put “the health care consumer in charge, letting them determine value.”
NPs and PAs Will Become Integral to the Care Continuum
As the doctor shortage continues, the supply of NPs and PAs is projected to increase. That's a positive trend because the benefits hospitals will accrue by integrating these practitioners into the clinical workflow — lower facility costs, shared workload with physicians, ease of recruiting, and increased patient satisfaction — both in EM and HM, are too numerous to ignore.
SCP Health has always focused on a team-based system of care, and NPs and PAs are critical parts of our healthcare teams. We value their autonomy and support them with the necessary tools, education, and leadership opportunities to grow in their career.
Health Systems Will Boost Higher-acuity Investments to Stay Viable
An article in Healthcare Dive, reporting on a study conducted by Moody's Investors Service, said that hospitals are "disproportionately dependent on lower acuity inpatient admissions." That will change with the shift toward greater outpatient care.
To stay viable, EM and HM physicians will need to acquire more critical care skills to treat higher acuity patients, and capital investments will go toward higher acuity, more intensive cases, such as "intensive care units and larger operating rooms," the article stated.
Physicians Must Contend with New Healthcare-related Paradigms
In the future, physicians will have to prepare themselves to address healthcare paradigms outside their usual scope of practice. Three are worth noting: violence in the ED, patient loyalty, and post-acute care.
Violence in the ED
Violence in America's emergency departments is on the rise according to new research from the American College of Emergency Physicians (ACEP), causing harm to physicians, staff, and patients alike.
ACEP polled more than 3,500 emergency medicine physicians from across the nation, nearly half (47 percent) of whom reported having been physically assaulted while at work, with 60 percent saying the assaults occurred in the past year.
Consumers empowered to make choices about where to receive care means that hospitals and physicians must emphasize increasing loyalty by improving the patient experience. As one person put it, patients are only about as loyal to their healthcare providers as they are to their mobile phone plans.
Post-acute Patient Care
Although hospital medicine is typically tied to the inpatient setting, increasing numbers of hospitalists are spending time outside of the hospital, visiting patients in post-acute settings, including the patient's home, inpatient rehab facilities, long-term acute-care hospitals, and skilled nursing facilities.
The Future of Emergency and Hospital Medicine
Bottom line, what does the future hold for EM and HM physicians?
In an article in ACEPNow, Ricardo Martinez, MD, FACEP, summed up the future of EM best:
"Some believe the world of emergency medicine is eroding, with the growth of urgent care, freestanding emergency departments, retail clinics, and virtual care that can compete for patients. Others hold the view that the same change in the landscape is evidence of an expansion of our specialty.
"I tend to believe the latter: with an aging population, an increase in the insured, and a shortage of providers, there will always be a continued need for unscheduled acute care. No matter where those patient needs are, we want to be there. Emergency medicine exists to fill that gap."
David Grace, MD, SFHM, senior medical officer at SCP Health, believes hospital medicine will flourish for two reasons: an aging population that will require more acute care and a shift in the payment model, from volume to value-based.
"The average number of hospitalizations for patients aged 65 and over has remained constant for the past 20 years," Grace said. "In the future, as the Baby Boomer generation continues to age, that number will rise dramatically. As the population gets older, the need for hospitalists will increase to the point where they become the de facto caregivers in the inpatient world."
If we are to believe these two learned colleagues, the future of both professions is bright despite challenges like the physician shortage, changing ways patients consume healthcare, or any of the other issues mentioned in this post.
The very reason we changed our brand name from Schumacher Clinical Partners to SCP Health is to meet the demands of this fast-changing healthcare landscape and bring hospitals and physicians together in the pursuit of clinical effectiveness, no matter what the future holds.
e-book: 9 Steps Providers Can Take to Influence Patient Loyalty
Blog: Exploring New Opportunities in Hospital-Based Medicine
Case Study: Breaking the Cycle of Staffing Shortages and Operational Challenges