Hospitals' adoption of health IT may lessen the demand for physicians in the coming years, according to a new analysis.
By 2020, the United States will face a physician shortage of more than 91,500 physicians, according to the Association of American Medical Colleges. The expansion of health IT, however, may have the ability to ease the effects of the physician shortage by significantly reducing the demand for in-person physician care, according to a literature review recently published in Health Affairs.
Most models used to predict physician demand have relied on past trends and practices, as it's often easier to look back then it is to look forward, says study author Jonathan P. Weiner, DrPH, a professor of health policy and management and health informatics at the Johns Hopkins Bloomberg School of Public Health and the director of the Johns Hopkins Center for Population Health IT in Baltimore. However, he felt the recent surge in IT adoption across the industry warrants investigation into how electronic health records, mHealth applications and devices and other soon-to-be-ubiquitous technologies could affect future demand for physicians, motivating this literature review.
"We wanted to take the best available literature we had — it wasn't zero, but it could have been better — and with some knowledge of health IT and an understanding of the healthcare system, we wanted to begin a discussion on health IT's likely impact on future trends," says Dr. Weiner.
To better understand the effects of technology on physician demand, the researchers narrowed their focus to physicians in office-based settings. Additionally, predictions on health IT's effect on the demand for physicians 10 or 15 years down the road depend on the rate of health IT adoption and the extent to which healthcare providers allow these new systems to transform care delivery. Because of the unknowable nature of this measure, the researchers made separate predictions based on projected penetration of "full health IT," defined as comprehensive health IT systems featuring interoperable EHRs, clinical decision support, provider order entry and patient web portals, similar to health IT systems currently found at the top 3 or 4 percent of integrated delivery systems across the country. Two scenarios were imagined — a future of where 30 percent of delivery systems have this level of health IT integration, and a future where 70 percent do.
Researchers then identified three main impacts of full health IT systems on physician demand.
1. Gains in efficiency. Technology that allows patients to email physicians or access health information remotely would lead to a decreased demand to in-person visits. Assuming the physicians are not under a fee-for-service payment model and are financially incentivized to adopt the right technology, about 15 to 20 percent of services could be handled this way, says Dr. Weiner, leading to a decrease in demand for physicians. Researchers estimate the drop in demand to be 2 to 5 percent under the 30 percent full IT penetration model and 4 to 11 percent under the 70 percent full IT penetration model.
IT also has the ability to improve providers' workflows, and "we have to assume a gain in office efficiency will lead to another gain in the number of patients a physician can see," estimated to be up to 10 percent, says Dr. Weiner. The increase in efficiency is estimated to potentially lead to a decrease in demand in the range of either 2 to 4 percent to 4 to 8 percent, depending on the IT penetration model. Together, efficiencies gained on both the patient and provider side could mean up to a 19 percent drop in demand, according to the researchers.
2. Support of delegation. "Organizations with good EHRs and good decision support software don't always need a doctor for every service," says Dr. Weiner, and the ability for remote consults can allow primary care physicians to do a lot of what specialists are currently needed for. The researchers estimate full health IT implementation could lead to 10 to 20 percent delegation to nurse practitioners or physician assistants and an additional 5 to 15 percent delegation from specialists to general practitioners. This delegation could lead to a 6 to 12 percent drop in physician demand under the 30 percent penetration model and a 12 to 25 percent drop in demand under the 70 percent penetration model.
3. Increase in remote or asynchronous care. "We believe between 5 and 10 percent of care could be done by a doctor who wasn't physically there, and 10 to 20 percent of care could be done not in real time by a remote physician," says Dr. Weiner, leading to up to a 7 percent drop in physician demand in the 30 percent penetration model and a 15 percent drop in the 70 percent penetration model.
Overall, these gains from full health IT systems should enable physicians to meet the demands of about 8 to 15 percent more patients than they would be able to without health IT, putting a significant dent in physician demand. "It's a brave new world," says Dr. Weiner. "We're not sure whether or not [these predictions] will happen, but we're confident they can happen."
Dr. Weiner hopes this literature review provides the basis for further investigation into the relationship between health IT adoption and physician demand. "This study isn't perfect, mostly because the literature isn't perfect, but it's the most comprehensive out there right now and we hope others expand on it," he says.
The review's findings may be somewhat surprising to healthcare leaders, says Dr. Weiner. "The numbers [representing decreases in physician demand] are all fairly modest, but they add up," he says, showing technology may end up having more of an impact on physician demand than previously thought. "The takeaway for healthcare leaders is to know this could happen, and this has been happening," he says.
Dr. Weiner hopes healthcare leaders use the results of the study to realize the full potential of health IT and begin to think more outside the box in terms of improving care delivery. "It goes to show we can't resolve all the challenges in healthcare by just adding more doctors," he says. "We need to explore other ways of making the healthcare system better."
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