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How Healthcare Will Look With a Physician Shortage

Posted By Chicago Tribune , Friday, November 06, 2015

The Association of American Medical Colleges projects that the nation will face a shortage of 12,000 to 31,000 primary-care physicians by 2025. So it's no wonder you may be finding it harder to find a doctor or to schedule an appointment with the one you have.

What's fueling this problem? The baby boom generation pouring into older age, an aging physician workforce preparing to retire and an estimated 30 million Americans joining the ranks of the insured since enactment of the Affordable Care Act in 2010.

What that means is that you may not being seeing a doctor at all the next time you go for health care.

"The impending physician shortage is an opportunity to move to a health care model where the physician can be more of a quarterback on a team of health care providers, rather than being on the front lines," said Dr. David Gorstein, managing director of Health Innovations, a health care consulting firm in Charleston, S.C., focusing on new models of health care. It's time to look to other, more affordable and accessible settings, he said.

Here are five options for addressing shortages and reining in costs.
Retail clinics

Maybe you have a scratchy throat and suspect another cold, but there's a two-week wait to see your doctor. Or you're out of town on business or are self-employed without health insurance.

Typically located in pharmacies, groceries and "big box" stores, these walk-in clinics began cropping up in 2000 and served more than 20 million patients in 2014, according to their trade association, the Convenient Care Association. To date, they number over 1,800 in 40 states and Washington, D.C., offering lower-cost options for health services with transparent pricing, so consumers know what they are paying for.

Visits typically range from $40 to $75 and address acute conditions, such as bronchitis and ear infections, as well as provide immunizations and physicals. Usually staffed by nurse practitioners, who are highly trained registered nurses, some incorporate pharmacists into ongoing care (which is particularly valuable in medication counseling for chronic diseases like diabetes or asthma). The clinics generally accept health insurance and can send a record of your visit to your primary-care physician.

"While the care can be excellent and the wait times and cost to the patient much less than emergency rooms, it's important to understand that walk-in clinics only treat a limited list of problems," said Dr. John W. Rowe, professor of health policy and aging at the Columbia University Mailman School of Public Health. They should not be relied on as a source of ongoing care, he cautioned. Yet Dr. Don Goldmann, chief medical and scientific officer at the Institute for Healthcare Improvement in Cambridge, Mass., sees their growth as proof that they fill important needs, providing "easier access to providers and quick, convenient care."

Urgent-care centers

Although they've been around for decades, the more than 6,400 urgent-care centers in the U.S are seeing an upswing in growth (from 8,000 to 9,300 since 2008), fueled by consumer frustration with long waits in emergency rooms and for appointments with primary-care physicians. These same-day walk-in clinics focus primarily on emergency medicine for acute (but less severe) medical problems. Typically staffed by trained and licensed physicians and medical assistants, registered nurses and X-ray technicians, nearly one-third of them are hospital owned and operated.

Many offer evening and weekend hours, perform X-rays and some on-site lab tests (like urinalysis and pregnancy and strep tests) and provide procedures like suturing and casting, usually more economically and with less wait time than hospital emergency rooms. In some communities, they function as primary-care practices for some patients. One study estimated that up to 27 percent of emergency room visits could be handled appropriately at retail clinics and urgent-care centers, offering cost savings of $4.4 billion per year.

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