CHAPTER 19
Hiring and Managing Medical Providers
John Shufeldt
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WITHOUT THE RIGHT MEDICAL provider, an urgent care clinic can struggle and even fail. This chapter discusses challenges in hiring and managing medical providers.
In 1997, the federal government placed a cap on Medicare funding of hospital residency training programs. Since the cap was put in place, the number of physicians trained in the United States has grown only marginally, whereas population size and population aging have increased significantly, driving up demand for physician services. This has also fueled the demand for midlevel providers.
The Association of American Medical Colleges (AAMC) believes that by 2025, the United States will face a shortfall of nearly 160,000 physicians, of which more than 50,000 are in primary-care specialties. According to the AAMC, the Affordable Care Act will increase the shortage by 31,000 physicians. The American Academy of Family Physicians projects a global deficit of 149,000 physicians by 2020, and the US Health Resources and Services Administration projects a shortage of 65,000 primary-care physicians by the same year.
Moreover, a study published in JAMA by Staiger et al showed a 5.7% decrease in hours worked by nonresident physicians in patient care. Given a workforce of approximately 630,000 in 2007,1 this is equivalent to a loss of approximately 36,000 physicians from the workforce.2 The authors of the study postulate that declining physician reimbursement in real dollars and decreased job satisfaction are directly correlated to declining work hours.
The way physicians practice also affects physician supply. The private-practice model is rapidly being replaced by hospital and large medical group employment. Many younger physicians prefer the set hours and controllable lifestyle typical in large-practice employee settings to the longer hours characteristically associated with private, small group, or lone-physician practices. In addition, the influx of female physicians into the workforce also has had an inhibiting effect on overall physician full-time equivalents.3
Finally, a white paper published by Merritt Hawkins & Associates on behalf of the Physicians Foundation disclosed that only about 25% of the physicians surveyed plan to continue with their current mode of practice. Close to 75% plan to take steps likely to reduce the number of patients they see or to remove themselves completely from patient care.4
These data reveal that the need for urgent care centers, staffed by both physicians and midlevel providers, will be an important component of the continuum of care in the near future—even more than it is today.
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