Healthcare Associations Look to Soften Impact of Physician Shortage
by ANNABEL ROCHA
Florida is growing at a rapid pace, and Central Florida is particularly hot. According to the U.S. Census Bureau, Polk County is the fastest-growing county in Florida and the seventh-fastest-growing in the nation. Combine that astronomical growth with an aging physician workforce, and the full scale of the state’s physician shortage becomes evident. In 2019, Florida was short nearly 4,000 doctors. That number is projected to increase to nearly 18,000 by 2035.
Dr. Noureen Akbar, a primary care physician in Orlando who is also a board member of the Florida Academy of Family Physicians, sees trouble brewing.
“There is a huge chance that this will become a crisis, because we’re already seeing that.”
A number of factors are exacerbating the already tenuous situation.
Dr. Doug Murphy, an OB-GYN at his own private practice in Ocala, is the president of the Florida Medical Association.
“The other things that are making physicians retire is a combination of burnout and just dissatisfaction with the amount of extra work that’s being heaped on them through hospitals, insurance companies, and electronic health records,” Murphy says.
In an attempt to solve the issue, FAFP and FMA have identified some solutions to reducing the shortage.
Embracing telehealth and telemedicine, which allows long-distance patient-to-clinician contact, has proven to increase accessibility to patients and reduce administrative burden.
“Telehealth is here to stay, and we’ve shown during the pandemic that it can be helpful to allow us to see patients or talk to patients either during office hours or other more easily accessible times for patients,” Murphy explains.
Akbar agrees, citing how telehealth allowed her to see her geriatric patients during the pandemic without putting them at-risk of infection by coming into the office.
She says that even low-income or elderly patients who may not have access to technology have been able to access telehealth through loaner tablets kept in her office.
“There’s only a handful that we’ve had some difficulty with, mainly because they have some form of disability like they’re hearing-impaired or visually impaired,” she says.
“In those situations, we have to come up with mostly some form of home health scenario.”
FAFP and FMA say that relying on physician-led, team-based healthcare is also a way to aid the physician shortage and provide the most efficient care possible.
“It really streamlines the process,” Akbar says. She says that coming from a traditional practice, she experienced the burden placed on her and other physicians, leaving them feeling overwhelmed.
“We can’t see that many patients and on top of that take care of all their needs. But when you have a team-based care you can create a plan and those duties can be delegated according to the expertise of the team members. I have seen an amazing delivery of care now because of that.”
Murphy says it is important for physicians to lead. In some cases, he has seen an influx of responsibility placed on nurse practitioners and PAs to fulfill duties outside of their expertise. He stresses that while these healthcare professionals are intelligent and competent, their training is dramatically different than that of a physician. He points to over-ordering testing as an example.
“When we’re trying to make a diagnosis and we want to order testing, we shoot with a rifle as opposed to a shotgun. We narrow our target down to something very small and if we miss our target because we made an incorrect diagnosis, then we widen the scope of that surveillance net and try to get the diagnosis correct. We don’t order every test in the book,” he says.
While some patients think this is best, he says, it is expensive and spends time examining issues that a physician could have ruled out by asking questions.
Akbar and Murphy say that increasing the number of residency positions in the state is key to reducing Florida’s physician shortage. Medical students need this training to become fully qualified, and most physicians tend to stay where they complete their residency.
“I’m the prime example,” Akbar says. “I was not from Central Florida, but I came here, I liked it, formed a lot of connections and I ended up deciding to stay in the Orlando area and I think that’s something that a lot of residents do.”
In 2020, Congress approved one thousand new residency positions, but many say it is not enough to support the growing number of medical school enrollment and it does not ensure a sufficient increase to Florida directly.
Florida Trend reports that the state has 34.9 medical residents per 100,000 people, while New York has almost three times that amount.
Murphy explains that the large number of retirees in Florida makes access to physicians even more crucial.
“We probably need more physicians per capita than someplace that has a younger overall population,” he says.
In 2021, there were 7,608 residency and fellowship positions in Florida, and these are essential for producing the next generation of doctors as well as providing options to in-need patients.
“Those residents usually take care of low-income patients for little to no cost,” Akbar says, “and residents usually take care of a lot of Medicare and Medicaid patients so that helps reduce the shortage.”