health transformation
.foundation
Joaquim Cardoso MSc
February 14, 2024
This is an Executive Summary of the article “We need to redesign the care delivery model in a way that allows physicians to be the good doctors they are while still providing patients with full access to care”, based on a conversation betwenn Daniel W. Varga, MD, and Thomas H. Lee, MD, , and published by the NEJM Catalyst
What is the Message?
The message conveyed in this discussion between Daniel W. Varga, MD, Chief Physician Executive for Hackensack Meridian Health System, and Thomas H. Lee, MD, MSc, Editor-in-Chief for NEJM Catalyst, is the urgent need to address physician shortages by reforming the current care delivery model.
Varga emphasizes the necessity of adapting to changing demographics, physician preferences, and evolving healthcare demands to ensure patients receive adequate care despite the impending shortage of physicians.
The conversation underscores the critical importance of redesigning healthcare delivery to maintain access to care while accommodating the changing expectations and needs of both physicians and patients.
What are some the new care models
The conversation highlights several new care models aimed at addressing physician shortages and improving healthcare delivery.
These models are supported by evidence indicating their effectiveness in optimizing resource utilization, enhancing patient access to care, and improving overall healthcare outcomes.
Some of the new care models mentione
d include:
1.Regionalized and Rationalized Care:
Navigating Physician Shortages: Redesigning Healthcare Delivery for the Future”
health transformation
.foundation
Joaquim Cardoso MSc
February 14, 2024
This is an Executive Summary of the article “We need to redesign the care delivery model in a way that allows physicians to be the good doctors they are while still providing patients with full access to care”, based on a conversation betwenn Daniel W. Varga, MD, and Thomas H. Lee, MD, , and published by the NEJM Catalyst
What is the Message?
The message conveyed in this discussion between Daniel W. Varga, MD, Chief Physician Executive for Hackensack Meridian Health System, and Thomas H. Lee, MD, MSc, Editor-in-Chief for NEJM Catalyst, is the urgent need to address physician shortages by reforming the current care delivery model.
Varga emphasizes the necessity of adapting to changing demographics, physician preferences, and evolving healthcare demands to ensure patients receive adequate care despite the impending shortage of physicians.
The conversation underscores the critical importance of redesigning healthcare delivery to maintain access to care while accommodating the changing expectations and needs of both physicians and patients.
What are some the new care models
The conversation highlights several new care models aimed at addressing physician shortages and improving healthcare delivery.
These models are supported by evidence indicating their effectiveness in optimizing resource utilization, enhancing patient access to care, and improving overall healthcare outcomes.
Some of the new care models mentioned include:
- 1.Regionalized and Rationalized Care
- 2.Regionalized and Rationalized Care
- 3.Specialized Primary Care Models:
1.Regionalized and Rationalized Care
This model involves consolidating specialized services at larger hub hospitals within a region, thereby reducing the need for duplication of resources across multiple facilities.
Evidence suggests that regionalizing care can improve efficiency, standardize practices, and enhance the quality of care delivery. Examples include:
Establishing comprehensive stroke centers at regional hub hospitals to provide specialized care for stroke patients across multiple smaller hospitals within the same geographic area.
- Concentrating orthopedic surgery services at select hospitals to streamline resources and ensure consistent access to high-quality care for patients with orthopedic conditions.
2.Utilization of Advanced Practice Clinicians (APCs):
This model involves maximizing the capabilities of advanced practice clinicians, such as physician assistants and advanced practice nurses, to deliver care at the top of their licensure.
Evidence suggests that APCs can effectively complement physician-led care teams, particularly in specialty areas where physician shortages are prevalent. Examples include:
- Integrating physician assistants and advanced practice nurses into neurology practices to provide consults, follow-up care, and patient management under the supervision of neurologists.
- Deploying advanced practice providers in orthopedic surgery clinics to assist with patient evaluations, diagnostic workups, and post-operative care, thereby optimizing workflow and improving patient throughput.
3.Specialized Primary Care Models:
This model involves redesigning primary care practices to incorporate subspecialized services and address the evolving healthcare needs of patients.
Evidence suggests that integrating subspecialty expertise into primary care settings can enhance the comprehensiveness and effectiveness of care delivery. Examples include:
- Creating primary care practices with specialized focus areas, such as sports medicine or chronic disease management, to provide targeted services for specific patient populations.
- Collaborating with subspecialists, such as physiatrists in spine surgery programs, to offer comprehensive evaluations and treatment plans for patients with complex musculoskeletal conditions.
Overall, these new care models demonstrate promising strategies for overcoming physician shortages and ensuring equitable access to high-quality healthcare services.
By embracing innovation and leveraging available resources effectively, healthcare organizations can adapt to evolving patient needs and deliver optimal care outcomes in an era of physician workforce challenges.
Examples and Statistics
- Physician Shortages: Estimates project a shortage of 50,000 to 150,000 physicians by the mid-2030s, driven by factors such as an aging population, physician burnout, and changing demographics.
- Productivity Replacement: Varga highlights the challenge of replacing highly productive physicians, indicating that it may require recruiting multiple physicians to match the productivity of a single experienced doctor.
- Generational Differences: The conversation identifies generational shifts in physician preferences, with younger physicians seeking better work-life balance and different practice models compared to previous generations.
- Regionalized and Rationalized Care: Hackensack Meridian Health System is exploring regionalized care models to optimize resources and improve efficiency in delivering specialized services across multiple hospitals within a region.
- Utilization of Advanced Practice Clinicians (APCs): To address workforce shortages, the system is increasingly relying on APCs to deliver care at the top of their competency, particularly in specialty areas where physician shortages are acute.
Conclusions and Recommendations
Short-term Solutions:
- Leveraging the size and resources of large health systems to implement regionalized care models and utilize APCs effectively.
Medium-term Strategies:
- Focusing on optimizing workforce utilization, particularly through the use of APCs, to ensure all providers are practicing at the top of their licensure.
Long-term Approaches:
- Embracing care redesign efforts that accommodate shifts in healthcare delivery, including the incorporation of virtual care models and innovative access points beyond traditional primary care.
The discussion underscores the importance of proactive measures to address physician shortages and adapt to changing healthcare landscapes. It emphasizes the need for collaboration between healthcare leaders, policymakers, and providers to develop and implement sustainable solutions that ensure continued access to high-quality care for all patients.
Daniel W. Varga, MD
Chief Physician Executive, Hackensack Meridian Health System, Edison, New Jersey, USA; President, Physician Services, Hackensack Meridian Health System, Edison, New Jersey, USA
