Amid the ongoing COVID-19 pandemic, providers across the U.S. quickly adapted to rapidly changing circumstances. In this blog we will examine the context of this response and implications for ambulatory care transformation.
The COVID-19 pandemic struck the U.S. in the midst of endemic physician burnout and increasing shortages of primary care providers. Among physicians in general, a recent survey revealed that 44% report feeling “burnt out.” For Internal Medicine and Family practice the numbers are closer to 50%. This issue is not surprising given the range of challenges physicians face from adapting to use of the electronic health record and accountability for quality metrics, to the distraction of “unfunded mandates” and ever changing payer relationships.
When you combine this with the dramatically high debt medical students incur, it’s no wonder that we’ve seen dire predictions of ever-increasing primary care physician shortages. Estimates by the Association of American Medical Colleges predict that the supply of primary care doctors in the U.S. will be as much as 55,000 below what is needed by 2032. Most concerning is a report that of the 8,116 Internal Medicine residency positions available in the 2019 National Resident Matching Program, only 41.5% were filled by graduates from American medical schools.
Innovation in Ambulatory Care
In stark contrast to these negative forces at play, the pandemic has unleashed an unprecedented level of creativity and innovation across ambulatory care practices. From rapid implementation of virtual visits and using parking lots as waiting rooms, to curbside encounters and creation of “dirty” and “clean” offices, it’s remarkable that providers have demonstrated an amazing ability to adapt quickly when the stars align to encourage change. While the NextGen Advisors have heard about a variety of concerns from our discussions with providers throughout the country, our team has also observed excitement and energy regarding the opportunity to accelerate the transformation of healthcare.
Hope for the Future
This wave of innovation offers hope that we are not bound by our history. While many practices have begun to modify their approach in the context of value-based contracts, most have not undergone transformative change. That said, there are a variety of models employing visionary concepts of patient engagement and redefinitions of the healthcare team that may offer insights into some of the possibilities ahead. The American Academy of Family Medicine notes several potential models. In Illinois, a group of physicians formed the Home Centered Care Institute, which focuses on providing in-home based primary care to high risk populations. The Cambridge Health Alliance in Massachusetts implemented a model where they combine primary care with public health services so that social determinants of health are managed in close coordination with clinical care. In Nebraska, a whole person care model was implemented and became one of the nation’s most successful Accountable Care Organizations.
Dr. David Meltzer, at the University of Chicago implemented an internal medicine approach called the Comprehensive Care Physician model. Physicians in this practice have organized to take care of a small number of exclusively high-risk patients and provide both outpatient and hospital care. Remarkably, they have shown promising results for patient outcomes and utilization as well as provider morale.
These are but a few of the more transformative approaches to care that are already operating in isolated settings. In future blogs we will be taking a deep dive into several of these experiments to gain insights regarding scalable transformative attributes for the practice of the future.