'It's only going to get worse': How physician shortages will transform care access

Matt Mazurek, MD, assistant clinical professor of anesthesiology at St. Raphael's Campus of Yale New Haven (Conn.) Hospital, joined Becker's to discuss how physician shortages will transform care access. 

Editor's note: Responses were edited lightly for clarity and length. 

Question: What's your biggest concern regarding the physician workforce right now?

Dr. Matt Mazurek: The biggest issue is continued staff shortages and the fact that a good portion of active physicians are 55 and older and are either going to be retiring within the next 10 years or are looking to find a way out now. This is already a problem, and it's only going to get worse. 

First and foremost on everyone's mind is proceduralists — you can't replace proceduralists with any other provider. Urology, for example, is going to reach crisis proportions in all rural areas in the U.S. in the next decade, same thing with gastroenterologists, vascular surgeons, ENT physicians, etc. There's going to be a huge transformation as a result of that shortage where rural areas will become really good at doing the basics really well, and patients needing advanced or specialty care will probably have to head to a metro area. Hospitals will be fortunate to keep some of those services local, but I doubt many will be successful. Reimbursements are too low, and specialty providers do not want an onerous call burden as a sole provider.  

Q: What's the danger of this issue continuing in the long term?

MM: A part of the danger is the timing of the surgical procedures, particularly with specialties. When patients in rural areas have an acute problem, sometimes these procedures need to be done within the next two to three hours. What are patients going to do if they have, for example, sepsis from a perforated bowel or a kidney stone? These patients need to be airlifted to the nearest facility. It costs a lot of time and money, and if the patient is not doing well, outcomes are impacted by lack of timely access. Additionally, a lot of these patients in rural areas lack sufficient primary care access as well. Managing chronic conditions to avoid unnecessary hospitalization, for example, is far more difficult without access to care.  

Q: What are some ways that this could be addressed?

MM: Honestly, I think it should be addressed with increased telehealth access, but the problem right now is reimbursements have not adequately rewarded telehealth. There's also a problem with access to specialists via telehealth and the visits not being adequately reimbursed. 

How can a busy urban physician find time to provide his or her services for telehealth for rural patients? There's a competition for the resource, and the winner is going to be whoever reimburses for the service itself. Additionally, many of the big players are withdrawing from telehealth provision — Optum, Walmart, etc. In fact, Walmart is completely exiting the healthcare space entirely. It's a mess. But I think the real problem is reimbursements are not adequate for telehealth, and the lack of providers exacerbates the problem. 

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