The Physician Shortage Crisis Is Here—And So Are Bipartisan Fixes

As doctors know all too painfully well, the current physician shortage is already limiting access to care for millions of people across the country. And it’s about to get much worse if changes aren’t made now, AMA President Jesse M. Ehrenfeld, MD, MPH, told news media gathered for his recent address to the National Press Club in Washington.

“The physician shortage that we have long feared—and warned was on the horizon—is here. It’s an urgent crisis hitting every corner of this country—urban, rural—with the most direct impact hitting families with high needs and limited means,” said Dr. Ehrenfeld, an anesthesiologist.

“Imagine walking into an emergency room in your moment of crisis, in desperate need of a physician’s care, and finding no one there to take care of you. That’s what we are up against.”

Physicians, Dr. Ehrenfeld said, know exactly how America finds itself in this crisis mode. Among the factors contributing to burnout that is leading physicians to retire early, cut back hours or leave medicine all together, are:

Administrative hassles that burden physicians daily and make them feel powerless to make meaningful changes.

The Physician Shortage Crisis Is Here 2Consolidation that gives more power to the country’s largest hospital, health systems and insurers that leaves patients and physicians with less autonomy and fewer choices.

Falling Medicare payment rates—when adjusted for inflation, a 26% drop since 2001.

“Sadly, every day we wait, the size of this public health crisis grows,” said Dr. Ehrenfeld, who is a senior associate dean, tenured professor of anesthesiology and director of the Advancing a Healthier Wisconsin Endowment at the Medical College of Wisconsin.

Here’s what needs to change

Legislative solutions to many of the problems that Dr. Ehrenfeld outlined are already pending before Congress—and they even have strong bipartisan support.

“There isn’t much that our two major political parties see eye to eye on right now, but on these issues they do,” Dr. Ehrenfeld said in his remarks. “We just need the will—and the urgency—to get it done. We need leaders in Congress to step forward and make this happen.”

In his National Press Club address and a companion AMA Leadership Viewpints column, Dr. Ehrenfeld outlined some key steps that the nation must take to begin addressing the complex physician shortage problem, many of which are drawn from the AMA Recovery Plan for America’s Physicians.

Give doctors the financial support they need to care for patients. Congress needs to pass the Strengthening Medicare for Patients and Providers Act, which would give physicians an annual payment update to account for practice cost inflations as reflected in the Medicare Economic Index. It’s a benefit others already get.

Reduce administrative burdens, including the overused and inefficient prior authorization process. The Improving Seniors’ Timely Access to Care Act would expand prior authorization reforms that the Centers for Medicare & Medicaid Services finalized, and the Biden administration can improve the landscape if it finalizes proposed regulations. State legislatures also have the power to reform.

Expand residency training options, provide greater student loan support and create smoother pathways for foreign-trained physicians. The Conrad State 30 and the Physician Access Reauthorization Act, the Retirement Parity for Student Loans Act, the Healthcare Workforce Resilience Act, and the Physician Shortage GME Cap Flex Act would all help ease the physician shortage. Ensure that physicians aren’t punished for taking care of their own mental health needs. State medical boards, hospitals and health systems need to remove questions about past diagnoses and counseling and focus on whether a current health condition exists that, left untreated, would affect patient safety.

“Our nation’s physician shortage is not a problem to set aside and deal with tomorrow. It is an urgent problem we need to address today,” Dr. Ehrenfeld concluded. “We must take action to create a stronger and more resilient physician workforce to care for an ever-changing nation.”

New CDC Director Outlines 6 Big Fixes Needed To Crush COVID-19

As newly appointed Centers for Disease Control and Prevention (CDC) Director Rochelle P. Walensky, MD, MPH, steps into her new role leading the agency, the to-do list is long. Stay on top of breaking news, discover great discussions and never miss an update with our new and improved channels and tools.

Help get a pandemic under control. Create an equitable health system. Bolster public health infrastructure. Improve communication and combat misinformation circulating on social media and elsewhere. Build relationships with people at the state, community and tribal levels. Boost internal morale for scientists at the agency. Assess the collateral damage of the past year, including falling behind on childhood immunizations. And more.

Dr. Walensky, who heads to the CDC after serving as a professor of medicine at Harvard Medical School and practicing as an infectious disease physician at Massachusetts General Hospital and Brigham and Women’s Hospital, is ready for the challenge.

“I’m calling it my midcareer residency. I’m going to dive in. I got called during a code and when you get called during a code, your job is to be there to help,” Dr. Walensky told viewers during a JAMA Network™ livestreamed interview on the eve of her officially taking over as the CDC’s new director.

Combating COVID-19

On her first day on the job, Dr. Walensky announced that as a protective public health measure, she will extend the order that temporarily halts residential eviction until at least March 31. She said in a statement that the pandemic is a historic threat to the nation’s health and that it has “triggered a housing affordability crisis that disproportionately affects some communities.” Learn more with the AMA about why eviction moratorium key weapon in the pandemic fight.

In the livestreamed interview led by Howard Bauchner, MD, editor-in-chief of JAMA and senior vice president of AMA scientific publications and multimedia applications, Dr. Walensky talked about key areas that need improvement to help crush the pandemic and secure longer-lasting public health gains.

Vaccines. President Joe Biden is aiming to have the nation reach 100 million doses administered within his first 100 days in office, a goal she believes is attainable. Dr. Walensky said more thought should be devoted to vaccine eligibility to hit the sweet spot between supply on the shelf and the number of people eligible.

Vaccinators. Dr. Walensky said the U.S. must ensure there are enough people who can administer vaccinations, which means looking broadly for help from medical military, Public Health Service Commissioned Corps members, medical students and nursing students, dentists, veterinarians and more.

Vaccination sites. A four-pronged approach to reach people is being worked on: Community vaccination centers, such as stadiums and gymnasiums; mobile units to do the outreach to communities that otherwise wouldn’t be reached; federally qualified health centers; and a pharmacy program.

Collaboration. The federal government needs to work with the states, offering support and resources available from the national level to help get vaccines distributed. Dr. Walensky said the role of the federal government will be to step in and ask each state “What is the help you need?”

Public health investment. The pandemic has laid bare the nation’s frail public health infrastructure. “We need to fix that public health infrastructure and we need resources to do it,” Dr. Walensky said. “One of my challenges is to make sure Congress knows and understands that we are in this because we had warning for many, many other public health scares over the last 20 years and we didn’t fix our public health infrastructure and our data infrastructure.”

Agency morale. Internally, Dr. Walensky said she needs to figure out how to make sure the CDC’s many talented scientists—who fortunately have not left in a mass exodus—understand and feel the value that should be given to them.

“They’ve been diminished. I think they’ve been muzzled. Science hasn’t been heard. This top-tier agency, world renowned, hasn’t really been appreciated over the past four years … I have to fix that,” she said. “I need to make sure that those voices get heard again—that I’m leading with trust.”

Public communication. Lastly, the CDC must better communicate with the American people: “I want to be able to convey in layman’s terms what the science shows, when guidelines change. … And not just me, but subject-matter experts who can convey that.” Subscribe to the “Conversations with Dr. Bauchner” podcast. Each week, he interviews leading researchers and thinkers in health care about their recent JAMA articles.

The AMA has created a COVID-19 vaccine resource center that features an array of information relevant to physicians about the development and distribution of COVID-19 vaccines. The AMA also partnered with the CDC and the Food and Drug Administration to provide a series of educational webinars that help explain the process of vaccine development and offer a deeper dive into the data to understand safety and efficacy results. These webinars are also available on the AMA COVID-19 vaccine resource center.

(Picture: AP News)