I practiced cardiology in North Carolina for nearly 15 years. Many of my patients lived in rural, underserved communities. The effectiveness of my clinical practice was largely informed by my ability to reach my patients, or their ability to access the care I was providing. Some of my patients would have to travel 45 minutes to see me for services that, in many cases, could have been provided just as easily, and just as effectively, by advanced practice nurses who were a lot closer in proximity.
I think about those patients – especially those who were just out of reach – a lot. In fact, my time practicing in North Carolina has guided much of my thinking over the past 15 years. Today, I’m building new, value-based models of care that are founded on creating greater access to more convenient healthcare experiences. New models of care should all strive to accomplish these two goals. But to do so, they’ll need to address workforce challenges the industry has been struggling with for decades – the same challenges that prevented advanced practice nurses from delivering care to my estranged patients in North Carolina.
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These challenges manifest in two distinct forms: as physician burnout caused by administrative burden, and as dissatisfaction among nursing staff due to inability to practice at the top of their licensure. Both contribute to widespread workforce shortages, but the root cause is a misallocation of resources. Healthcare’s chronic workforce shortages could be much more manageable were provider systems better able to organize care around clinicians who are able to practice at the top of their licensure.
As a physician, I know the level of care I want to provide for my patients. But when I take a step back and look at how care delivery works in new models, the problem is plain as day: medicine, technology, and care delivery continue to evolve, but the role of the physician always remains the same.
Rethinking the role of the physician
Everyone in healthcare has heard (or made) criticisms about how lethargic this industry can be, especially when it comes to embracing change or adapting to modern consumer expectations. The reality is, healthcare and the practice of medicine have advanced rapidly over the past 50 years. Our understanding of diseases – and the plethora of treatments we use to treat them – becomes more thorough with each passing day.
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The complexities people live with today are much different than they were half a century ago. The disease burden has shifted to chronic conditions, of which 50% of the U.S. population has at least one. Our understanding of medicine has evolved in tandem with that shift. The roles of the practitioners of medicine, however, have not.
The only significant change to the physician job description in the past 50 years came with the advent of EHRs, which, incidentally, have only added more administrative burden to the role. While the role of the physician has remained the same, everything around them continues to change – even payment models. A recent report found nearly over half of practices have a significant portion of their revenue tied to value-based arrangements, and a majority of practices have also invested in the technology necessary to succeed in those arrangements. Healthcare’s payment model is evolving to align with value, but the care delivery model has not evolved to meet that opportunity.
Doctors no longer need to do everything. In many cases, in fact, they cannot – especially when they are inundated with complex and frail patients, some of whom may be many, many miles away. There are highly-trained nursing and medical assistants, licensed practical nurses, and community health workers who are more than capable of handling many of the tasks traditionally handled by physicians when treating people with chronic conditions, acute conditions, and those in need of preventive care.
Both their training and state licensures enable them to provide several of those services under the supervision of a physician or nurse practitioner.
These clinicians are more than capable of handling something as simple as putting in a medication refill order for a patient who already has a script and has taken the same medication for diabetes for the past ten years – and they are more than able to do so without sacrificing quality of care. Yet, something like this will typically get routed to physicians to manage. To make matters even worse for the patient, some providers will require an appointment before a refill can even be ordered, even if they have been seen recently.
Truly allowing clinicians to operate at the top of their license should mean offloading administrative work for physicians and result in faster cycle time for patients. Many large health systems and provider practices continue to be restrictive, routinely assigning tasks like ordering preventive services such as referrals for annual eye exams or mammograms to overburdened physicians, rather than utilizing nurses who are credentialed for these services. The result is dissatisfied nurses, strained physicians, and frustrated patients.
At the end of the day, enacting change will always come back to the way we work. Healthcare’s transformative lethargy is a symptom of its refusal to adapt to the workflows of a digital economy – but it doesn’t have to be. As new models of care are developed to create greater access, reduce costs, and improve outcomes, provider systems must be able to organize their clinical workforce in ways that accommodate those models. The dynamics of care delivery are changing. So, too, must our clinical workforce.
Photo credit: Chinnapong, Getty Images
Bimal Shah is the chief operating officer of Homeward, a company focused on improving access to high-quality, affordable comprehensive care in rural communities. Bimal is part of the founding team of Homeward and has a deep passion for increasing access to comprehensive, value-based care in rural markets.
Bimal is also a practicing cardiologist and has experiences over the past 20 years of providing care in underserved communities. Previously, while at Duke University, he investigated issues and trends in the quality of care and outcomes in patients with cardiovascular disease. His work also focused on developing projects on cost-effective analysis for medical interventions, use of remote technologies for chronic disease management and risk stratification, and drivers utilization of care across the United States.
Bimal is a seasoned health tech executive, mentor, investor and board member. Previously, Bimal served as chief medical officer at Livongo where he led the clinical development of their cardiovascular program.
Bimal completed his Bachelor of Arts in Economics and Chemistry at the University of North Carolina at Chapel Hill. He went on to get his MBA in Health Sector Management from the Duke University Fuqua School of Business and his MD from the Duke University School of Medicine.
