Mid-levels + Telehealth = The Answer to Provider Shortages?

“The U.S. has the best health care in the world but access to it is fading fast.”
STAT News

If you’re not worried about the physician shortage, you’re simply not paying attention.

The Association of American Medical Colleges (AAMC) projects a shortage of up to 120,000 physicians by 2030. Their analysis predicts, “The serious threat posed by a real and significant doctor shortage.” By 2030, the numbers show:

• A shortfall of between 14,800 and 49,300 primary care providers.
• Non-primary care specialties will see a shortage of 33,800 to 72,700.

Driving these trends are the healthcare demands from an aging Baby Boomer population, which will increase the number of adults over age 65 by 50% by 2030. That same trend will impact doctors, according to AAMC, because one-third of our current physician base will also be older than 65 by 2030. At the same time, the U.S. population will increase overall by 11%.

HFMA says these numbers are based on “researchers modeling various scenarios, such as the potential for nurse practitioners and physician assistants to assume more duties traditionally handled by physicians.”

David Grabowski, a professor from Harvard Medical School, said, “The problem is not the number of doctors, per se, but rather the types of doctors and where they practice.” An article in HFMA suggests that the primary care shortage is actually caused by growing tuition debt. New doctors choose the higher income found in specialty care fields to help counteract student debt. Is the answer increasing the incomes of primary care providers so that more new doctors will choose the profession?

An article in U.S. News & World Report says that the answer to all of these issues is actually to increase the volume of nurse practitioners (NPs) going into the field. But what if these NPs joined other mid-levels in using telehealth technology to extend access to care in new ways? Could an influx of new NPs armed with the virtual house call inherent in telehealth add the bandwidth we need to an overburdened health system?

Let’s explore some possible solutions to our growing shortage of clinical providers.

Today, much of our work still flows through the physician, no matter the specialty or the size of the practice. While we’ve elevated the mid-level, doctors still heavily impact the process of providing care. But the next phase of care delivery will continue to elevate mid-levels. This escalation will continue because it must; looming physician shortages require a rapid shift in how and who provides care.

However, STAT says, “But the potential of non-physician providers to deliver care is hindered by laws that limit their ability to diagnose and treat patients on their own.”

It’s clear that graduate medical education should be reformed in order to push more mid-levels and physicians into the market. While much of the funding for physician residency comes from the federal government, organizations like the AAMC are calling for increases that will ease the bottleneck caused by a limited number of residency spots. AAMC reports funding for these positions has been frozen in place since 1997. AAMC suggests the federal government should support another 3,000 residency training positions in the next five years to curb the physician shortage.

But that still won’t completely eliminate the physician shortage and many believe the answer is to increase the deployment of NPs in the market. While scope of practice laws keeps a tight rein on the current utilization of NPs, a second step toward easing access to care could be to change these rules to allow the expansion of NP duties. Currently, U.S. News & World Report says, there is a patchwork quilt of licensure rules tied to how NPs and other mid-levels practice. Standardizing or lifting outdated restrictions could be particularly helpful in rural areas, where access to care is so limited.

But what could happen if we broadened the reach of our mid-level providers while also increasing the volume of residency seats available? What if we added telehealth technology as the third leg of the healthcare access stool?

Earlier this month, U.S. News & World Report published stats showing that visits to non-physician clinical providers are skyrocketing; from 2012 to 2026, our visits to mid-levels increased by 129%. The research also showed that these visits were more cost-effective than physician visits, in part, because NPs “focus on health promotion, disease prevention, health education, and counseling, guiding patients to make smarter health and lifestyle choices.” Not only are these visits less expensive – they are significantly less expensive by up to 30%, according to the article.

Telehealth technology has also been shown to significantly reduce the cost of care while improving access to treatment, particularly in rural areas. But how effective is the tool for mid-level providers? A study in Advances in Medical Education and Practice suggests “The use of telehealth technology presents new opportunities for addressing these challenges by increasing patient access to care and decreasing costs, while improving desired health outcomes.”

The Journal for Nurse Practitioners recommends combining NPs with telehealth to extend healthcare’s reach, saying:

For NPs who are providing health care directly to patients in both rural and urban settings and in locations ranging from clinics and hospitals to emergency/urgent care sites, private physician or nurse practitioner practices, and nursing homes, among others, using telemedicine can help improve health care delivery to underserved populations.

Telehealth is rapidly expanding, and the positive outcomes include improved patient satisfaction, access to care, and quality outcomes, and reduced cost. NPs can use this technology to stretch healthcare’s reach by providing patient education, clinical face-to-face time, and even use it for remote monitoring of chronic care conditions.

Telehealth, when coupled with midlevel providers could play a key role in alleviating the physician shortages of the future.

OrthoLive offers a telehealth application designed to extend the reach of the orthopedic physician. Our low-cost, HIPAA compliant platform can be used to reduce wait times for clinical visits and reduce the patient’s inconvenience of traveling to an office. The application is suitable for physicians and mid-levels in orthopedic practice. Contact us to see a demo of the service.