I read the ads.” “The what?” I replied, dumbfounded.
“Not ‘In the Literature,’ ‘Key Clinical Questions,’ the cover stories, John Nelson’s practice management column?”
“No,” “no,” “no” and “no” were the responses.
Encasing my slightly bruised ego behind a facade of curiosity, I inquired of my friend who directs a large community hospitalist practice why the first thing he reads in The Hospitalist are the advertisements.
“Because I need to know what the competition is offering, so that I can keep my docs,” my friend explained.
“With that it was clearer than ever that we have a shortage of hospitalists. Let’s take a look at some numbers.”
Numbers Part I
The good news is there are close to 20,000 hospitalists in the U.S. This meteoric rise occurred in 11 years; something emergency medicine took 20 years to accomplish. It is commonly assumed the mature hospital medicine field will grow to 30,000 providers. More grandiose estimates place the top estimate as high as 70,000.
Numbers Part II
The concerning news is the number of adults 65 and older is expected to double by 2030. This demographic accounts for nearly 50% of all hospital admissions, and thus heralds an onslaught of growth in hospital medicine. Workforce models predict a physician shortfall of 200,000 by the year 2020.1
Numbers Part III
The frightening news is the number of U.S. medical school graduates matching into internal medicine (IM) residency programs has dropped from 3,884 in 1985 to 2,660 in 2007.1 Only 22% of graduating U.S. medical school students chooses to match in IM and only 55% of IM residency positions are filled by U.S. medical school graduates.2 Nearly 60% of IM graduates choose subspecialist careers, with only 8% choosing hospitalist careers.3
The U.S. is likely to witness an astronomic growth in the supply of hospitalized patients. Fewer students are choosing IM, with the majority of these opting for subspecialty careers. Hospital medicine faces an ever growing workforce shortage that has the potential to cripple the field.
I often wonder if hospital medicine is developing too fast. Our haste to grow and take on new business can, at times, lead us astray. To be sure, some of this growth is thrust on us by external forces, such as the mass exodus of primary care doctors out of the hospital and hospital executives’ eagerness to tap the resource efficiency of the hospitalist model. However, we cannot allow our foremost mission—improving patient experiences and outcomes—to be lost in a landslide of growth that outstrips our staffing.
To that end, I think one very logical solution to this pending workforce shortage is to limit growth. Take a breather and let the supply catch up with the demand before growing further. The skeptic will say this is not possible, but recall that hospitalized patients received care for hundreds of years prior to hospitalists. Ask yourself how much of the work you do could be done by another physician group. A recent study I was part of reported more than 22% of a community hospitalist’s workload consists of orthopedic, neurological, and general surgical diagnoses.4 Our study design was unable to account for patients previously cared for by medical sub-specialists, such as cardiologists and gastroenterologists, but I suspect the number is large, as well.
Although a 22% decrease in volume across the board would not solve all of our problems, it would be a solid start. Consider this the next time a surgical or medical subspecialty group requests you care for their patients. It may be a poor business move to refuse this work, but perhaps you can build a collaborative, long-term plan that allows you to better care for the patient obligations you have today while incrementally caring for their patients as your group matures.