By Jasmine L. Kiai and John D. Stobo

Several organizations (e.g., the Association of American Medical Colleges) have pointed to a serious physician shortage in the United States. It has recently been estimated that there will be a shortage of 100,000-150,000 physicians by 2020-2025. According to the AAMC, 30 million people live in federally designated shortage areas and 1 out of 3 active physicians are 55 and over, and therefore likely to retire soon. The impact of this shortage could be magnified by present efforts to provide health insurance to the presently uninsured.

Many commentators believe that the solution to the physician shortage is to increase the number of medical schools and existing class sizes. Indeed, the AAMC has called for increasing the number of medical school graduates by 30 percent by the year 2015. However, even if the number of medical school graduates increases by 30 percent by the year 2015 (5,000 physicians a year), this still falls short of closing the gap. From 1960 to 2009, the number of U.S. medical schools increased from 86 to 129, resulting in an increase in the number of medical school graduates by 792 students – but this has not solved the physician shortage.

The impact of the physician shortage is a decrease in health care access manifested by longer wait times to see physicians and an increase in emergency room visits. Access to health care will not improve using the approach of solely increasing the number of physicians – in other words, we can’t get there from here. A different approach needs to be used.

An alternative approach is to create a different model for the delivery of health care – one that leverages the capabilities of existing numbers of physicians as well as other health care professionals, and uses advances in technology.

For example, the way health care is delivered can be changed by increasing the involvement of other health professionals (nurses, allied health professionals, community-based workers, health navigators, promatoras), and allowing them to play a more significant role in addressing health needs. The traditional belief is that only physicians are qualified to treat patients. This is not the case. Furthermore, physicians and other health care professionals need to be taught to work in interprofessional teams in order to provide more patient-centered care.

Another way to change how health care is being delivered is by relying more on technology (telemedicine, electronic/personal health records) to provide faster and comprehensive treatment to patients. This has the added benefit of increasing access to health care among medically underserved populations as well as potentially decreasing health care costs.

There are many examples of how UC Health is working on reducing the physician shortage and reforming the way it delivers health care to Californians. Below are a few examples:

• UC Nursing: UC Davis established a school of nursing in 2009. There are plans being developed to increase the number of graduates by 342 in UC schools of nursing by the year 2013-2014.
  
• UCLA’s Medical Home Project: This project serves over 90 children with special health care needs. Physicians, patients and care coordinators work as a team to meet the health care needs of these children.
• UCSF’s Housecalls Program: This program serves almost 100 San Francisco elderly residents who have difficulty getting to a doctor. UCSF physicians travel to the homes of the elderly patients so that they may obtain treatment earlier.
• California Telehealth Network: Managed by UC, the California Telehealth Network is a statewide initiative using telemedicine to improve health care access in rural and underserved communities.
• UC San Diego’s IMPACT-ED program (Improving Medical home and Primary care Access to the Community clinics Through the Emergency Department): This program uses an Internet-based referral system that allows emergency room departments to schedule follow-up clinic appointments for patients.

There are many more examples of how UC Health is reforming the way it delivers health care. UC Health is well positioned to transform the way health needs are met and how health care is delivered. We will keep you abreast of these as national health care reform unfolds.

Jasmine L. Kiai, J.D.
Health Policy and Project Analyst
UC Health Sciences and Services

John D. Stobo, M.D.
Senior Vice President
UC Health Sciences and Services