More than 65 million Americans live in a primary-care desert.
Amid a looming shortage of doctors that could see demand outstrip supply by as much as 90,000 by 2025, the jack-of-all-trades family doctor, also known as a primary care physician or general practitioner, is generating the most urgent concern. It is predicted that a third of the medical shortfall, largely driven by America’s aging population, will be made up of demand for local general practitioners.
Things are already looking grim. It is estimated that around a dozen states already have less than 50% of the general practitioners they need, with some like Connecticut (15%) and Alaska (35%) falling well below even that stark level.
These are the people living in that primary-care desert.
Worse, the Association of American Medical Colleges expects the family doctor shortage to occur regardless of planned interventions, including upskilling nursing staff, delaying doctor retirement, or introducing retail clinics.
Their projections, however, don’t include the rise of telemedicine, and the impact of video conferencing on healthcare.
Six Billion Dollars Spent on Digital Health Investment
While the AAMC continues to lobby Congress to spend more money on medical training in U.S. colleges, the private sector is well and truly invested in the digital side of tomorrow’s healthcare system.
More than $6 billion is expected to be spent on digital health startups this year, a figure comfortably more than three times higher than in 2010. Some of those funds will go toward the continued proliferation of video calling apps that connect patients with doctors, and some will be directed toward larger, in-hospital technologies.
And some of that funding could be just as important as money spent on producing more doctors. As Texas company Evolution Health has demonstrated, digital innovations including remote video consultations and centralized patient care and management can have a powerful real world impact.
The service currently cares for two million high-risk patients across 15 states, and has reduced emergency room attendance in the area where it works by 20%, and hospital inpatient stays by 40%.
It does so by centralizing all a patient’s care needs into a remote medical command center that guides each step from the initial report to specialist treatment, hospital stays, and home care.
By building on that approach and emphasizing the use of virtual primary care, this type of digital system could one day replace the family doctor altogether.
Connecting Real Patients with Virtual Doctors
An obvious reason to bring the Evolution Health model to bear on the doctor shortage issue is its ability to operate across borders. A centralized service could use video conferencing to link patients in Connecticut and Alaska with experts or generalists in more resource-rich states.
Patients could log in to a centralized service from home, or within an understaffed clinic, pass on their medical records and be allocated to a scheduled or next-available video check-up.
There are already remote virtual clinics operating out of major centers that service rural and remote patients by video call. Encouragingly, some have even stated their desire to expand their service across the entire country. That’s one way to help fill the doctor shortage–just connect those without to those with too much.
It doesn’t, however, address an overall shortage of primary care doctors. To do that, you have to rethink the role of the family doctor and replicate the specific duties in a digital manner.
The Online Family Doctor
The major difference between a general practitioner and an emergency room is the time frame. If expert, surgical intervention is needed in the next 10 minutes you’re best to head to the nearest hospital. If the symptoms are vague and treatment isn’t needed immediately, a generalist with the ability to initiate low-level treatment or refer a patient to a specialist is a better use of everyone’s time.
That’s a family doctor’s role, and before we get too sentimental about preserving the traditional family doctor bear in mind that two-thirds of Americans are already willing to see a doctor online.
So perhaps that stripped down, non-emergency triage service is what should be delivered online. Establish a network of these medical command centers. Equip them with digital triage nurses armed with video calling capabilities and the current range of remote sample and vital sign detecting technologies. And let every patient with a cough, a persistent headache, or an ongoing affliction like high blood pressure or diabetes, get their treatment online.
The more severe or complex cases can be referred to specialist care through the command center’s web of expert contacts. It’s a radical undertaking, and one that could be implemented first in states already mired in a doctor shortage.
Perhaps the best way to deal with the limited number of family doctors, though, is to phase them out altogether, and split the current resources between digital triage nurses and specialists. The combination could become a digital oasis of primary care–and open up a way for doctor-deprived areas to get examinations whenever necessary, with a minimum of time and travel.
Photo by NEC Corporation of America with Creative Commons license.