I believe the projected doctor shortage caused by the Affordable Care Act will drive primary care into two opposite tracks

  • The “Apex of the Pyramid” Track
  • The Concierge Medicine Track

Each is a distinct and logical response to the patient overload from the doctor shortage that is rapidly approaching. Each points out gaping holes in our medical education that must be addressed. Concierge medicine has an additional powerful force acting in its favor which I detail below.

The coming tidal wave of newly insured patients

Association of American Medical Colleges  estimates that there will be a doctor shortage of 63,000 doctors by 2015 and 130,600 by 2025 in the wake of the SCOTUS decision to let the Affordable Care Act stand. This doctor shortage is caused by a tidal wave of newly insured patients has to be served somehow and US Medical Schools and Residency Programs cannot supply anywhere near these numbers of new physicians in this short of a time frame.

How will healthcare markets respond to this doctor shortage – especially with regards to primary care? I see two likely options  – please leave a comment with your thoughts.

1) Volume Driven:  Doctor as apex of a care pyramid

 

In the more traditional practice structure, the doctor shortage will force the primary care physician to become the leader of a care team supervising a number of physician extenders who provide the majority of the hands on services. The skill and experience of the physician will be saved for the more complicated and severe cases seen that day.

The majority of the doctor’s activity will be devoted to leading and coordinating the care provided by the pyramid of N.P’s and P.A.’s who are their direct reports.

The challenge to this model is the complete absence of functional leadership skills training in most medical school and residency programs. 30-50% of these physician’s time will likely be spend in leadership and management activities for which they are not prepared on graduation.

 

2) Service Driven: Concierge Medicine/direct care model

As the doctor shortage worsens, the typical patient will begin to notice they are only seen by a physician on rare occasion. A certain percentage will become willing to pay for that privilege. I suspect this will quickly grow to a huge new demand for concierge medicine services, where you pay a reasonable monthly fee to guarantee you are always seen by your doctor.

As the doctor shortage continues to worsens,  I believe a larger and larger segment of our population will become willing to pay to continue to see their primary care doctor as they do today and their only alternative will be concierge medicine.

The huge popularity of concierge medicine will have another important driving force – the office duties of the concierge medicine physician are exactly the opposite of those in example #1 above.

In a concierge medicine practice,  the physician is often seeing less than 15 patients a day, providing direct patient care and continuing to have meaningful personal relationships with their patients.

The challenge to the concierge medicine model is the absence of business training – and specifically marketing training – in most medical education programs. The concierge medicine model is inherently entrepreneurial and will always involve a fairly sophisticated marketing program to be successful.  This is not an insurmountable obstacle and I have yet to meet a newly board certified MD who understands the essentials of marketing.

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So if you have 10 years or more of practice ahead of you, I suggest you look at these models – the pyramid and concierge medicine – and get ready to be met by a fork in the road as the doctor shortage approaches. Will you choose to lead a team or build your cash/concierge medicine practice?

If you are leaning in one direction, I suggest you get started building your missing skill set – be that leadership or marketing. The wave of newly insured patients is coming.

PLEASE LEAVE A COMMENT with your thoughts on concierge medicine and how to handle the coming doctor shortage.