Three physician-shortage strategies worth a second look

In the face of a severe physician shortage in primary care and some specialties, a few practice models that were once considered unique are capturing more widespread attention.

Consider, for example, GreenField Health, founded in Portland, Ore., in 2001. Well before health reform pushed physicians to become more efficient than ever, GreenField physicians spent only a quarter of their work effort on face-to-face office visits. The balance: 35 percent on phone calls and 40 percent on secure web messaging. Doctors' initial visits with patients last 90 minutes, with annual visits taking an hour and follow-ups a half hour.

To make the model economically viable, the practice charges patients an annual retainer fee from $350 to $650, depending on the patient's age, to cover what insurance doesn't.

Another well-established approach being looked at anew is the shared medical appointment (SMA), offered by Harvard Vanguard in Massachusetts since 2008 and elsewhere even earlier.

SMAs are scheduled for physicals, well-child checkups, chronic illness management and other types of primary care, as well as for specialty care. Typically lasting 90 minutes, six to 14 patients, who sign agreements to keep information about the others confidential, participate. Doctors take vital signs in front of the group but examine patients in a private room when necessary.

Physicians bill the same for patients seen in an SMA or individually. According to internist Dr. Gretchen Gaida, the higher hourly income from SMAs enables Harvard Vanguard to pay for the extra health professionals needed to run them smoothly.

Finally, healthcare organizations are increasingly recognizing that returning a nonpracticing physician to clinical medicine is significantly less expensive and time consuming than to train a new one. Also, in the current economic climate, many retired physicians are looking to return to medicine, notes Physicians News Digest.

Formal physician reentry programs, such as the Drexel Medicine Physician Refresher/Re-Entry Course of Drexel University College of Medicine in Pennsylvania and The Center for Personalized Education for Physicians based in Denver, help assess individual physicians' needs and design a curriculum to bring their skills up to date. Programs don't just address clinical medicine, they also may cover electronic medical records, medical documentation changes, computer or research skills, medical errors and health policy changes.

To learn more:
- read this article in USA Today
- check out this story in Physicians News Digest
- see this HealthLeaders Media piece

Related Articles:
Health reform exposes need for primary care physicians
What does it take to retain rural doctors?
Physician shortage could worsen if decline in fees, hours worked, continues