How Will the Changing Physician and Nurse Supply Affect Your Health?

Dr. ALlen Weiss, MD, MBA, FACP, FACR
April 1, 2007 - Most people acknowledge that one’s health is one’s most important treasure. Thus, among the most important decisions you make in your lifetime are your choice of primary care physician and how you interact with him or her. Depending on the stage of your life, this caregiver can vary among a family physician, obstetrician/gynecologist, pediatrician, internist or geriatrician. Having someone you trust who knows you is as important as self care with good nutrition, exercise, and preventive practices.

Yet, modern society faces a curious paradox: an insufficient number of physicians locally and globally to care for all of the aging patients concurrent with an increased quantity of vehicles available to prevent, diagnose, and treat illnesses. The latter part of the anomaly is well documented with new medicines and technologies. Concerning the former part, the Council on Physician and Nurse Supply predicts that in the United States a 200,000 physician shortage will occur by 2020, the same time that the “baby boomers” need maximum care. Twenty-five percent of physicians in the United States today are foreign medical graduates helping to ameliorate the growing national shortage. However, this trend is not beneficial for the health of the donating countries. Collier County parallels this national trend with a current physician shortage of between 125 and 175 physicians as based on recent hospital surveys.

Physicians are stressed both by profit margin squeeze and work/life balance issues. Flat or dropping reimbursements combined with rising professional overhead yields financial stress. Also, increased patient demand translates to fewer hours for personal and family time. Work/life balance is important for good mental and physical health for everyone but particularly for physicians and other caregivers. Sleep deprivation and resulting fatigue strip caregivers of the necessary sympathy and compassion to connect to patients. How often and for how many years can sleep be interrupted? How many hours per week can one work in the office, hospital or on call without vigilance fatigue? While Marcus Welby was idolized, his model is not truthful. Reality is that physicians need reasonable work conditions to remain sane and effective as they care for patients.

The above conflicting trends—physician shortage and stress versus growing expectations from patients in the consumer revolution—have produced new models of care delivery such as concierge medicine (limited patient panels made of people willing to pay a premium), hybrid models (mixed concierge and traditional), and hospitalists (physicians specializing in hospital care). No doubt other, as yet to be defined methods of satisfying needs, will follow. Meanwhile, mid-level providers such as nurse practitioners, physician assistants, and nurse mid-wives can and do provide quality care for many patients with a variety of illnesses.

With four hospitals Collier County does not have a shortage of beds, even with the seasonal variation of 37.5% according to a Chamber of Commerce estimate. However, a worsening shortage of physicians and mid-level providers to care for the 4.1% yearly growth in the county will continue.

Locally, solving this difficult problem requires a multi-faceted approach. First, collaborate within the healthcare community. All providers face the same situation. Second, work in cooperation with those whom we serve. Consumers need to put forth reasonable expectations. Third, encourage more physicians to stay in practice. Unfortunately, the average retirement age has dropped by over four years. Fourth, bring more physicians, mid-level providers, nurses, and support personnel to Collier County. Here, addressing cost of living and life style issues is essential.

Attracting physicians and other caregivers to our area must be a major initiative of all the existing health providers as well as the citizens if we want to maintain the health of the community. Good health yields the other personal and social ambience that we enjoy. Help us help you be successful in the quest for your well being.



Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.