A health care worker shortage this year may be one of the biggest problems facing physicians in private practice. Medical practice management teams are assessing their systems and processes to make sure they are as efficient as possible because of changes in the marketplace. While medical practices want to deliver superior care, at times that can be at odds with a strong financial performance. In 2023, managing and growing a medical practice are challenging due to regulatory mandates and record-breaking staff shortages.
Evan R. Goldfischer, MD, President of the Large Urology Group Practice Association (LUGPA), said practicing medicine today is becoming increasingly more difficult for the nation’s independent physicians. “The challenges that we face stem in part, from the escalating physician shortage in the United States,” Dr Goldfischer said. “Due to the number of retiring urologists, the workforce shortage is projected to become more severe over time.”
A 2021 study published in JAMA estimated that there will be a continued decline in urologists per capita through 2060, based on the current growth of the profession, he noted.
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In addition to the challenges in the physician workforce, recruiting and retaining a good staff are also problematic. “Since the pandemic, the lack of availability of qualified personnel, due to people leaving the workforce or changing careers, has become almost an epidemic in itself,” Dr Goldfischer said. “These workforce shortages lead to longer wait times for appointments and other inconveniences for our patients.”
Job vacancies for various types of nursing personnel increased by up to 30% between 2019 and 2020, according to an analysis by the American Hospital Association (AHA). The report notes that staff turnover due to COVID-19 pressures increased from 18% to 30% for some hospital departments (emergency, intensive care units, and nursing) during this same period. Data suggest that there could be a critical shortage of 3.2 million healthcare workers by 2026.
Patricia Pittman, PhD, Fitzhugh Mullan Professor of Health Workforce Equity at George Washington University’s Milken Institute School of Public Health in Washington, DC, said the biggest hurdles facing physicians and outpatient independent medical practices today are a combination of increasing patient needs and decreasing control over their clinical practice. “On the demand side, the pandemic has created a backlog of medical visits, and an accompanying worsening of complex chronic conditions, both behavioral and physical,” Dr Pittman said. “On the supply side, there are pressures created by the continuation of a volume driven payments system, combined with just enough value driven payment that quality reporting requirements are experienced as an additional unfair burden.”
In addition, greater use of electronic health records that add more work to the day, along with unprecedented administrative burdens on clinicians, are taking time away from patient-facing activities. “Clinicians are tired and angry, and so it’s not surprising that some are leaving independent practice and even clinical practice entirely,” Dr Pittman said. “The workforce shortage has become a vicious cycle. As clinicians get fed up with the system and leave, those who remain behind are witnessing worsening quality and patient safety.”
Many clinicians know that major changes are warranted to turn around the worsening morale and the impetus to quit clinical practice. “It’s time for a whole range of stakeholders to reconsider the ways in which the status quo is driving clinicians out, and to make the health worker experience of providing care a central consideration in reviewing how they do business,” Dr Pittman said.
On top of an escalating shortage of urologists, many independent practices are currently experiencing the effects of high inflation along with an impending 4.5% Medicare Physician Fee Schedule (MPFS) payment cut, Dr Goldfischer said. “The MPFS is also the only payment method within Medicare without an annual inflationary update, which is particularly destabilizing for clinicians who are small business owners,” he said. “The long‐term consequence of failing to prevent these cuts will be a decrease in patient access to care.”
Due to the health care workers shortage, more and more practices are experiencing big increases in labor costs and Medicare rates have not kept up with these costs. Some experts contend that consolidation in the health care industry is continuing to jeopardize not only independent practices, but also patient access to quality care. “Federal aid at the beginning of the COVID-19 pandemic favored hospital systems, despite vows from policymakers to fight consolidation,” Dr Goldfischer said. “Therefore, hospitals continued to combine or buy up smaller practices, resulting in colossal hospital systems that create fewer choices for where patients can seek healthcare. This decrease in competition will increase the cost of care for patients.”
LUGPA is advocating on Capitol Hill to decrease regulatory burdens and level the playing field between hospital and independent physician reimbursement. Independent urologists must do all they can to educate policymakers on the benefits of integrated urologic care to ensure all patients have access to high-quality, affordable and efficient overall care, Dr Goldfischer said.
“I believe that patient care is what drives most independent physicians in their choice to be independent,” he added. “I am deeply committed to independent urology, as it allows me to provide care to my patients in a manner that is less restrictive, less expensive, and ultimately more effective for patients. At the end of a long and stressful day, it’s important for independent physicians to remember their personal passion that motivates them and to hold to it.”
Significant structural changes in the health care system are urgently needed to address the labor shortages today and in the future. “LUGPA has dedicated efforts to work with the next generation of physicians, as they are essential to the future of independent practice and to our country’s ability to provide effective urologic care in the decades to come,” said Dr Goldfischer.
