Telehealth represents an opportunity for retired and other physicians and advanced practice providers to bolster the clinician workforce
As the U.S. confronts its most significant public health emergency in over 100 years, concerns over a future physician shortage are becoming a reality. As recently as December 2019, the Association of American Medical Colleges was predicting a physician shortfall of over 100,000 by 2032; today, we are concerned that we may not have an adequate number of healthcare professionals by the end of the month. Across the country, hospitals are enacting emergency staffing plans that maximize the delivery of patient care while minimizing the number of healthcare providers placed at increased infectious risk at any one time. Proactive steps, such as the cancellation of elective surgical services, will help allocate resources and staff to areas of urgent need. All active healthcare professionals will be called upon to provide some form of covid-related care.
While these measures will help ensure best practices of the current workforce, it is inevitable that our healthcare force will be exposed to and diagnosed with coronavirus. As such, there is an urgent need to identify additional available healthcare professionals and operationalize a reserve medical workforce if and when our front-line providers are ill or quarantined.
There is no precedent in recent times for creating and utilizing a civilian reserve medical workforce; as such we must consider all those with the knowledge and capacity to contribute. In New York, Governor Andrew Cuomo called on retired medical professionals to register with New York State Department of Health should their services be needed; in Italy, the National Health System is calling on recent medical school graduates, of which there are approximately 10,000, to meet primary care needs across the country.
Now is the time to quantify our available reserve workforce and assess the workplace readiness of retired physicians and soon-to-be physicians. While we estimate that there will be almost 20,000 new graduates from U.S. medical schools this year, there is no publicly available data currently on the number of recently retired healthcare professionals that could be mobilized during this emergency.
The first step in mobilizing a retired workforce will be to count the potentially available providers and appropriately quantify their risk status. The majority of retired providers are >65, making them an at-risk population, and may have or be in frequent contact with other older adults with high-risk comorbid conditions.
It is difficult to predict exactly when and where we will experience shortages in the physician workforce during this crisis, and it will be important to assess the risk-benefit profile of each physician, balancing their risk of health with their ability to serve patients. However, there are many opportunities to engage providers immediately. In an era when practicing social distancing will save lives, telehealth, wherein videoconferencing and virtual communications replace in-person consultation, are quickly becoming a necessity for the delivery of ideal care that protects both patients and providers.
Recognizing the need to promote social distancing, both federal and state orders are making the provision of telehealth easier. Under new Centers for Medicare & Medicaid Services regulations, Medicare will make payment for telehealth visits for both new and established patients, virtual check-ins and communications via online portals for all beneficiaries.
States are working to take these mandates even further; In Massachusetts, Governor Baker executed an order for insurance reimbursement to allow all in-network providers to provide clinically appropriate services to their members.
We will need to leverage federal agencies and local government to count available providers and disperse ready healthcare professionals to fill in where populations are underserved.
Many states have already begun to remove the logistical barriers to quickly mobilize healthcare providers, through expedited emergency credentialing of those who have recently retired (within 2.5 years) and/or providing temporary waivers to those with active licenses in other states . Currently, these efforts are being coordinated at a state level in response to emergency action plans. We encourage all able, retired physicians and other healthcare providers to contact their state board for more information.
The reserve medical force may be the ideal population to immediately support the needs of an overworked active workforce to facilitate the delivery of everyday healthcare. Experienced providers can leverage telehealth to triage acute care visits, such as those of patients with respiratory symptoms, or provide routine follow-up for patients with chronic medical conditions. As we enter a period that will be defining for physicians of all types, now is the time to begin to ready our untapped healthcare workforce, leverage their shared skills, and prepare them to serve in this time of need.
Claire Sokas, MD is a general surgery resident in Boston, MA and a research fellow at the Center for Surgery & Public Health. Twitter: @clairesokas