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The Physician Shortage In Texas: THR’s Barclay Berdan On Physician Extenders, Technology

Studies point to the Affordable Care Act having had a positive impact on the rate of health insurance coverage in Texas. Too, the outcome of King v. Burwell was good news for more than 1 million Texans who received subsidies to buy insurance through the marketplace under the ACA. But all this good news is accompanied by a challenge: Who is going to provide care for the additional people now seeking services?
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Editor’s Note: The impending physician shortage has now bubbled to the surface. And politicians both at the state and federal levels are doing something about it. Texas is facing a broad need, particularly in the wide-open rural counties and in urban sectors where poverty is rampant and infrastructure is lacking. Statewide, there are about 186 physicians for every 100,000 residents, according to the Texas Medical Association. The national average is 236.

But the need is more acute in different sectors of the state. Fifty-seven percent of the state’s practicing physicians operate in the five large urban counties of Bexar, Dallas, Harris, Travis, and Tarrant despite containing just 44 percent of the state’s population. And while 2.2 million Texans (of about 27 million total) call rural communities of 40,000 or less home, these towns contain just 2.5 percent of the state’s physicians.

Part of the shortfall is because of a deficiency in medical residency slots. That can change. And soon. On the state level, legislators this session passed Senate Bill 18 and funneled $300 million into an endowment fund to help pay for more residencies inside the state. At the congressional level, the Resident Physician Shortage Reduction Act of 2015 provides similar assistance with a national scope.

In the coming weeks, D Healthcare Daily will be asking executives at some of the major regional health centers to reflect on the potential impact these measures could have on the state’s physician shortage. Last month, Baylor Scott & White Health’s Joel Allison kicked the series off. You can read his here. And last week, UT Southwestern’s Bruce Meyer added his voice.

Below, Texas Health Resources CEO Barclay Berdan writes about how physician extenders and technology can each be harnessed to help practitioners maximize their time. 

Barclay Berdan, CEO of Texas Health Resources
Barclay Berdan, CEO of Texas Health Resources

A recent study published by Rice University’s Baker Institute and the Episcopal Health Foundation says that the Affordable Care Act had a substantially positive impact on the rate of health insurance coverage in Texas. The recent decision by the Supreme Court in King v. Burwell was good news for more than 1 million Texans who received subsidies to buy insurance through the marketplace under the ACA.

But the good news is accompanied by a challenge: Who is going to provide care for the additional people now seeking services?

Access to affordable insurance coverage means there will be increased utilization of physician practices, hospitals, and other healthcare providers because people with insurance are more likely to seek care. Texas is already challenged by a shortage of physicians and a rapidly growing population. Even if additional funds are appropriated to increase the number of medical school graduates and residency slots, it will take several years for medical schools in the state to educate enough physicians to meet the needs of our population.

How can Texas deal with the increased number of people seeking care from a physician workforce that is already stretched?

One answer is to leverage “physician extenders” in a robust, well-coordinated network of primary care providers and specialists. Texas Health Resources is developing such a network that integrates services across a variety of innovative access models including convenient work-site and neighborhood clinics, outpatient surgical clinics, behavioral health services, diabetes resource centers, and hospital-based clinics.

Physician extenders may be nurse practitioners (NPs, who are also referred to as advanced practice registered nurses) and physician assistants (PAs). Physician extenders, so-called mid-level providers, work under the supervision and direction of a physician – either an M.D. or D.O. – and can deploy a wide variety of diagnostic and treatment capabilities. This enables the physician to practice at the “top of license” and oversee efficient team-based care. Using physician extenders is like using all 10 fingers to type rather than just pecking with your thumbs—it produces quality work faster and in greater quantity.

Nursing schools and health sciences programs can educate NPs and PAs—all highly qualified health professionals—in far less time and in greater numbers than is possible for medical schools to train physicians.

Another approach to managing around the physician shortage is to deploy innovative information technology capabilities and mobile health applications that enable a physician to provide quality care focused on better managing chronic disease of an identified population, such as patients with diabetes, and reduce episodic strain in the system of care. Information technology also allows a physician to deliver care more efficiently across a wide geographic area.

For example, secure digital connectivity facilitates access to medical information and diagnostic images from anywhere, saving time and decreasing the need for duplicate images or tests. This also enables a physician to check on patients in remote locations and intervene in a timely manner if treatment is necessary.

Wearable health devices enable patients to monitor their own health following guidelines from their physician. Physicians and physician extenders can also deploy mobile devices to remotely monitor patients, such as those with diabetes or heart disease, and to reduce the likelihood of readmission after discharge from a hospital.

Leveraging physician extenders and deploying innovative approaches to deliver health services can help meet the challenges of providing timely access to affordable, reliable health care for North Texans.

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