In-person, Virtual, & Hybrid Coverage Models
In 2020, the United States (and the world) faced a monumental uphill battle — defeating COVID-19. With what would quickly become an all-hands-on-deck scenario growing day-by-day, physician and healthcare worker shortages were quickly thrown into the spotlight.
Over the last year and a half, many hospitals struggled with retaining healthy staff. But it isn’t just the pandemic that is causing the shortage; the number of physicians has been waning for years due to an aging patient population and retiring pool of physicians.
The most recent report from the Association of American Medical Colleges (AAMC) projected that the US will be short up to 139,000 doctors by 2033. This is up from the shortage of 121,900 projected in 2032 last year.
It’s also important to note that this shortage does not take into account the effects of the COVID-19 pandemic on the healthcare industry. The AAMC report was conducted and released prior to the pandemic.
Addressing Shortages, A Multi-Pronged Approach
With major physician shortages on the horizon, a big question is: how can we fix this? The answer, though, is rarely one-size-fits-all. COVID-19 created an environment where provider safety had to be given the first priority. Specialty caregivers (coincidentally the segment that will see the biggest decline over the next 15 years) drove the rise in popularity of telemedicine.
Anyone who could see a patient virtually, did so. And, it worked. 80% of physicians used telehealth during the pandemic, a 2020 survey shows, and 92% of physician respondents expect to keep using telehealth even after the pandemic. Consumers, too, find value in virtual care, with over 50% of respondents saying they will use telehealth more in 2021 than they did before the pandemic. These recent survey results pave the way for hybrid care—a combination of virtual and in-person care—to almost seemingly become the norm going forward.
Another solution to physician shortages is hiring advanced practice providers. Nurse practitioners and physician assistants have made up a greater proportion of the healthcare workforce for the last 15 years. A study from The New England Journal of Medicine estimates that 67.3% of practitioners added to the workforce between now and 2030 will be advanced practice providers.
Attracting, placing, and retaining in-person medical talent has always been a challenge for businesses, and no more the case than in the healthcare industry.
Traditional healthcare staffing has involved recruiting for permanent positions through an in-house recruitment department or working with a specialized agency to fill physician openings. Agencies generally help providers with general hiring, marketing, and recruitment strategies, though they can also identify inefficiencies in onboarding processes, help with diversity and inclusion, and highlight other needed human resource management improvements.
Healthcare organizations have also utilized locum tenens models to engage both primary and specialty practitioners for many reasons: as a stand-in for a vacationing doctor, to aid in the increase of a facility’s demand, or to ensure that a specialty physician or advanced practitioner is available during a specified time of year.
Staffing via locum tenens can fill both temporary or permanent shortages at a healthcare facility. With the rise in “traveling” healthcare professions, we’re seeing the model adapt even further. Many young doctors and other healthcare staffers are keen to travel, but still want to pull in a steady paycheck.
Virtual healthcare visits saw rapid growth in the last year. Prior to the pandemic there were concerns that a virtual visit would not provide the level of care that a patient was used to receiving in-person. A Massachusetts General Hospital study found that patients reported strong personal connections with providers when using telehealth visits. 62 percent of patients said the quality of telehealth visits was just as good as in-person visits; 21 percent said it was even better.
When staffing for a telemedicine position, healthcare organizations have access to a much larger pool of applicants via a broader geographical reach, lessen if not eliminate costs while removing certain administrative burdens. Physicians and advanced practice providers are also able to begin working immediately by providing online consultations versus having to relocate.
Telemedicine can also help hospitals and healthcare facilities try to prevent burnout. Three years prior to the pandemic, the AMA noted that nearly 60% of physicians said they felt burned out. Telemedicine allows healthcare organizations to even out the workload virtually, fixing both coverage shortage and load imbalances.
Hospitals and healthcare facilities in rural areas, with lower patient volume, also do not have resources to justify the cost of hiring a full-time, in-person physician, advanced practitioner, or specialist. Virtual staffing can allow for individuals to be shared across multiple facilities to maximize their utilization.
The Rise of Advanced Practice Providers
The American Academy of Nurse Practitioners indicates that between 2018 and 2019 the number of NPs licensed to practice jumped by an estimated 22,000. Also, the U.S. Bureau of Labor Statistics estimates the job outlook for advanced practice providers is projected to grow 52% between now and 2029.
Primary care is the clinical focus of the majority of advanced practitioners, an area that is estimated to experience physician shortages between 46,900 and 121,900 by 2032. In fact, advanced practitioners can deliver many of the services typically provided by a primary care physician. As patient demand increases, more and more NPs / APPs are available to resolve the health concerns patients have during this physician shortage.
The growing number of advanced practitioners leads to greater access to care for those who need it most. Rural communities are often underserved, and metropolitan populations need sufficient care for their numbers. The prevalence of advanced practitioners has increased in both rural and non-rural settings.
While we’re all used to seeing an advanced practitioner when we go in to our primary care office, there are many benefits to utilizing APPs in a telehealth setting. According to a recent study, “It has been reported that agencies using telehealth have an average patient-to-nurse ratio of 15:1, as compared with non-telehealth agencies having a ratio of 11:1.” This means that a advanced practitioner can use telehealth to see more patients and provide timely care. APPs can educate, follow-up, collect data, manage care, and provide family support remotely.
Finding a Balance
For many organizations, the balance will most likely fall somewhere in between. Cost savings is almost always a consideration when determining whether to hire in-person or virtually and whether to hire a physician or an advanced practice provider.
Modern day locum tenens contracts are typically one to six months. Your organization could potentially pay a qualified physician up to 150% of what a normal salary would be per day, however, there are rarely any benefits other than a high salary and the ability to have a flexible schedule with locum tenens work.
Your organization will save on provider credentialing and liability insurance, health, vision, dental, 401k, etc. With permanent, in-person physician placement, the salary and combined benefits are often far beyond that — this is especially true for doctors with specific credentials.
During the ongoing COVID-19 pandemic, many healthcare organizations have utilized cross model staffing out of necessity. By using a hybrid in-person/virtual model, your organization can address shortages in staffing whether it is forced, temporary, or permanent, while still remaining agile enough to pivot should the need arise.
Hybrid healthcare brings together the best of telehealth and in-person treatment. It relies heavily on technology for video conferencing, patient monitoring, appointment scheduling, and follow-up. Patients find hybrid healthcare more convenient, proactive, and less time-consuming, while providers see the opportunity to deliver more effective healthcare at reduced costs. While both patients and healthcare providers may struggle with the speed and complexity of healthcare’s digital transformation, telehealth’s rapid expansion indicates there’s no going back.
Need a Staffing Partner?
MedLink is your go-to source for all of your Urgent & Planned staffing needs. While we embrace our reputation as a company that can find the right physician or advanced practice provider fast, it’s important to understand that we are more than just a stop-gap measure for urgent coverage needs.
We are even better at partnering with hospitals, practices and telemedicine service providers to help them staff up for planned growth or anticipated vacancies. Learn more about the benefits of working with us.