When Demand Exceeds Supply: Older Patients and Fewer Physicians in Workers' Comp

Fast Focus

The U.S. workforce is aging, including the healthcare workforce. In particular, the average physician age is going up. Many doctors are expected to retire in the coming decade, causing a physician shortage that may be most acutely felt in workers’ comp.

The aging of the American workforce has been a subject of much discussion in workers’ compensation, and for good reason. By 2020, one out of four workers is expected to be 55 or older.1 This startling fact raises concerns about injury rates and health issues that become more likely with age, such as comorbidities, polypharmacy, and longer recovery times.

These are legitimate concerns that deserve the attention they are receiving. But injured workers are not the only people who are aging. The American population is getting older, including the people we count on for care – physicians, nurses, and other healthcare professionals.

THE LOOMING PHYSICIAN SHORTAGE

Over 50% of U.S. physicians are over the age of 50 and one third will be over the age of 65 in the next decade.2 Experience is a valuable asset in medicine, but this is not just an issue of more mature providers. Thirty percent of physicians retire between the ages of 60 and 65,2 and more are leaving the profession before retirement age due to job dissatisfaction and burnout. A limited number of residency programs, combined with fewer young people aspiring to careers in medicine, has restricted the number of new physicians. All of which means that physicians are leaving the profession faster than they can be replaced.

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OF PHYSICIANS WILL BE OVER THE AGE OF 65 IN THE NEXT DECADE

The Association of American Medical Colleges projects a shortage of 47,000 – 122,000 physicians by 2032,2 with family and internal medicine, emergency medicine, hospitalists, and radiologists all falling within the top 10 specialties experiencing shortages. Urgent care, cardiology, orthopedic surgery, neurology, general surgery, and anesthesiology are all included within the top 20.

By 2030, the share of the population aged 65 and older will increase from 13-19%.3 Because older adults consume a disproportionate share of healthcare services, the supply of physicians is shrinking just as the demand for care is expanding.

And we cannot count on allied health professionals to fill the gap. The average nurse age is now 514 and 44% of physician assistants are over the age of 40.5 According to the Center for Health Workforce Studies, approximately 15,400 new nurse practitioners and physician assistants will be needed each year between 2016 and 2026 to fill new positions and those being vacated.6

THE AVERAGE NURSE AGE IS NOW 51

Ironically, the size of the healthcare workforce overall is expanding and now accounts for 14% of the total U.S. workforce. But the increased staffing is occurring in administrative positions, not frontline care providers,7 which adds cost without increasing access to medical care.

PERCENTAGE OF U.S. WORKFORCE AGED 55 AND OVER

PHYSICIAN AGE BY GENDER

IMPACT ON WORKERS’ COMP

Older injured workers often require more complex courses of treatment, which alone raises the specter of higher medical costs and increased compensable time. In addition, the longer wait times and higher professional fees for healthcare providers could lead to compromised care for patients.

The risks of higher costs and suboptimal care exists for all healthcare, of course, but the threat is greater to workers’ compensation programs for the following reasons:

A highly regulated environment with stringent requirements for provider qualifications, timely access to care, and patient choice

Limited ability to mitigate physician shortages through technological innovations, such as telemedicine, due to reimbursement challenges and outdated workers’ comp legislation

Severe shortage of occupational medicine physicians

Increased care complexity due to pain management needs

Longer claim durations and delayed return-to-work times resulting from increased wait times

Severe provider shortages in rural areas that already pose coverage challenges

Some efforts are being made to address physician shortages and modify workers’ compensation laws to keep up with the changing healthcare landscape. For example, California recently spent nearly $70 million to pay off student loans for doctors with at least 40% MediCal patients. And a new bill was introduced in the New York State Senate to examine how connected health technology could improve outcomes for injured workers and increase access to care providers.

Any positive measures to address physician shortages and/or mitigate its consequences for workers’ comp are welcome, and we need more of them. Unfortunately, even if all 50 states took aggressive action, the remedies could not be realized quickly enough to forestall the impending issues. Already the wait time for new-patient appointments has increased by 30% or more in 15 major metropolitan areas since 2014,8 and the number of qualified medical evaluators in California declined 20% from 2012 to 2017.9

WHAT TO DO

The double threat of an aging workforce combined with a shortage of healthcare providers is upon us, and workers’ compensation payers should take proactive steps to meet the challenge, including:

USING DATA ANALYTICS to assess injured worker populations and identify at-risk patients for early intervention and assistance

UTILIZING PHARMACISTS for clinical oversight and intervention programs to assist patients and fill gaps between provider appointments

INVESTING IN PATIENT ENGAGEMENT and wellness programs to empower patients with the right knowledge and tools to aid their own recovery and prevent unnecessary complications

IMPROVING REFERRAL AND CLAIMS ADJUDICATION PROCESSES to speed care delivery

SELECTING RELIABLE BENEFITS MANAGEMENT PARTNERS who strike the right balance between quality care and cost savings

STAYING INFORMED ABOUT LEGISLATIVE ACTIVITY and aligning with other workers’ comp leaders to advocate for needed changes

The aging worker population and healthcare provider shortage are matters out of direct control, but workers’ compensation payers, managed care organizations, and their partners can work together to test and implement new strategies that will continue to contain costs and ensure the best possible outcomes for injured workers.

References

  1. Toossi M, Torpey E. Older workers: labor force trends and career options. Bureau of Labor Statistics. May 2017. https://www.bls.gov/careeroutlook/2017/article/older-workers.htm
  2. The complexities of physician supply and demand: Projections from 2017 – 2032, 2019 update. Association of American Medical Colleges. April 2019. https://aamc-black.global.ssl.fastly.net/production/media/filer_public/31/13/3113ee5c-a038-4c16-89af-294a69826650/2019_update_-_the_complexities_of_physician_supply_and_demand_-_projections_from_2017-2032.pdf
  3. How an aging workforce and population will impact health care in the U.S. 2016. Willis Towers Watson. https://www.beckershospitalreview.com/pdfs/The%20Aging%20Workforce%20and%20Health%20Care%20.pdf
  4. National nursing workforce study. National Council of State Boards of Nursing. 2017. https://www.ncsbn.org/workforce.htm
  5. Pasquini S. Physician assistant stats, data, and demographics. The Physician Assistant’s Life. https://www.thepalife.com/physician-assistant-stats/
  6. Health care employment projections, 2016-2026: an analysis of Bureau of Labor Statistics projections by setting and by occupation. Center for Health Workforce Studies, University of Albany, State University of New York. 2018. http://www.chwsny.org/wp-content/uploads/2018/02/BLS-Projections-2_26_18.pdf
  7. Employment projections – 2016-2028. US Bureau of Labor Statistics. Sept 4, 2019. https://www.bls.gov/news.release/pdf/ecopro.pdf
  8. 2017 Survey of physician appointment wait times. Merritt Hawkins. September 2017. https://www.merritthawkins.com/news-and-insights/thought-leadership/survey/survey-of-physician-appointment-wait-times/
  9. Jones SL. Changes in the QME population and medical-legal trends in California workers’ compensation. California Workers Compensation Institute. Feb 2018. https://www.cwci.org/document.php?file=3804.pdf

RxInformer

Since 2010, the semi-annual RxInformer clinical journal has been a trusted source of timely information and guidance for workers’ comp payers on how best to manage the care of injured worker claimants and plan for the challenges that lay ahead. The publication is an important part of Healthesystems’ proactive approach to advocating for quality care of injured workers while managing the costs associated with treatment.
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