Arizona’s alarming doctor shortage and what we’re doing to fix it
You might as well just say, “Ahhhhhhh,” right now because your jaw is about to drop.
The unemployment rate recently hit a 49-year low of 3.7 percent. Any idea what the unemployment rate is for hospital workers? It’s just 1 percent.
“It is an employee’s market and healthcare is clearly impacted,” says Carol Cheney, vice president of staffing and workforce planning for Banner Health. “We are in need of many positions, as are other healthcare organizations. There is also a national nursing shortage, which adds to the complexity in our space.”
According to data from the Association of American Medical Colleges, the United States could see a shortage of up to 120,000 physicians by 2030, impacting patient care across the nation. And few states feel that shortage as much as Arizona, which ranks 44th of 50 states in total active primary care physicians, with just 77.9 primary care physicians per 100,000 population. The U.S. average is 91.7 primary care physicians per 100,000 population.
“This year’s analysis reinforces the serious threat posed by a real and significant doctor shortage,” says AAMC President and CEO Darrell G. Kirch, MD. “With the additional demand from a population that will not only continue to grow but also age considerably over the next 12 years, we must start training more doctors now to meet the needs of our patients in the future.”
To make matters worse, the aging population not only impacts the demand for physicians but the supply because one-third of all currently active doctors will be older than 65 in the next decade. When these physicians decide to retire, it could exacerbate the current shortage.
Impact in Arizona
So how badly is the shortage of healthcare workers impacting Arizona?
“Arizona is facing a workforce shortage that is impacting every part of the healthcare industry,” says Jennifer Carusetta, executive director of the Health System Alliance of Arizona. “Members of the Health System Alliance of Arizona already compete with other states to recruit the best and brightest healthcare minds to Arizona. The workforce shortage and the projected growth in the Arizona population have only exacerbated this shortage and increased the urgent need to find solutions.”
Much of the increased demand comes from a growing, aging population. The U.S. population is estimated to grow by nearly 11 percent by 2030, with those over age 65 increasing by 50 percent by 2030. And with Arizona being an attractive retirement destination, it only amplifies the crisis.
“Metro Phoenix is an attractive place to live,” says David Hanekom, MD, CEO of Arizona Care Network. “As a result, we have one of the fastest-growing counties in the nation – more than 100,000 new residents join us each year. Consequently, the demand for healthcare services is increasing. We face a critical shortage of primary care providers. That’s why we are seeing the proliferation of innovations like telemedicine, the ‘retailization’ of healthcare and discussions on how to relieve provider burnout to save the providers we do have.”
But it’s not just primary care physicians that is in short supply.
“Throughout Arizona and the country, there is a shortage of registered nurses and other allied health professionals, creating a staffing challenge at times,” says Frank Molinaro, CEO of Abrazo Community Health Network.
The greatest need
Cheney says Arizona’s healthcare sector has workforce needs across the spectrum — from ambulatory care services to acute inpatient.
“From a clinical perspective, we are in need of nurses — from ICU to operating room, progressive care, care coordination, home health, etc.; physicians — especially those in the primary care areas; certified medical assistants; surgical technicians; medical imaging and radiology technologists; certified nursing assistants; and behavioral health RNs and technicians,” Cheney says. “Those are amongst some of the clinical areas with the greatest need. Also due to the employee market, we are in competition for housekeeping and culinary jobs, as well, but that is also a nationwide challenge.”
Technology and information security roles are also in high demand, and experts say most people do not understand that healthcare has those technology needs, opportunities and challenges, as well.
“As healthcare technology becomes more complex, so does the skill set required of staff to provide care to patients,” Molinaro says. “Consumers expect the latest technology and procedures. But to provide care for our patients we need physicians, nurses and allied health professionals who are not only clinically qualified, but also well-versed in the technologies we use.”
Recognizing the growing crisis, the Arizona House of Representatives Appropriations Committee hopes to make the path toward becoming a doctor a little easier. Senate Bill 1354 will help alleviate the physician shortage by appropriating a total of $50 million split among five programs including Graduate Medical Education (GME), the University of Arizona Medical School, primary care provider loan repayment, medical student loan repayments and nurse training.
“This legislation is an important step toward ensuring Arizona has a sufficient number of medical professionals to care for our rapidly growing population,” says Steve Purves, president and CEO of Maricopa Integrated Health System. MIHS operates one of Arizona’s largest and longest running physician training programs and is affiliated with the Creighton University – Arizona Health Education Alliance. “With Maricopa County set to double in population by 2040, we need to solidify a plan today to meet the healthcare needs of the Valley tomorrow.”
Only 42 percent of Arizona’s medical students remain in the state after graduation, according to the Association of American Medical Colleges. The most significant factor impacting this rate is the shortage of post-graduation training opportunities. GME, commonly known as physician residencies, has not been state-funded in a decade, thus leaving matching federal funds on the table. SB 1354 will contribute $20 million to GME, matched by approximately $47 million in federal funds — making it a total of $67 million that would become available.
“We desperately need to retain our trainees in the state, and these funds will help us achieve that goal,” says Dr. Jacqueline Chadwick, executive director of the Creighton University-Arizona Health Education Alliance, which oversees more than 20 residency and fellowship programs training more than 300 learners in Phoenix.
While a boost from lawmakers is a step in the right direction, experts say there isn’t one pill that will cure all that ails the state’s shortage of healthcare workers.
“There is no magic bullet,” Dr. Hanekom says. “We need to be addressing our challenges with innovation on all fronts.”
A few that Dr. Hanekom considers essential:
Expanding the use of advanced practice providers like physician assistants and nurse practitioners: “We can greatly extend physician network capabilities by inviting advance practice providers to serve on the healthcare team. This team approach to care ensures that appropriate resources are available for all patients.”
Data-driven decision-making. “There is no shortage of data in healthcare,” Dr. Hanekom says. “The challenge is making that data actionable. Despite many advances, there remain significant barriers to unlocking the value of data transfer. If we are going to ensure that patients have access to the care they need in the setting their condition requires, we must solve our interoperability issues and make that data actionable at the provider level.”
An evolution to value-based medicine: “We are in the midst of a transition from the legacy fee-for-service healthcare delivery model to a value-based medicine model,” Dr. Hanekom says. “The skill set required for success under this new model is very different from the training providers receive today. Tomorrow’s successful physician must possess financial and actuarial acumen, understanding of contract risk factors and predictive modeling. They must be committed to placing the patient at the center of care coordination rather than continuing with a comfortably familiar physician-centric model. They must view care not in episodes, but along a continuum. Today’s training, technology and reimbursement models are not yet fully aligned with these needs.”
Easing the crisis
Better use of technology and telehealth has also proven to be a critical bridge to help fill the gap in care, according to Carusetta.
“Using telehealth, we are able to connect patients in outlying areas with providers around the state,” Carusetta says. “This provides an important resource for those who might have otherwise suffered from access to care, or for those who needed access to specialty care, but who did not have access to that specialty in their local community.”
Arizona’s schools are also doing a better job of preparing students for a career in healthcare by offering more STEM-focused curriculum, experts say.
“We have partnered with local school districts to provide guest speakers and invite STEM students to visit our hospitals, as we recently did at Abrazo Central Campus,” Molinaro says. “On the post-secondary side, our colleges and universities continue to offer health profession courses and degrees, and partner with hospitals for educational opportunities. Medical schools are expanding, and starting this year Abrazo is growing its graduate medical education program by adding Internal Medicine and General Surgery residencies in addition to our existing Family Medicine residency program.”
So while many people in many different industry sectors worry about how artificial intelligence may someday take their jobs, the healthcare sector — with it’s startlingly low 1 percent unemployment rate — promises very healthy job security.
“Many people don’t realize that healthcare makes up approximately 20 percent of Arizona’s economy,” Carusetta says. “Arizona’s hospitals alone contribute nearly $25 billion in direct economic impact and, year after year, members of the Health System Alliance of Arizona are among the largest employers in the state.”
People travel to Arizona from around the world for the world-class, innovative care that Arizona healthcare facilities offer to their patients.
“In addition to growth in high-paying jobs, growth in healthcare means growth in support to other industries including retail, hospitality and finance,” Carusetta says. “If the healthcare industry is expanding, it benefits the broader economy in a very positive way, which provides a net benefit for the residents of our state.”
So where should you focus if you want to become part of this recession-proof industry?
“There are so many areas — depending on the desired schooling time and passion areas,” Cheney says. “We have careers that are supported by two-year degrees, four-year degrees and so forth.”
Regardless of the role that is chosen, experts say working in healthcare is one of the most rewarding career choices available.
“Each and every day, you are impacting the lives of people in your community,” Cheney says. “Opportunities in this space are endless. Additionally, healthcare is in a unique position to transform from old models of healthcare delivery to new models that meet technological and consumer demands. Healthcare is now being compared with Amazon, Apple, Google, Uber. This means the need for those interested in innovation, technology, supply chain, administration, etc. have the unique opportunity to apply their skills in a way that impacts the health of a nation, literally.”