The Association of American Medical Colleges (AAMC) projects that by 2025 the United States will face a shortage of 130,600 physicians, representing a near 18-fold increase from the deficit of 7,400 physicians in 2008. The widening gap between physician supply and demand has grown out of a complex interplay of legal, political, and social factors, including a progressively aging population, Congressionally mandated caps on the number of Medicare-funded residency slots and funding for graduate medical education, and waning interest among medical school graduates in pursuing careers in primary care.
These issues generate unprecedented opportunities for healthcare innovators and entrepreneurs to design solutions that can effectively address widening disparities between healthcare supply and demand, particularly within vulnerable and underserved areas.
In line with Einstein’s discerning remark that “we cannot solve our problems with the same thinking we used when we created them,” perhaps the most promising solutions are those that begin by rethinking the basic structure and organizing principles that underlie and support traditional systems of healthcare delivery. Central among these initiatives are patient-centered medical homes, retail clinics (such as the MinuteClinic), and novel uses of telemedicine. These innovations disrupt the prevailing infrastructure of healthcare delivery by wielding cutting-edge information technologies, team-based care models and other unorthodox measures to augment the efficiency, affordability, and accessibility of healthcare services.
The shifting clinical landscape occasioned by these disruptive innovations augurs profound changes in the doctor-patient relationship and in clinical ethics more broadly. Novel questions that arise within the retail clinic setting include how to ensure the same degree of continuity of care typically afforded in more traditional care settings, how to safely and effectively integrate health information across fragmented outlets of care, and how to best avoid conflicts of interest that might arise when corporate interests become so closely tied to patient care. The patient-centered home, with its distinctive team-based approach, prompts us to reconceptualize the doctor-patient relationship, both as it is and how it ought to be.
With implementation of these changes well underway, it behooves policy makers, providers, and medical educators to carefully consider strategies that not only ensure access to care for those who need it, but also optimize the quality, efficacy and ethical integrity of the care provided in the coming era of Healthcare 2.0.