‘Spread the wealth,’ utilize team-based care to combat growing GI provider shortage
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There are no easy solutions for the ongoing and increasing shortage in GI providers — everybody is feeling this challenge.
Physicians must strike a sensitive balance between doing procedures and seeing patients, particularly established patients who need to visit the office more regularly. This is especially true in the world of inflammatory bowel disease.
On the other hand, leadership often wants us to see new patients, because they usually generate more bottom line to the institution compared with more established patients.
In my practice, this boom in patient volume began about 16 months ago, and it has only gotten worse.
The phenomenon of people retiring early because of burnout or leaving their institutions to work in a different field is detailed in the cover story. Like Joseph J. Vicari, MD, MBA, FASGE, said, one solution to this problem may be increasing utilization of advanced practice providers (APPs). But if they are also specializing in complex IBD patients, there is a danger of burning them out, too.
It is a fine balance where, like Darrell S. Pardi, MD, MS, mentioned, we have to make sure employees are deriving meaning from their work and appreciate the bigger picture. And without more fellowship spots, we will never have enough providers to care for this growing population.
Fixing the disproportion in matching patients with providers is an uphill battle that will take time to fix. For now, providers and institutions need to focus on how to best care for themselves and their patients.
One short-term solution is adopting a team-based care approach of allied health staff, nurses, nurse practitioners and/or physician assistants. Yes, there may be patients who will push back against this model, because it does not fit their conception of the patient-physician relationship. They want to identify with one provider rather than whoever is on call, or they might not want to see a nurse practitioner or APP over a physician.
However, given the current shortages, we must strive to develop new models of care. It will take lots of patient education, and teams must be structured so patients always feel like they are receiving excellent care.
Our IBD group has a pharmacist embedded within the team who provides education to patients, puts in infusion center orders, and saves both patients’ and physicians’ time. We have found that our patients enjoy this, because they are seeing another provider who is an expert in their field and able to address different treatment modalities available to them.
Overall, I think spreading the wealth is the best way to go to combat this growing problem.
- For more information:
- Edward V. Loftus Jr., MD, is professor of medicine at the Mayo Clinic in Rochester, Minnesota, and chief medical editor for Healio Gastroenterology.
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