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    Transcript for Ask an Expert About … Health Care Workforce Shortages


    MICHAEL DILL: Hello. I'm Michael Dill, director of Workforce Studies here at AAMC. I've been at the association for a little over 15 years and director of Workforce Studies for about six, I would say. And as director of Workforce Studies, it is my privilege to work with a team of researchers and data analysts who look at, think about, and try to improve anything and everything that has to do with the physician workforce in the United States. That includes doing data collection, data analysis, publishing those data analysis, doing original research that we publish online and through peer-reviewed journals. We do a lot of external collaborations with experts in the field of physician workforce, everything from do we have enough to how do I improve access to how well our physicians are faring? What's their well-being like?
    And it is our goal to improve the health of the nation along with the rest of AAMC.

    AARON DILLARD: Thank you so much for the great intro, Michael. Welcome to the show. My name is Aaron Dillard. I’m your host for today. This is “Ask an Expert.” I appreciate the time you've given us today. I know you have a busy schedule, so let's dive right in. Let's start with how you ended up here, where you are now in your career in the field of workforce studies, and what brought you to AAMC?

    DILL: Well, I've been doing research and data analysis in order to change policy in a positive direction for decades now. It started actually back when I was working on early childhood education, and so I did similar work in the childcare space whenever after having experienced it myself as an early childhood educator, I realized that we needed to make some changes as a society. And one pathway to doing that was pulling together the data and the research that showed what was wrong and how to fix it, and then using that to influence policy. Along the way, I got interested in health care and that led me to look at specifically the health workforce, the people who heal us. What can we do to help support them and in so doing, improve how we're all doing.

    And it was my good fortune to work with a man named Ed Saltzberg in Albany, New York, doing that kind of work. And then he left to come to D.C., and I stayed on there for a while, moved to D.C. for a different type of job, didn't like it. I wanted to get back into doing that work where we're supporting the healers of this country. So, I looked around, found something applied, and it turns out I had applied to work with Ed Saltzberg again here at the AAMC. Yeah. So, he has the dubious distinction of having hired me twice. And I considered him to be a mentor of sorts in this line of work. And I started here as a data analyst and just worked my way up by trying to do better and do more and figure out how I can support AAMC and, you know, improve everybody's lives.

    DILLARD: How do you analyze the current and future physician workforce shortages based on what's currently happening?

    DILL: That process begins with a lot of listening, you know, listening to our members, of course, listening to other folks here at AAMC. We have a lot of brilliant people at AAMC who know what's going on. And listening to my team as well, and then listening to what's happening in the world. I mean, that's where it all starts. You know, ultimately, we have to turn that into research and data and foreign policy, but it starts with listening and goes from there. And that's how we engage with the continuous improvement of the work that we do. So, it starts there and then it becomes a matter of refinement based on what we're hearing. What can we actually do that will make a difference? And we go from there.

    DILLARD: What are some factors that you believe are contributing to these shortages and how they're impacting our health care field?

    DILL: I know it's going to seem a bit obvious, but the major factor impacting the shortages is that we don't have enough physicians. And if that's the definition of a shortage, I know, but I find myself having to say that out loud on a regular basis anyway. So that's the main thing right there. You know, we need more and I would argue we need more for the health of the nation, but we also need more for the health of the physicians themselves because they're working too hard, working too much. They're burnt out and more burnt out with each passing year. And as you can well imagine, COVID didn't make that any better, you know. So though, I mean, we don't have enough physicians, that's the main thing. And, you know, to stop being a little tongue in cheek about it, I'll also mention that, you know, we have a growing an aging population that needs more and more physicians. And so that's clearly one of the main factors that we're looking at as well. And an aging population requires increasingly complex services, which requires not only more physicians, but more highly trained specialists. And so, you know, those are the things that are driving it. And the consequence and why ultimately we care about shortages is that because we don't have enough physicians, we don't have enough access to care.

    There are other things that are impacting access to care. But even if all the other things go away, all the other barriers to access go away. If we don't have enough physicians, people are still not going to be able to get care. Right. And that means not only will people be less healthy, but think about what that means in terms of the quality of their lives and the lives of those around them and of their communities. And it all needs health. And so, you know, that's the way shortages are playing out. The health of our people, our communities, our nation is not where it could and should be.

    DILLARD: Going back a few years in 2021. You were a presenter at AAMC annual Learn Serve Lead conference. During your presentation you mentioned in September of 2020, 76% of health care workers reported exhaustion and burnout and that 40% of physicians felt burnout at least once a week. Wow. It's been a little over three years since the peak of the COVID pandemic. Now, our physicians are still experiencing burnout in the same way? What are your thoughts on how they're coping and dealing with burnout and the overall shortage of physicians?

    DILL: Well, that’s an excellent question, but really, that’s a field of questions. So, I'll start at the beginning and work through. So, yes, physicians are burnt out, the health workforce is all burnt out, and that's not surprising. You know, even before COVID, this was a national crisis. You know, my team focuses mainly on physicians, so I'll talk about them.

    But I don't mean to discount, you know, the nurses and the employees and the lab techs and everybody else. Physicians were significantly burned out before COVID hit, and that made it worse. We've actually collected data here at AAMC, longitudinal data, to look at that question specifically. And we found I know this is a shocker, that burnout got worse between our data for 2019 and 2022.

    So, you know, COVID burnout went up. Interestingly, though, the increase in burnout was worse amongst physicians where the facilities or institutions where they worked, you know, had to furlough staff or lay people off, etc., which is an interesting insight. I mean, dealing with the actual pandemic itself was stressful for physicians, but the hardest part of it for them was what happened in the employment setting in terms of how their employers were navigating COVID.

    Now as they navigated it more in terms of functioning like in a business that just needs to lay off staff, then, you know, burnout got a lot worse. And that makes sense if you think about it. But it means that there's a lot happening at the institutional level that directly impacts physician well-being and, you know, how institutions navigate what's happening with the broader economy and the, you know, just the world at large is a big part of how well physicians will fare.

    And so, there's a lot that needs to happen at the institution level to help improve physician well-being. I mean, you know, I've said it before and I will say it again, you know, telling physicians and your workforce, well, you know, we'll help subsidize your parking and give you a yoga room is not the answer. And it's not. Sorry. And our data show clearly where the answer lies. It was, you know, reduced staffing makes things worse, which again, it seems intuitive. But I have to say it out loud because we're sometimes going the wrong way, and that's making things worse. And that means thinking about who all you need on the team that's providing care to support each other.

    And so, it’s not just physicians, but it’s nurse practitioners and physician associates and all the other folks on the team. And we need to support all of them and their ability to work together and support each other. And whatever we do in that space is going to make things better. And then we also need to think about who's doing what. You know, our own data show that physicians spend an inordinate amount of time filling out paperwork on the phone with insurance companies, those sorts of things. You know? Yeah. And add to that, we're in an era where health care is evolving in a way that leaves physicians with less and less autonomy and the work that they do, you know, and that contributes to the burnout and very deep and meaningful ways. And we need to think about how we can address that, too.

    DILLARD: Based on the changes in health care that you've seen over the last several year,s with it modeling more of a business. And the dichotomy that arises when you consider the reason most get into the field of medicine is because they want to help people and take care of patients, right? How do those ideals work together when they seem to conflict?

    DILL: If I were certain of the answer to that question, I would be out there shouting it from the rooftops. But I think the kernel of the answer is actually in your question, because you mentioned that, you know, why physicians become physicians. It's not a business proposition for most of them. For most of them, it's because they want to do good in the world. I mean, physicians are at their core healers, right? They want to help heal people or help people with their own healing. And a profession that starts from that basis, I have to believe, will fundamentally find a way to continue to center that in what they do. And then we just need to figure out how to better support them in that. Exactly what that looks like, I don't know. But, you know, I'm hoping that over the course of the rest of my career, I can help them figure that out.

    DILLARD: With an increasing number of patients getting older and a decrease in the number of doctors coming into health care, how do we meet in the middle? Even in the advent of more and more telehealth care, how are patients ensure that they're receiving the adequate care in the time that's most needed?

    DILL: Well, I think to some extent, if you don't have enough physicians, they can’t. And, you know, not surprisingly, there's a growing body of research that shows that burnt out providers don't necessarily provide the same level and quality of care. I mean, and nobody should be surprised by that. I mean, this is one of the many arguments for why we need more physicians and we need more team-based care.

    And you mentioned telehealth. We need to leverage technology better. For the most part, technology has been used to improve the lives of folks who already had better access to care than everybody else. And so, we need to take the next step and figure out how do we use that to improve access and quality for everybody else. Because there are two main things that need to happen in order to solve this complex of scenarios. And I've mentioned one which is, you know, we need to train more physicians, but we also need to systematically reduce barriers to care and access to quality care. We need to do those things hand in hand. One without the other won't get us there. In fact, without more physicians, you can't do the other completely. As we discussed earlier. So, we need those things to happen together.

    DILLARD: Is there any concern for future medical students being taught by those in health care that might be suffering from burnout?

    DILL: Your logic is sound. There are two interesting things I'd like to note in that space, though. We actually did research looking at whether or not physicians with an academic affiliation, or more likely to be involved in medical education, or whether they were more or less burnt out than other physicians. And it turns out they're less burnt out. And there's a growing body of work to which we're contributing significantly that shows that if you give physicians the time and the opportunity to engage in education and research as well as clinical care, you know, they're actually less burnt out and more satisfied because there are inherent rewards that come with teaching and with doing research as well as the rewards that obviously come with clinical care. But having that variety of tests and if you think about it in our own lives, in our own jobs, if you're just doing one thing all day, every day, you're going to be more burnt out than if you can switch around and mix it up a bit.

    Physicians are people and, you know, and they are experts in what they do and they actually enjoy imparting that to others. So, I would suggest to you that in that there's also a remedy to the problem that you so adequately describe. The other thing is, and I've only sort of begun to think about this, you know, the older physician workforce, the number who are retiring, we're looking more closely at what retirement actually looks like for physicians because it's not like they work full time up to a certain age to 65 and then just stop working. And that's not how physicians, you know, they keep going and going. And it turns out older physicians are less burnt out than younger physicians. So, you have a potential here for the folks who've been doing this work the longest and arguably have a lot of wisdom and expertise to impart who are, you know, we're also the least burnt out. I mean, there's a potential source for teaching there that could help ameliorate, again, the problem that you've so adequately described.

    DILLARD: In wrapping up, what advice, interventions, or potential solutions do you think could address adequately what's happening with physicians and their level of current burnout?

    DILL: I only have some beginning suggestions. There's a lot more I still need to learn and understand. But let's begin with the basics. At the risk of repetition, we need more physicians. That's a key part of the solution. We also need to and I've mentioned teams more than once, we need to engage team-based care better and more than we do now. And I think that will go a long way. And I'm willing to bet that you have experience working in a highly functioning team and exactly how satisfying that can be, right? It actually gives you energy rather than taking it away. Again, physicians are people. The same thing is true for them. So, we definitely need to do that. 

    We need to figure out how to support them better in the workplace, too. Again, this falls along the lines of physicians are people too and there are a lot of things that we could do in the workplace at an institutional level to help them. You know, one is evaluating how they're spending their time and we've touched on a couple of those things. You know, the amount of administrative burden that physicians are experiencing, and we need to do something about that. Increased autonomy, more time for a variety of activities like teaching and research as well. I think all of those things would help. It's tough. I'm not saying these are easy things to do. Our health care systems are feeling a squeeze right now in order to produce, you know, actual income. Right? In order to be financially viable. Ok. That makes sense. You know it. But if we don’t support our workforce, you know, in the long run, they’re going to be less financially viable institutions. I’m just saying. So, we need to do all those things, I think. And those are a good start towards answering the question, you know, what do we do to help address physician burnout?

    DILLARD: Thank you for joining us today on this episode of Ask an Expert. Michael Dill, our director of Workforce studies, we appreciate your time, expertise, and insight. Thank you so, so much. 

    If you're a part of our community and have a question for our next expert, be sure to follow us at AAMCToday on X, formerly known as Twitter, or Instagram.

    DILLARD: You can also join our community at communities.AAMC.org. And we'll see you on the next episode of “Ask an Expert.”

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