New York, LA, and Chicago — the 1, 2, 3 of largest metros — are only going to grow by 10%.

Dallas, Houston, and Atlanta (4, 5, and 6) will grow about 50%.

As the Boomers retire to warm weather states, the change and impact to healthcare delivery services will be two fold. First, end-of-life care in these metro areas will boom, which has mixed financial results. Second, the migration of Boomers out of other (Northern/Mid-West) cities will reduce the baseline procedures that most healthcare systems rely on to stay in the black. (Heart, ortho, neuro, cancer, and peds/OBGYN.)

This suggests that we’ll see a clear two-tier health system emerge in the most rapidly growing cities — new buildings, new technology, new delivery mechanisms but likely only for those who can pay for it.

More about Metro growth here.

In another sign of the economy’s toll on the nation’s health care system, some hospitals say they are seeing fewer paying patients — even as greater numbers of people are showing up at emergency rooms unable to pay their bills.

– Hospitals See Drop in Paying Patients, New York Times

I was hoping this wouldn’t happen for 2 years or so, but a client alerted me to this after noting a downtick in volume and wondering if it was pandemic.

The news about the financial sector meltdown is everywhere, but how will it impact healthcare?

In this second part of a special webinar, Paul Griffiths, the CEO of MedTouch, will walk through how the sub-prime crisis led into Wall St. failures, which has spilled over into the bond market, threatening usual routes of funding for healthcare, muncipalities, and non-profits.

We’ll review what hard decisions providers will have to make over the coming year, and talk through some possible short and long term results from the financial bailout.

The Impact of the Global Financial Crisis on Healthcare

What you’ll learn:

* Why the financial crisis started
* Why the crisis will make it harder for hospitals to stay in the black
* Which healthcare providers should do today

The Changing Face of Medicine, due out later this year, will address the issue of the gender changes coming in the medical field.  From the blurb:

The number of women practicing medicine in the United States has grown steadily since the late 1960s, with women now roughly at parity with men among entering medical students. Why did so many women enter American medicine? How are women faring, professionally and personally, once they become physicians? Are women transforming the way medicine is practiced? To answer these questions, The Changing Face of Medicine draws on a wide array of sources, including interviews with women physicians and surveys of medical students and practitioners. The analysis is set in the twin contexts of a rapidly evolving medical system and profound shifts in gender roles in American society.

Throughout the book, Ann K. Boulis and Jerry A. Jacobs critically examine common assumptions about women in medicine. For example, they find that women’s entry into medicine has less to do with the decline in status of the profession and more to do with changes in women’s roles in contemporary society. Women physicians’ families are becoming more and more like those of other working women. Still, disparities in terms of specialty, practice ownership, academic rank, and leadership roles endure, and barriers to opportunity persist… Women’s presence in American medicine will continue to grow beyond the 50 percent mark, but the authors question whether this change by itself will make American medicine more caring and more patient centered. The future direction of the profession will depend on whether women doctors will lead the effort to chart a new course for health care delivery in the United States.

Here’s the other statistic that gave me pause: 74% of Boomer doctors retiring in the next 20 years are men.

Think that doesn’t require a complete rethink of how you recruit these docs?

The silent killer is patient access.   The less chance a patient has of being seen quickly, the worse off he or she will be.  Having an adequate supply of doctors is the basic ingredient of healthcare delivery.  And primary care doctors, who provide those front-line services, are getting even harder to find.

Here’s three reasons why you might be facing an uphill battle, wherever you are.

1. Supply is dwindling.

The AMA reports that nearly half of its members are 50 or older.   If you segment out primary care docs, the news gets worse.   Medical schools are graduating an increasing rate of some specialists, but primary-care graduate rates are falling as medical school becomes an increasingly costly investment.   In the wake of the Patriot Act and the falling value of the dollar, there’s also the fact that more international students are going back home instead of staying put.   (Thomas Friedman calls this the “reverse brain drain” in his book, The World is Flat.)

2. Demand is growing. 

The US population continues to a) grow and b) require more healthcare.   From an economic point of view, there’s no reason to think demand will curtail any time soon.  In fact, hospitals are seeking to drive more care to newly created Centers of Excellence to address complex diseases and conditions.  As more people demand more care from more providers, the rate of demand increases in both directions: hospitals need more doctors to improve patient access as well as treatment.  A client recently told me that a few treatment positions added to ease the strain on the existing physicians were now completely swamped with diagnostic visits.

3. Increasing alternatives to traditional practice models.

While graduating physicians can choose to start or join a traditional practice, there are a variety of other avenues as a result of the changing demands of new docs.  Whether hospitalist positions, physician-run speciality practices, locum tenens assignments, or roles within bio-tech companies, these options often provide fewer hours and more work/life balance than the classic physician practice model.  (Example: many hospitals around the country are now paying for “on call” services.)  Considering that 50% of the med school population are now women, these options will increase, primarily clustered around delivering less hours and less stress.

What’s the solution?

More on that later this week, but we’ll give you a hint: it has something to do with our upcoming webinar.

As I grew up in the rust-belt of Upstate New York, I am well aware of the level of quality of RPI’s educational programs and I’m sure this foray into healthcare has been well thought out. (Except, perhaps, for not inviting us to speak…)

It’s going to occur on both coasts, which means you’re at most 1,500 miles away. If you’re tired of the usual suspects of speakers at conferences, RPI is working hard to bring some different voices to the table.

Below is the info, should you be interested.

• Marriott, Newport, Rhode Island
  Tuesday-Wednesday, May 13-14, 2008
• Hyatt Fisherman’s Wharf, San Francisco, California
  Thursday-Friday, May 22-23, 2008

Healthcare is facing crises on a number of fronts, from changing demographics to payers’ cuts and a shift toward “Retailization.”

Rensselaer Polytechnic Institute, one of America’s foremost technology universities brings its thought leadership to this critical topic.

Electronic communication with your audience in the most customized way possible for the smallest, measurable segment possible.

Why does this matter for healthcare?

Because if you’re like any of our clients, you have some programs you have to grow, some you don’t want to grow, and some you could only grow by a handful of patients… or doctors for that matter. The scaling problems of healthcare, as a business, are related to cost of delivery. Adding another patient could cost you nothing… or make you unprofitable.

Most healthcare websites are only spoken of in terms of the past -- pageviews, visitors, the bizarrely misnamed “hits” — but measuring the past is only a start.

Most healthcare marketers have a far better handle of offline demographics than online, but only because the people who sold you the media told you so!

The good news is that it’s entirely possible to get a grip on your online audience. What you should be after is a working theory that can be tested and validated over time.

The key is to be curious and challenge assumptions whenever possible. More about that, next post.

Or read about it on his blog — running a hospital. (See link at right.) The main link today is to a Boston Globe editorial about infection rates.