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We’ve done a fair amount of research this year on the impact of the physician shortage and how it will hamstring the marketing, planning, and delivery of healthcare services in the future.

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.

Forbes magazine’s recent issue has a cover with a patient escaping from an ER, wearing only a paper johnny, and the text “Stop That Patient!  Big, risky hospitals don’t want you going to small rivals — where you could have safer, better surgery.”  You can read the article, entitled “Bad Medicine“, on Forbes’ website, but the message to me is clear: consumers want to understand the quality of care they can expect to receive before they check in.

I’ll admit to only a cursory understanding of the issues surrounding these physician-run hospitals and the legal implications of referring your own patients to a facility you have an economic stake in.  (Despite protests that such a conflict of interests can lead to unnecessary surgeries, one of the physician-run opponents, HCA, has itself been sued over excessive and unnecessary surgeries resulting from direct compensation plans to physicians under its employ.)

A growing trend we’ve been seeing for years is the need for consumers to understand their healthcare choices, options, and risks.  One of the top reasons that consumers visit hospital websites, according to a 2006 Forester survey, is to research hospital care and quality.  A shockingly small amount of hospitals provide any kind of this information, even spawning a sub-industry as a proxy for quality results — healthcare institutions pay large fees to HealthGrades for the analysis, reporting, and ranking of their hospitals on the numerous lists HealthGrades produce.

And the free market is rushing to fill the gap.  In addition to hospitals licensing HealthGrades results or paying for consumer-satisfaction surveys from Press Ganey, sites like NetDoc or Revolution Health are attempting to make sense of the confusing data surrounding patient outcomes to help consumers make decisions.

But the last line of the Forbes article really caught me and I’ll leave you with it here.   Forbes gives the parting shot in the argument to hand surgeon Blake Curd.  As a summation of why docs should be able to own hospitals, Blake throws down the gauntlet:  “Physicians innovate in health care,” he says.  “Hospital administrators do not.”