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Q&A with Richard Biehl; The challenges facing health care systems engineers

June 23, 2017
From the June 2017 issue of HealthCare Business News magazine

HCB News: Why are we facing a doctor shortage and how can we prepare for this growing crisis?
RB: The problem of doctor supply is very complex and has many dimensions. The number of new doctors entering the field is limited by the capacity of our medical schools. Of those entering practice, many choose to work in geographic locations or clinical specialties that don’t address the actual patient demand curves adequately. Many doctors leave the field because of economic pressures, liability concerns or simply the pursuit of more advantageous opportunities. Many doctors are baby boomers who will simply reach retirement over the next decade. All of these factors combine to cause the supply of doctors not to keep up with the ever-growing demand for care.

There are many opportunities to address this problem at the system level. Policy changes can reduce some of the burdens of being a doctor and cause more to stay in practice. Incentives can be designed to shift some practices to higher-demand specialties in underserved geographic areas. We can make it easier for immigrants to obtain medical licenses in states. These options represent system tinkering that can have a short- or medium-term effect, but won’t fix the problem long-term.

University of Central Florida

Systemically, we’re already addressing the problem in several ways. First, we’re rethinking the provision of care so that more of it can be provided by professionals not traditionally seen as doctors. This is one reason we use the term provider rather than physician (or doctor), because increasingly the person providing care isn’t a physician. This spreading of care across a broader sector that includes stakeholders outside of hospitals and physician practices dramatically increases the system’s capacity even though the number of doctors is declining.

Additionally, we’re working to engineer out waste. Unnecessary procedures take up valuable capacity without improving health outcomes. Reapplying that capacity can increase the yield of our system with the same supply. Ultimately, we make health information more broadly available so that patients make better life choices, further reducing the demand on doctors to provide care. A patient developing a disease that could have been prevented is even more wasteful to our system than a doctor ordering an extra blood test. Waste of any kind reduces useful capacity, and systems engineering looks at all of these dimensions.

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