The downward pressure on the overall system from the shrinking provider networks and decreases in physician reimbursement may also contribute to proliferation of bills to secure additional scope expansion for non-physician personnel in a race for "savings". We have repeatedly voiced concerns over the severity of the Medicare cuts associated with this year’s Medicare Physician Fee Schedule because, combined with the impact of high inflation, the impact is felt locally in many of the states. As physicians are forced to adjust to the new realities, many may leave the field (either through retirement or career adjustment), practices may be closed or sold, and a significant number of patients could lose access to a variety of physician specialties in their local communities. Sweeping expansion of scope for non-physicians is not a cure-all remedy within a healthcare system that is arguably ready to fracture in so many different directions because quality clinical performance hinges first and foremost on quality education and experience that can only be provided by physician team leaders.

HCB News: Can you think of other avenues policymakers could take to address the problem they are trying to solve?
EB: It depends on how policymakers define the problem — is it global/local/long-term or an immediate issue that needs to be resolved quickly. Some avenues that policymakers could look at:
Cost of medical education in the U.S.
Increasing the number of radiology residency program slots.
Telemedicine — radiology has some of the best use of telemedicine.
Look at the state climate and why they might be struggling to attract physicians — are there issues like medical liability reform, prior authorization bureaucracy, shrinking competition among insurers in a specific market, or a drawn-out licensure process?

HCB News: For facilities struggling with physician shortages, are there any non-legislative resources or solutions they should be tapping into?
EB: In broad terms, the states where hospitals/facilities and physicians work in concert toward a comprehensive healthcare reform see the most success. For example, we know that all physicians shoulder exhaustive hours of administrative burden due to ineffectiveness of a prior authorization system that seemingly exists to delay and deter use of services. Facilities have a large role to play in advocating for reductions of administrative bureaucracies for by lending their voice to the discussions in state capitols.


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