Attract Residents to Underserved Areas
For medical school graduates who are ready to go but lack a residency spot, Arkansas, Kansas, Missouri and Utah have passed legislation to provide provisional licenses to some of these medical school graduates who have not been able to find a residency spot. However, there’s a condition. "With these provisional licenses they can practice primary care under the medical license of another physician, but it has to be in a medically underserved area," Farr explains. He calls this "one of the most creative solutions that I've heard. It's addressing an untapped pool of candidates."
Midwestern states may also start to fall in line with this approach, says Dave Lenihan, PhD, JD, President of Ponce Health Science University in Puerto Rico, and President and CEO of Tiber Health, a medical education company developing new curriculum and analytics strategies. However, he feels that adding incentive for newly graduated physicians to take residencies in underserved parts of the country requires reducing the cost of medical education.
"If we want to put new physicians in rural America, we can't have students with a quarter million dollars in debt," Lenihan says.
One solution he proposes is to change the way medical education is delivered, thus reducing its cost, as they do at Tiber.
The cost of a new medical school can range between $150 to over $600 million in development costs. This includes building and curriculum design. When a new campus is opened, a significant amount of money goes towards curriculum development, he explains. “Tiber uses a standardized curriculum so that the costs of development are minimal. The cost of the faculty is spread across many more students. Because the curriculum is already developed with world-class faculty and approved to a Gold Standard, the proposed new school can open in a significantly reduced period of time.”
At Ponce they also offer a "flipped classroom" approach — in which students listen to their lectures offline, out of the classroom, and use class time to go over clinical cases. "You don't need all that brick and mortar —that's not what's required to train these future doctors."
Embracing Physician Extenders
One of the quicker solutions to get more patients served may be to train more physician assistants (PAs). There are already nearly 90,000 practicing PAs in the US, according to the Kaiser Family Foundation. PAs are not required to do three to seven years of residency training; they only require a one year rotation, which could make them available to the workforce quicker than physicians.
Physician extenders "can help one physician care for more than one patient at a time," says Karen Sibert, MD, President of the California Society of Anesthesiologists and a professor at UCLA. In her field, physician anesthesiologists rely on the support of advanced practice practitioners and assistants — either certified registered nurse anesthetists (CRNA) or certified anesthesiologist assistants (CAA). "They are exactly analogous to what PAs are for a primary doctor or surgeon," she explains. They are trained in a medical, not nursing, model, and work directly under the supervision of physician anesthesiologists. The CAAs, she says, "provide an opportunity for the physician anesthesiologist to focus on emergencies and saving lives, and not some of the lower level tasks such as initial screening and paperwork."
This speaks to many physician frustrations with doing work that doesn't make the best use of their talents. "There are days where, here I am with a lot of experience and higher education, and I'm pushing a stretcher down the hall for lack of somebody else to do it," Sibert says. She does not consider herself above the work, but says "it's really not an effective use of society's resources."