Health care providers said they feel undervalued and unsatisfied with the current health care system, and many are considering leaving the workforce, according to Elsevier Health’s first “Clinician of the Future” report.

Hemalee Patel, DO, DipABLM, who participated in the report, said that considerable changes are needed over the next decade to better support clinicians.

“This report reveals a call to action and sense of urgency to meet the demands of a changing workforce and consumer needs,” Patel, the senior medical director of chronic care management and clinical design lab at One Medical in San Francisco, told Healio. “The report also highlights the gaps that exist in medical training and within health care, showing that we need policymakers, health care leaders and others to really think through how we will close those gaps.”

Overall, “we in the health care profession are at a pivotal moment in time,” Patel added.

The report includes survey results from clinicians around the world. Elsevier Health conducted three phases of research:

• phase 1: 60-minute interviews with 23 clinicians conducted between Aug. 24, 2021, and Sept. 10, 2021;
• phase 2: 15-minute online quantitative surveys of 2,838 clinicians conducted between Oct. 21, 2021, and Dec. 9, 2021; and
• phase 3: three virtual roundtable discussions with four key opinion leaders (KOLs) in China on Nov. 22, 2021, four KOLs in the U.K. on Dec. 7, 2021, and five KOLs in the U.S. on Jan. 12.

Participating clinicians were asked to identify and discuss their roles in health care, drivers of change in the field and trends that are likely to affect the future of the industry. Results from the three phases were compiled as insights into the current and future state of health care.

Workforce changes

One in three clinicians are considering leaving their current role by 2024, according to the report. Also, 71% of physicians and 68% of nurses believe their jobs have changed considerably in the past 10 years, and a majority of clinicians in the U.S. (71%) and the U.K. (66%) believe that their roles in health care have changed for the worse. Nearly all clinicians (97%) agreed that the pandemic has been a key driver of change.

“The pandemic exaggerated preexisting health inequities,” Leo Anthony Celi, MD, MS, MPH, the clinical research director and principal research scientist for the laboratory of computational physiology at MIT and an attending physician specialist at Beth Israel Deaconess Medical Center, told Healio. “It also heightened a cultural war that found clinicians and public health practitioners front and center of anti-science/anti-establishment sentiments. Morale is at its all-time low at the frontlines of care for a number of reasons. We’re approaching 1 million U.S. deaths, but the numbers can’t capture how these deaths occur: alone.”

Leo Anthony Celi

High burnout rates, shorter tenures and increased demand of clinicians to care for an aging population has put the industry on track towards a critical workforce shortage, according to Celi. Based on the report’s findings, workforce shortages are widely expected, with 74% of respondents predicting a shortage of nurses and 68% predicting a shortage of physicians in 10 years.

Many clinicians reported feelings of burnout. Only 57% believed they have a good work-life balance and 26% agreed that well-being support is a priority. Globally, 29% of clinicians said that they work more now than they did 5 years ago.

Celi and Patel also emphasized the need for changes to medical training.

Training must be adopted in parallel to both trainees and the trainers, according to Patel.

“If young doctors are being trained by senior clinicians who are not using the technology themselves in practice, the gap will only widen,” she said.

Moreover, medical knowledge should be more easily accessed and shared, according to Celi.

“Currently, the knowledge system is heavily guarded and maintained by an elite group of academics, but that needs to be revamped and will require some fundamental redesign in how we train clinicians to integrate data science into the curriculum,” he said.

Patient care

Only 51% of clinicians reported that the amount of time they are able to spend with patients is sufficient to provide good care.

The survey results also revealed gaps in care, as clinicians are only able to treat patients who present to them. Nearly half of all participating clinicians (49%) expect that the majority of health care will be provided in a patient’s home instead of a health care setting in the next 10 years. This belief was more often held by clinicians in China than those in the U.S. (61% vs. 33%). Most (87%) clinicians reported that health care information for patients already needs improvement.

Clinicians anticipated an emphasis on preventive health care in future years, with 79% of respondents reporting that not enough is currently being done in way of preventive care. In fact, 68% of clinicians agreed that there is too much focus on cost rather than care, with particularly high agreement in the U.S. (83%), France (83%) and Germany (92%). In addition, 93% of clinicians identified aging and the aging population as key drivers of change in future years, and 72% of clinicians said there will be an increase in comorbidities among younger patients. Nearly all clinicians (94%) reported noncommunicable diseases as key drivers of change in the industry as well.

Technology

Regarding the future role of technology in health care, 88% of clinicians agreed that tech-savviness will be more important in a clinician’s daily work compared with 10 years ago. However, 69% of clinicians also said that digital health technologies are a challenging burden and 64% believe it will exacerbate health inequalities. Eighty-one percent of clinicians identified health inequity as a driver of change in health care. Many clinicians (51%) said that telehealth will negatively impact their ability to demonstrate empathy with patients and expect that patients will be less likely to need in-person care (45%). According to the report, 69% of clinicians are currently dealing with an overwhelming load of patient data.

“Given the rapid pace that technology is entering all aspects of clinical practice, it’s not surprising that 69% of clinicians feel overwhelmed by data and that digital health applications will be a challenging burden for them in the future. I see this daily in my own clinical practice and amongst my colleagues of all ages,” Patel said. “What I find encouraging is what I have experienced firsthand, which is how the evolution of health technology is allowing me to step away from the desktop and giving me back time to spend with my patients. User adoption and applicability is something we need to focus on, and it will be critical in allowing all clinicians to feel empowered to better care for themselves and their patients.”

Thomas (Tate) Erlinger, MD, MPH, the vice president of clinical analytics at Elsevier Health, said the health care industry has a responsibility to act on the report’s findings.

“Now is the time for bold thinking — to serve providers and patients today and tomorrow,” he said in a press release. “We need to find ways to give clinicians the enhanced skills and resources they need to better support and care for patients in the future. And we need to fill in gaps today, to stop the drain on health care workers to ensure a strong system in the next decade and beyond.”

References:

Clinician of the future report 2022. https://www.elsevier.com/connect/clinician-of-the-future. Published March 15, 2022. Accessed March 15, 2022.

Doctors and nurses worldwide point to roadmap to future-proof healthcare. https://www.elsevier.com/about/press-releases/corporate/doctors-and-nurses-worldwide-point-to-roadmap-to-future-proof-healthcare. Published March 15, 2022. Accessed March 15, 2022.

PERSPECTIVE

BACK TO TOP 

Margot Savoy, MD, MPH, FAAFP

I am struck that in a discussion about the clinician of the future there was no family physician noted in the U.S. roundtable, and yet the report ultimately lands on the conclusion we have known for decades. The clinician of the future, as described in the report, is literally a family physician practicing in a sustainably funded patient-centered medical home.

The medical home was coined in 1967 by the American Academy of Pediatrics, expanded by WHO in 1978, and embraced by the Institute of Medicine since the 1990s. In 2004, the American Academy of Family Physicians applied the model to family medicine, linking it to proposed primary care payment models which would empower patients, improve health and lower health care costs. A few years later, the major primary care organizations came together to publish the joint principles of the patient-centered medical home, which includes a personal physician, physician-directed medical practice, whole person orientation, care that is coordinated and/or integrated, quality and safety are hallmarks and the availability of enhanced access, all made sustainable through proper payment for primary care services.

To have any hope of moving forward improving health care, we must stop wasting time re-examining the wheel and start investing in the already established best practices. I agree with many of the recommendations outlined in the report. Physicians should be partnering with patients and communities to deliver preventive and restorative care. We should be leveraging technology to optimize efficiency and expand access to care. Our physician-led team should be a collaborative, multidisciplinary team engaging each team member at the top of their skill set while respecting clinician well-being. Health equity, empowering our patients, and advocating on behalf of our communities should be skills as accessible as auscultating a heart or palpating an abdomen. Fortunately, we are already training our current and future family physicians to do these things and more. Now if only primary care could be sustainably paid so we can continue to deliver comprehensive care without burning out ourselves and our teams — that would be a future we could all look forward to.

Margot Savoy, MD, MPH, FAAFP

Senior vice president for education, American Academy of Family Physicians

Adjunct associate professor of family and community medicine

Adjunct associate professor of urban bioethics and population health

Lewis Katz School of Medicine at Temple University

Healio Primary Care Peer Perspective Board member