By: Harris Eyre, MBBS, Visiting Australian Fulbright Scholar, University of California, Los Angeles, and Global Ties Fellow

The commentary by Dr. Des Gorman¹ provides an exciting health care intelligence model for the 21st century—a method to negate the characteristic health workforce “feast or famine” cycle, which occurs all too often in workforce planning. This method involves a number of key factors. The New Zealand health system only utilizes quality and cost-effective innovations; plans workforce based on a sequential hierarchy; plans services on service aggregates; endorses generalism in health workforce to “future proof” the workforce; and provides regular snapshots of workforce forecasting.

From a medical practitioner workforce perspective, the New Zealand model may assist with a particular growing concern. I am personally worried, as are many of my colleagues, that workforce planning isn’t taking into account the significant increase in the non-clinical engagement of doctors around the world, particularly in the U.S. Non-clinical engagement includes activities not directly related to frontline patient care, such as research, public health, education, leadership, engineering, management consulting, finance, biotechnology, entrepreneurship, politics and government, etc.

Here are some examples to illustrate these concerns in the U.S. First, doctors’ non-clinical interests are growing. A 2007 study of more than 108,000 US MD graduates identified a drop in the percentage of graduates planning to pursue full-time clinical practice (51% in 1997 to 47% in 2004).² This study hasn’t been replicated in recent years, but I expect it would reveal a greater drop in interest in full-time clinical practice. Second, alternative career organizations are increasingly common. The Society of Physician Entrepreneurs, a social network for doctors and other health-related professionals to explore bio-innovation and entrepreneurial activities, is proving to be very popular. They have 17,000 members in the U.S. alone. Likewise, the Drop Out Club is gaining popularity among doctors who look to leave medicine. Third, non-clinically relevant university courses appear to be increasing in popularity. For example, the number of universities offering dual MD/MBA courses increased fivefold in the U.S. between 1990 and 2010.³ These offerings have a significant effect on the clinical-to-non-clinical mix of doctors. A recent study of physician graduates from the Wharton School MBA Program at the University of Pennsylvania found that only 46% of 247 graduates considered clinical practice as their primary work sector 10 years after graduation.³ Fourth, the number of US doctors who reported burnout in Medscape’s large-scale Physician Lifestyle Report has increased from 40% in 2013 to 46% in 2015.⁴ This high rate of burnout, specifically among US doctors, may be causing them to leave clinical practice, although this has not been proven with data.

Despite all these changes, US workforce projections incorporate little to no data on the current and future non-clinical engagement and interests of doctors. For example, the AAMC’s Physician Supply and Demand Model does not currently account for such non-clinical activities and their impact on clinical work.⁵ The same is true for workforce projections in many major developed countries. The health care intelligence model from New Zealand then is novel in providing regular, accurate data and frameworks to “future proof” the New Zealand health workforce. This model seems useful, yet it requires more research and analysis, such as a consideration of the non-clinical engagement of doctors both now and into the future. The U.S. and other developed countries should pay close attention to this health care intelligence model as a guide for managing workforce issues in an uncertain future.

References

1. Gorman D. Developing health care workforces for uncertain futures. Acad Med. [published online ahead of print January 20, 2015]. 2015;90.
2. Jeffe DB, Andriole DA, Hageman HL, Whelan AJ. The changing paradigm of contemporary U.S. allopathic medical school graduates’ career paths: analysis of the 1997-2004 national AAMC Graduation Questionnaire database. Acad Med. 2007;82:888-894.
3. Patel MS, Arora V, Patel MS, Kinney JM, Pauly MV, Asch DA. The role of MD and MBA training in the professional development of a physician: a survey of 30 years of graduates from the Wharton Health Care Management Program. Acad Med. 2014;89:1282-1286.
4. Peckham C. Medscape Physician Lifestyle Report 2015. 2015. Available at: http://www.medscape.com/features/slideshow/lifestyle/2015/public/overview. Accessed February 6, 2015.
5. Dill MJ, Salsberg ES. The Complexities of Physician Supply and Demand: Projections Through 2025. Washington, DC: Association of American Medical Colleges; 2008.

Editor’s Note: This New Conversations blog post is part of the journal’s ongoing conversation on the present and future impacts of current health care reform efforts on medical education, health care delivery, and research at academic health centers, and the effects such reforms might have on the overall health of communities. To read other New Conversations pieces and to contribute, browse the New Conversations collection on our website, follow the discussion on AM Rounds and Twitter (@AcadMedJournal using #AcMedConversations), and submit manuscripts using the article type “New Conversations” (see Dr. Sklar’s January 2015 editorial for submission instructions and for more information about this feature).