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AMA updates cover a range of healthcare topics that impact the lives of physicians, residents, medical students and patients. Hear from medical experts, from private practice and health system leaders to scientists and public health officials, on COVID-19, medical education, advocacy, burnout, vaccines and more.
In today’s AMA News, former AMA President Gerald Harmon, MD, joins the discussion of the medical workforce shortage and the value of older physicians. Dr. Harmon shares his thoughts on his new role as interim dean of the University of South Carolina School of Medicine in Columbia, his work as vice president of medical affairs at Tidelands Health in Pawleys Island, South Carolina, and what it takes to navigate the medical field. field as a doctor. Tips on how to stay active. Doctors over 65 years of age. Host: AMA Chief Experience Officer Todd Unger.
After fighting for doctors during the pandemic, the American Medical Association is taking on its next unusual challenge: reaffirming the nation’s commitment to doctors.
Unger: Hello and welcome to the updated AMA video and podcast. Today we are talking about the workforce shortage and the importance of older doctors in solving this problem. This issue is discussed here by Dr. Gerald Harmon, interim dean of the University of South Carolina School of Medicine in Columbia, South Carolina, and former AMA president, or in his own words, “the reinstated AMA president.” I’m Todd Unger, Chief Experience Officer of AMA Chicago. Dr. Harmon, nice to meet you. How are you doing?
Dr. Harmon: Todd, that’s an interesting question. In addition to my role as AMA Recovery Chair, I have found a new role. Just this month, I began a new role in my career as Chief Health System Scientist and Interim Dean of the School of Medicine at the University of South Carolina in Columbia, South Carolina.
Dr. Harmon: Well, that’s big news. It was an unexpected career change for me. Someone contacted me about their qualifications and expectations. I feel like for me this is a match made in heaven, if not a match made in heaven then at least among the stars.
Unger: Well, I’m sure when they looked at your resume, they were impressed with some of your accomplishments. You have been a practicing family physician for 35 years, Assistant Surgeon General of the United States Air Force, Surgeon General of the National Guard, and, of course, most recently, President of the AMA. That’s not even half the battle. You’ve certainly earned the right to retire, but you’re starting a whole new chapter. What causes this?
Dr. Harmon: I think it was me realizing that I still have the opportunity to share my life experiences with others. The word “doctor” comes from Latin and means “to carry or teach.” I truly feel that I can still teach, share my life experiences, and provide education and guidance (if not guidance) to a generation of physicians in training and even practicing physicians. So it was too good to be true to take on a research assistant role while maintaining my clinical teaching capabilities. So I really couldn’t turn down this opportunity.
Dr. Harmon: Well, the role of provost is something I’ve never experienced before. I was a college professor and taught classes (literally taught) in person rather than giving grades and written evaluations to students, residents, and other healthcare professionals (nurses, radiologists, sonographers, physician assistants). For most of my 35-40 years of practice, I was a teacher, a practical teacher. So this role is not alien.
The appeal of academia cannot be underestimated. I’m learning – I’m using this analogy not with a fire hose, but with bucket brigades. I ask people to teach me one piece of information at a time. So one department brings their bucket, another department brings their bucket, the manager brings their bucket. Then I took a bucket instead of being flooded with a fire hose and drowning. So I can control the data points a little bit. We’ll try another bucket next week.
Unger: Dr. Harmon, the terms on which you are opening a new chapter here are interesting. At the same time, we know that many doctors are choosing to retire early or accelerate due to the pandemic. Have you seen or heard this happen among your colleagues?
Dr. Harmon: I saw it last week, Todd, yes. We have mid-pandemic data, probably the AMA’s 2021-2022 data survey, which shows that 20%, or one in five physicians, said they would retire. They will retire within the next 24 months. We see this among other healthcare professionals, especially nurses. 40% of nurses (two in five) said I would be leaving my clinical nursing role within the next two years.
So yeah, like I said, I saw this last week. I had a mid-level doctor who announced his retirement. He is a surgeon, he is 60 years old. He said: I am leaving active practice. This pandemic has taught me to take things more seriously than my practice. I am in a good financial position. On the home front, he needs to spend more time with his family. So he decided to retire completely.
I have another good colleague in family medicine. In fact, his wife came to me a few months ago and said, “You know, this pandemic has put a lot of stress on our family.” I asked Dr. X, her husband, and a colleague in my practice to lower the dosage. Because he spends more time in the office. When he returned home, he sat at the computer and did all the computer work that he didn’t have time for. He was busy seeing a large number of patients. So he cuts back. He was under pressure from his family. He has five children.
All of this causes a lot of stress for many older physicians, but those in mid-career, age 50 and older, are at high risk for stress, just like our younger generations.
Unger: It at least complicates the physician shortage situation that we’re already seeing. In fact, a study by the Association of American Medical Colleges projects the physician shortage to be up to 124,000 by 2034, which includes a combination of the factors we just discussed, an aging population and an aging physician workforce.
As a former family medicine physician serving a large rural population, what are your thoughts on this?
Dr. Harmon: Todd, you’re right. The doctor shortage is getting worse exponentially, or at least logarithmically, not just by adding and subtracting. Doctors are getting old. We’re talking about the fact that in the next ten years, patients in the US will be 65 years of age or older, and 34% of them will now require medical care. Over the next decade, 42% to 45% of people will require medical care. They need more care. You mentioned the shortage of doctors. These older patients require a higher level of care, and many live in sparsely populated rural areas.
So as doctors age, retiring doesn’t leave behind a flood of doctors and health care workers who want to go to rural areas, who want to go to areas that are already underserved. Thus, the situation in rural areas will indeed worsen exponentially. It’s as if the patients in the area are aging and the population in rural areas is not growing. We are also not seeing an increase in the number of healthcare workers moving to these rural areas.
So we have to come up with innovative technologies, innovative ideas, telemedicine, team-based care to help meet the needs of underserved rural America.
Unger: The population is growing or aging, and doctors are also aging. This creates a significant gap. Can you just look at the raw data what that gap looks like?
Dr. Harmon: Let’s say the current physician base serves 280,000 patients. As the US population ages, it’s 34% now and 42% to 45% in ten years, so as you noted, I think those numbers are around 400,000 people. So this is a huge gap. In addition to the projected need for more doctors, you will also need more doctors to serve an aging population.
let me tell you. Not just doctors. This is a radiologist, this is a nurse, not to mention how nurses retire. Our hospital systems in rural America are overwhelmed: there are not enough sonographers, radiologists, and laboratory technicians. Every healthcare system in the United States is already stretched thin by a shortage of healthcare workers of all types.
Unger: Fixing or solving the physician shortage problem now clearly requires a multilateral solution. But let’s talk more specifically. How do you think older physicians fit into this solution? Why are they particularly suitable for caring for the elderly population?
Dr. Harmon: That’s interesting. I think there is no doubt that they will at least sympathize, if not empathize, with the patients who come. Just as we talk about Americans 65 and older making up 42% of the population, this demographic is also reflected in the physician workforce: 42–45% of physicians are also age 65. So they will have the same life experiences. They will be able to understand whether it is a musculoskeletal joint limitation, a cognitive or sensory-cognitive decline, or a hearing and vision limitation, or maybe even a comorbidity that we get as we age, heart disease. diabetes. .
We talked about how the podcast I did showed that about 90 million Americans have prediabetes, and 85 to 90 percent of them don’t even know they have diabetes. As a result, America’s aging population also bears the burden of chronic disease. When we get into the ranks of doctors, you will find that they are empathetic, but they also have life experience. They have a skill set. They know how to make a diagnosis.
Sometimes I like to think that doctors my age and I can think and even make diagnoses without certain technologies. We don’t have to think about the fact that if this person has a little problem with this or that organ system, I won’t necessarily do an MRI or a PET scan or any laboratory test. I can tell this rash is shingles. This is not contact dermatitis. But it’s only because I’ve been seeing patients for 35 or 40 years that I have a psychological index that helps me apply what I call real human intelligence, not artificial intelligence, to diagnosis.
So I don’t have to do all these tests. I can more effectively pre-diagnose, treat and reassure the aging population.
Unger: This is a great follow-up. I want to talk to you more about this issue regarding technology. You are an active member of the Senior Physician Division, expressing opinions and making recommendations on matters affecting senior physicians. One of the things that comes up a lot lately (in fact, I’ve been talking a lot about artificial intelligence in the last few weeks) is the question of how older doctors are going to adapt to new technologies. What suggestions do you have regarding this? How can the AMA help?
Dr. Harmon: Well, you’ve seen me before – I’ve spoken publicly at lectures and panels – we need to embrace this new technology. It won’t go away. What we see in artificial intelligence (the AMA uses this term and I agree more with it) is augmented intelligence. Because it will never completely replace this computer here. We have certain judgment and decision-making abilities that even the best machines cannot learn.
But we need to master this technology. We don’t need to delay his progress. We don’t need to delay using it. We don’t need to put off some electronic recordings that we talk about disparagingly. This is new technology. It won’t go away. This will improve the provision of care services. This will improve safety, reduce errors and, I think, improve diagnostic accuracy.
So doctors really need to accept this and monitor it. It’s a tool, just like anything else. It’s like using a stethoscope, using your eyes, touching and looking at people. It’s an enhancement to your skills, not a hindrance.
Unger: Dr. Harmon, last question. What other ways can doctors who decide they can no longer care for patients stay active in their careers? Why is it beneficial for doctors and the profession to maintain such a strong connection?
Dr. Harmon: Todd, everyone makes their own decisions in their own universe using their own data. So, while a physician might have questions about his or her competency, his or her safety, whether it’s in the operating room or in the outpatient setting where you’re just making a diagnosis, you’re not necessarily doing instrumentation or surgery. There is some normal fluctuation. We all need to worry about this.
First, if you are truly concerned, if you doubt your abilities, cognitive or physical, talk to a colleague. Don’t be embarrassed. We have the same problem with behavioral health. When I talk to physician groups, I know we talk about physician burnout. We talk about labor problems and how frustrated we are. Our data shows that over 40% of doctors were considering their career options—I mean, that’s a scary number.
Post time: Oct-13-2023