What will the U.S. health care industry look and feel like in 2023?

If you want to call the U.S. health care a “system” today, what will that “system” look like in the year 2030, and how will it handle the health care needs of an older, sicker population?

With nearly everyone calling for system change and reform, including “burn it to the ground” and more, let’s look at the demographics of the U.S. physician workforce and imagine health care in 2030.

Here’s my crystal ball. What does yours look like?

What we know today

Workforce demographics. 47% of U.S. physicians are age 55 and over (~400,000 doctors in their prime). How many will retire between now and 2030, taking their decades of clinical wisdom and work capacity offline?

There is an estimated U.S. shortage of 139,160 physicians by 2030.

With a projected shortage of 200,000 to 450,000 nurses in 2030—roughly 10% to 20% of the nurses required to provide all patient care.

Women comprise over 53.8% of medical school students in 2022, yet 40% of female doctors go part-time or quit within six years of leaving residency.

In dozens of similar conversations, CMOs across the country have told me that it takes a minimum of two recent residency graduates to replace the quality and productivity of a single retiring boomer doctor.

Workforce readiness. The current physician workforce has a 62.8% burnout prevalence.

Every study of physician performance and burnout has found that “suffering from at least one symptom of burnout” leads to a pervasive negative effect on multiple metrics of physician performance and wellbeing.

Burnout is linked to lower care quality, safety, patient outcomes, patient satisfaction, and staff satisfaction and engagement, and higher medical error rates and malpractice risk.

Burnout is linked to higher rates of depression, alcohol and drug addiction, and suicide for the burn out physician (or any other burnout care team member).

Conversations with multiple CMOs have identified an additional burden for newly graduated doctors: current resident work-hour restrictions mean new graduates have 1/3 fewer hours of patient care experience than their boomer colleagues. This creates an acute need for an extended onboarding program to bring them up to speed with the existing doctors on the rotation. The first employer has been tasked with completing the medical education of the new hires.

Industry mergers and acquisitions. Health care services are now being offered directly by entities such as Walmart, CVS, Amazon, and more—entities that know little about caring for patients or employing physicians.

The care delivery focus is more on quick profits, convenience, and the absence of the need for human contact.

Private equity is very active in the health care industry due to the size of the marketplace. In 2021, health care spending reached $4.3 trillion, $12,914 per U.S. citizen, and 18.3% of GDP.

PE business models always focus on maximizing profits in all care delivery and payment aspects rather than patient care quality or provider and staff wellbeing.

Wildcard = AI. AI surrounds us with pervasive claims of benefits for doctors and patients. It is impossible to clearly understand how it will transform the provider or patient experience – just that it will be BIG. It is already BIG, and who knows what will happen when AI starts to train future generations of AI, eliminating human input along the way.

Where do we go from here?

I am certain the vast majority of physician employers will drive right off that cliff, forcing you to see as many people as possible for as much money as possible for as long as possible before it all comes crashing to the ground. And one day, you will show up for work, and the doors will be locked.

I believe the “system change” comes through the collapse of the existing entities and business models that are focused only on volume. The collapse comes in the loss of one service at a time—rapidly and randomly across the nation. Rural and other underserved populations are hit first and hardest.

When the last boomer OB/GYN at a smaller, rural hospital retires, the OB/GYN service at that rural hospital closes its doors and lets go of all the workers. It will seem sudden—an overnight shock and surprise. In reality, it has been obvious for years to the leadership team of that hospital. The service is absorbed by the academic practice 90 miles down the road. The local patients and the local economy suffer a permanent loss.

Services collapse one by one until the mother ship entity collapses or is absorbed by a larger or more stable entity.

I don’t know what rises in the place of the services of today for two reasons:

We don’t know how AI, the robot doctor remote monitoring, and the rest of the Tech Healthcare Fever Dream will replace physicians and nurses.

And we don’t know how low the average citizen’s health care service expectations will drop. Will 2030 patients feel that if they send a text message to their virtual provider within 5 minutes of the onset of their runny nose, the ideal scenario is Augmentin dropped on their front porch that day by a drone from the nearest Walmart? Is that what will be judged to be a 5-star service in 2030?

The organizations that survive the collapse will all have one thing in common:

These survivor organizations either have a meaningful physician wellness strategy in place now or will install one in 2024.

All organizations will need a massive increase in the ability to offer coordinated team-based care across multiple in-person and virtually settings.

Your leaders will need to stay on top of all the latest tech and AI/machine learning best practices as they are recognized—and implement them quickly.

And your leadership must understand that all of this is built upon a foundation of physician and staff wellbeing ensured by an effective wellness strategy.

Questions

Is your leadership team talking to you about 2030?

What is their vision and their action plan?

When you look around the room at your next medical staff meeting, how many of those physicians will not be here in 2030, and what impact will that have on your practice?

Dike Drummond is a Mayo-trained family practice physician, burnout survivor, executive coach, consultant, and founder of TheHappyMD.com. He teaches simple methods to help individual physicians and organizations recognize and prevent physician burnout. These tools were discovered and tested through Dr. Drummond’s 3,000+ hours of physician coaching experience. Since 2010, he has also delivered physician wellness training to over 40,000 doctors on behalf of 175 corporate and association clients on four continents. His current work is focused on the 7 Habits of Physician Wellbeing. Dr. Drummond has also trained 250 Physician Wellness Champions, and his Quadruple Aim Blueprint Corporate Physician Wellness Strategy is designed to launch all five components in a single onsite day. He can also be reached on Facebook, X @dikedrummond, and on his podcast, Physicians on Purpose.