EPtalk by Dr. Jayne 5/1/25

A hot topic around the virtual physician lounge this week was the potential for an impending staffing crisis. It’s not the nursing crisis that everyone talks about, however. Instead, it is the risk that we’ll see a bulk retirement of physicians in their late 50s and early 60s who are tired of fighting the system.

These are the folks who have watched medicine completely transform. They’ve witnessed the rise of Health Maintenance Organizations in the 1990s, the creation of Evaluation and Management codes, HIPAA, and more. They bore the brunt of early EHR transitions that may not have been smooth or well orchestrated, and some of them may have gone through two or three EHRs before arriving where they are today. They’ve dealt with increasing prior authorization requirements, aggressive case management and utilization review, and patients who are constantly challenging their knowledge.

With their departure goes quite a bit of collective knowledge, along with many years of learning related to the art of practicing medicine. These physicians are of the generation that were trained that touching the patient is essential and that it can perform a healing function as well as a diagnostic one. Many of them have diagnostic skills far beyond that of newly minted physicians. They also have a “Spidey sense” that they’ve honed over decades of practice. Some organizations have recognized this and put together plans that allow physicians to retire gradually so that the impacts of their departures are more subtle.

One of my favorite colleagues has a desire to retire early. She approached her health system with a plan to transition out of full-time primary care over the next two years. It can take a while to recruit a new primary care physician, and although she is only legally required to give them a 90-day notice, the lengthier notice was intended as a bargaining chip. In exchange for that, she requested the ability to continue to purchase health insurance coverage through the health system while working half time during the latter part of her proposed transition. They typically only allow workers to participate in the plan if they work at least 36 hours per week.

Although the physician leaders of her medical group were supportive, the plan was immediately scuttled by attorneys who were unwilling to even consider evaluating the modifications that would be needed to meet her requirements. 

Her practice is already understaffed by at least one, possibly two, full-time physicians. Recruiting has been difficult because of its location and challenging payer mix. The idea that the organization would risk her walking away rather than taking a structured approach to a long goodbye seems short sighted. There has been an open posting for a primary care physician for over 18 months, which is evidence of the challenge they’re going to face should she decide to leave.

During our quarterly physician lunch today, she confirmed her decision. She will be putting in her notice to depart the organization in August. It will be interesting to see if they counter with a retention offer or if they just let her go. We all agreed that it’s something that health systems need to start figuring out, because none of us is getting any younger and AI solutions aren’t going to replace us anytime soon.

The American Telemedicine Association is holding its annual Nexus conference in New Orleans this year, running from May 3-6. ATA is showcasing its Center of Digital Excellence (CODE) that includes provider-side member organizations such as Mayo Clinic, Stanford Health Care, UPMC, Sanford Health, MedStar Health, Ochsner, Intermountain Health, OSF HealthCare, and WVU Medicine Children’s. Solution-side members include AvaSure and Access TeleCare.

For those of us who were working in the telehealth space before COVID, it felt like we were making things up as we went along because there were no solid playbooks for various telehealth use cases. CODE pulls together organizations that are willing to share their successes, create implementation toolkits, and lobby together to promote the value of telehealth in the overall healthcare ecosystem. I’ve attended the conference in the past and found it valuable as far as bringing back a number of practical insights. Unfortunately, this year’s schedule puts it on top of a graduation weekend for one of my favorite students, so I’ll have to miss it.

I was interested to see this article in JAMA Network Open, “Cumulative Burden of Digital Health Technologies for Patients With Multimorbidity.” The authors specifically set out to answer the question, “What digital health technologies (DHTs) are available for patients with multimorbidity and how many individual DHTs would a hypothetical patient need to benefit?” They defined multimorbidity as a patient with five chronic conditions — type 2 diabetes, hypertension, chronic obstructive pulmonary disease, osteoporosis, and osteoarthritis.

They looked at 148 DHTs that had been approved by the US Food and Drug Administration or that had been vetted by the Organization for the Review of Care and Health Apps. They found that only five of the DHTs were intended to help monitor, treat, and/or manage two or more conditions. Some only offered a subset of features, such as recording or tracking health data, where others offered information or real-time interventions. Given the tools on the market, the patient in the hypothetical scenario would need prescriptions for as many as 13 apps and seven devices to provide the benefits that at least three of five clinicians felt were important. 

When I was in a traditional primary care practice, many of the patients I saw had multiple chronic conditions, with the most common combination being hypertension, obesity, and hyperlipidemia. A subset of those patients also had diabetes. All of those can benefit from lifestyle changes and several of them impact each other, so it would make sense to create one app to rule them all as it were.

I’m sure there are challenges with the FDA approval process in trying to get a submission approved for multiple health conditions, but I wonder if it is easier in other countries that have a more holistic approach to health. I’d be interested to hear from readers who may be more involved in the creation and use of DHTs.

Would you use a DHT that was proven to improve your own health condition? Leave a comment or email me.

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