There aren't enough physicians. What's the solution?

The Frame

There’s a quiet revolution taking place in our healthcare delivery system. While debates about physician shortages and healthcare access are all over the news for literally years, we are overlooking a powerful solution hidden in plain sight. That solution?

Non-physician practitioners. And I’m not talking about nurse practitioners, physician associates/assistants, and clinical nurse specialists, a.k.a. “physician extenders,” who are the federally codified official “diagnosticians” of healthcare. The other “diagnosticians” include physicians plus podiatrists, dentists, and doctors of optometry (for these types, diagnoses are limited to their fields).

The codified definition of “practitioner” includes mental health practitioners, dieticians, and audiologists. But I argue that the definition should also include physical, occupational, and speech therapists, and as well as pharmacists.

My stance is our healthcare access crisis isn’t solely or perhaps even primarily about physician shortages. It’s also about how we’re failing to utilize the full spectrum of qualified professionals already in the system and available.

In this week’s (newly-formatted!) article, I am challenging the conventional thinking that physicians must be at the center of every healthcare interaction. I explore what might be possible if we reimagined healthcare delivery with the entire clinical workforce in mind.

Field Notes

The Pulse

1. Physical therapists in primary care provide early access, collaborative care management and improved outcomes. PTs integrated into primary care serve as frontline responders for musculoskeletal issues and functional impairment (acute and chronic). Embedding PTs into primary care teams enables their access to patients to intervene early, even on the same day a patient presents to the practice with pain and/or mobility concerns. It naturally reduces delays in care and can protect against avoidable progression of pain, an impairment or a condition, which helps curb costs avoid inappropriate and/or unnecessary, more invasive interventions and services (like advanced imaging).

2. Occupational therapists should be integral participants in value-based care model success. This is another missed opportunity, but it’s not too late! OT professionals focus on measurable functional outcomes that reduce hospital readmissions and improve quality of life. Early this year, I was featured on OT Potential’s Value-Based Care course, where I outlined how OTs can approach a framework around contracting to ensure that their interventions, like enhancing patient ability to remain independent, are both incentivized and rewarded. By aligning service delivery with quality metrics like improved self-management and reduced disability, OTs can secure a valuable role in VBC initiatives.

   OT Potential Podcast Episode on VBC
   What is Value-Based Care? Glossary, Examples, and More. By Dana Strauss, PT, DPT

3. Pharmacists are medication experts and we need them on the front lines. They are indispensable care team members with value unaccounted for in the traditional healthcare hierarchy. Their expertise in reviewing complex medication regimens allows them to identify potential drug interactions and optimize dosing, inherently valuable in preventing adverse events and helping patients have smooth care journeys. In successful and popular programs addressing care for the most complex beneficiaries enabled by full risk contracting programs, pharmacists are arguably a non-negotiable team member.

   Pharmacists’ role in home-based primary care
   Bonus article from the American Academy of Home Care Medicine | A Toolkit for Health Partners
   

Medbridge is partnering with me this week to offer an additional discount on a Medbridge subscription for my newsletter subscribers. heck out their Primary Care PT Course. If you are new to Medbridge and choose to sign up, use code “DanaStraussDPTSummer,” valid through June 30th. This adds an additional $25 off, bringing the total discount to $126 off full price.

What I’m Seeing and How I’m “Reading the Tea Leaves”

Where data shows us that the healthcare delivered by a professional is safe, effective, appropriate, and prevents downstream spend, we will see that care elevated in the perception of its value.

Healthcare is still behind other sectors in how it leverages AI to pull actionable, real-time insights for healthcare consumers, payers, and at-risk providers. But we have a CMS Innovation Center leadership team intent on getting that data integrated quickly to meet many needs.

Hidden insights benefit the status quo and enforce cultural norms that may not always lead to the patient outcomes we would want for ourselves or our loved ones.

You don’t have to be Nostradamus to see what’s coming. It’s a GREAT time to be a high-value provider whose care leads to lower costs, better outcomes, patient journeys accessed swiftly because of easy access to the effective care.

Episodes are just a piece of the puzzle. We are on lifelong health journeys. As healthcare professionals, we must embrace that role and be ready for the next era of healthcare.

Read the “Make America Healthy Again” CMS blog from March 2025, written by CMMI Director Abe Sutton for more color 👇️ 

Field Kit

The 2025 CMS Innovation Center leadership says they will address primary, secondary, and tertiary prevention strategies to reign in spending and improve outcomes.

Here’s a helpful visualization of approximately what that looks like. It’s not hard to see the vital role the whole range of healthcare providers and practitioners will need to play to succeed at this at the population level!

Worth Revisiting

Pharmacists in Team-Based Primary Care (Timeless Autonomy guest post)—Jackie Boyle, PharmD, did a wonderful job explaining the role of pharmacists in primary care.

Future Proof PT Podcast | The Practitioner Paradigm—access the podcast page and accompanying brief article.

One Question

If you could redesign one aspect of the healthcare system to better support professionals, what would it be?