by Kyla Greenstein
Introduction
The future of medical specialties depends on two factors, what is needed and what is wanted. Throughout the past years and through the COVID-19 pandemic, changes have been seen in the demands of different medical specialties. These changes may foreshadow the future trends in medicine and define the future of healthcare. The areas that were emphasized due to their necessity were geriatric medicine, palliative care, and rural medicine with an emphasis on healthcare access. On the other hand, the specialties that were emphasized due to their more elective nature was the specialty of cosmetic plastic surgery. In this chapter, there will be information on how patients’ wants and needs are driving the direction of medicine, which specialties they’re affecting, and how medical education is adapting to accommodate the new demands in medicine and healthcare.
Growing Older Population
As research in medicine and public health continues, advancements in treatments and preventive measures will continue to increase the life expectancy of people worldwide. Due to improved health outcomes and healthier populations, the older population will continue to increase. It is stated in an Association of American Medical Colleges (AAMC) report from 2022 that, “the U.S. population is projected to grow by 10.6%, from about 328 million to 363 million,” with a 42.4% increase specifically in the aged 65 and above population. This population will have higher needs of more specialized care, which will increase the demand for geriatric specific facilities such as long term care or nursing homes, home healthcare, and hospice and palliative care. In fact, hospice and palliative care had a “786% increase in claims from 2018 to 2022” according to Definitive Healthcare. The COVID-19 pandemic also highlighted the needs of more specialized care for the elderly folk. According to an article from the National Institute of Health (NIH), the Center for Disease Control and Prevention found that “Older adults make up 15% of the U.S. population, yet, as of June 2022, accounted for 43% of hospitalizations and 75% of the mortality from COVID-19.” Not only is there a growing need for gertiatric specialized physicians in the future, but there is also a shortage of them currently. According to the National Institute for Health (NIH), in the US, there are only “7,000 licensed Geriatricians, yet an estimated need of over 33,000.” These dramatic statistics raise the importance of care for elderly folks, and indicate the foreseeable increase in demand in geriatric medicine and specialties that predominantly care for them.
Rural Health
A critical part of healthcare is the access to medical providers and healthcare facilities. Unfortunately, it can be extremely difficult to receive proper medical attention and health education. For some people, the nearest hospital may be hours away by car, and even then, the facility may have limited medical resources and staffing. People living in rural areas may be less likely to seek medical care due to these healthcare access barriers. Other populations that may also have barriers to healthcare are marginalized minority populations and people without health insurance. According to a 2022 AAMC report, if these populations “had the same health care use patterns as populations with fewer barriers to access, up to an additional 180,400 physicians would be needed now.” This just goes to show how important recognizing healthcare access is when considering the demands and needs of physicians.
Not only is there a lack of healthcare resources and providers in rural areas, but there is an oversaturation of healthcare resources and providers in urban areas. According to a 2018 report by the U.S. Department of Health and Human Services (DHHS), the distribution of general surgeons was unbalanced between rural, suburban, and urban areas. It says in rural and suburban areas, there were only enough surgeons to meet 69% and 75% of the demand for care in the respectively. On the contrary, “there were [19 %] more general surgeons than required to meet the demand for care in urban areas.” While rural areas are immensely lacking these surgical providers, urban areas are over-saturated, which displays that the problem goes beyond the physician shortage, but is also the skewed distribution of them between differently populated areas. The U.S. DHHS also evaluated the projected statistics for surgeons in these areas by 2030. While all of the percentages increased, the rural and suburban areas were still majorly lacking the numbers to meet the demands of care. It was projected to fulfill 79% and 77% of the general surgeon demands in rural and suburban areas respectively, and have a 28% overflow in demand of general surgeons in urban areas.
These surgical provider distribution statistics can be used to hypothesize the level of all physicians in these different areas. Consequently, rural areas are lacking physicians in all specialties and urban areas are oversaturated with physicians in all specialties. Due to these differences, the demand for physicians in rural areas is high, and rural medicine will continue to expand.
Plastic Surgery
On the other hand, there is an increase in demand in the modernized medical procedure of cosmetic plastic surgery. In a 2023 article by Spectrum News, they dove into the dramatic rise in cosmetic plastic surgery procedures, giving partial credit to the COVID-19 pandemic where working from home, paid time off, and stimulus checks may have contributed to this increase. They said, “according to the American Society of Plastic Surgery (ASPS), the industry has seen a 19% spike since before the COVID-19 pandemic.” The ASPS also reported that since 2019, breast reductions have increased by 54%, tummy tucks by 37%, liposuctions by 23%, and facial procedures by 19%, with “facelifts alone [seeing] an 8% increase.” From this report, it can be inferred that the field of cosmetic plastic surgery will continue to grow and expand, causing an increase in plastic surgery physicians.
Other Interesting Trends
The specialty with the most remarkable growth in recent years was sports medicine. This field of medicine is sparse compared to some other specialties with only 3,208 practicing physicians in 2021. However, this was a 42.5% increase from 2,252 practicing physicians in 2016, according to the AAMC 2022 Report. It is probable that this specialty will continue to expand and the number of sports medicine providers will continue to grow.
Encouraging Providers in Rural Medicine
As discussed earlier, medical providers are in high demand in rural areas. Several institutions are taking steps to encourage medical students and medical professionals to enter the field of rural medicine in efforts to fill in this gap in medical and healthcare access. According to the 2023 AAMC article, How Academic Medicine Serves Rural Communities Across the Country, “Rural areas tend to struggle more with the recruitment and retention of physicians and other key health care workers.” Due to this issue AAMC-member institutions are making strides to provide quality and affordable healthcare accessible to rural communities. An effective method of achieving this outlook is institutions partnering with rural teaching hospitals and developing Rural Track Programs (RTPs). The AAMC describes RTPs as “partnerships between urban teaching hospitals and rural participating sites where medical residents spend more than 50% of their training” with the purpose of “increasing health equity and reducing disparities” through academic medicine. This course of action can “increase the number of physicians training in rural areas and improve rural health outcomes.” Another effective method is supporting student loan forgiveness programs for students who commit to practicing in rural areas to reduce their financial burdens.
The University of North Dakota School of Medicine and Health Sciences has an RTP called the Rural Opportunities in Medical Education program, which “offers students the chance to train in rural areas and work one-on-one with rural providers, embedding them in the community on the ground level.” They also have a tuition forgiveness program called RuralMed, where their alumni physicians who go on to work in rural North Dakota communities after their residency receive student loan forgiveness.
The Dartmouth Institute at the Dartmouth Hitchcock Medical Center launched the Center for Advancing Rural Health Equity in 2022 which “brings researchers, clinicians, students, and faculty together with rural communities to advance health for all.” Here, they have the Rural Health Scholars program to help “medical students build the leadership and skills needed to provide care to rural, underserved populations.” In addition, they have the Dartmouth Atlas Projection which focuses on “research and data to examine health problems and solutions, including those involving health disparities in rural areas.”
The University of Mississippi Medical Center “partners with the state through the Mississippi Rural Physicians Scholarship Program (MSRPSP) to increase the number of physicians in rural areas” by recruiting college students in rural locations who aspire to practice medicine. They also offer a “state-funded rural physicians scholarship program” which allows young Mississippi residents access to “shadowing opportunities, resources to study for and take the MCAT® exam, and financial support.” The University of Mississippi also works with the state “on physician workforce issues to educate, sustain, and properly distribute the health care workforce.” This program can encourage young people to take an interest in medicine and increase the likelihood of them entering rural medicine after completing medical school.
In Georgia, the Mercer University School of Medicine offers an accelerated track with eliminated tuition after the first year of education and offers direct entry into a residency program if they go into pediatrics, family medicine, or internal medicine in a rural, underserved area in Georgia.
These programs encourage interest in rural medicine for medical students and rising medical professionals. This can result in better distribution of providers in rural areas and reduce geographic based barriers in healthcare access.
Encouraging Providers in Geriatrics
As discussed earlier, the older population is growing and there is increased demand for medical providers in specialties that are dominated by this population as well as medical providers specializing in geriatric medicine. While these specialties are important for improving the overall health of the older population, improving and expanding the education in the more general specialty of Internal Medicine, as well as all other specialties to include longer time spent and a heavier emphasis on geriatric medicine is important. Unfortunately, there is no standardized training or education for geriatric medicine. In fact, according to the article Prioritizing geriatrics in medical education improves care for all from the NIH, the “Accreditation Council for Graduate Medical Education (ACGME) has reduced the geriatric education requirements for IM residents.” The prior residency geriatric requirements was “at least four weeks of dedicated geriatric experiences,” while starting in 2022, only an undefined clinical exposure in Geritric Medicine is required. However, as technology advances, it has become easier to be educated through non-traditional media such as podcasts and websites. The NIH article states that Aquifer Geriatrics, an online platform with educational content, is “a national curriculum endorsed and supported by the American Geriatrics society, and can provide supplemental education materials where geriatric expertise is not readily available.” There were other forms of educational media that were mentioned such as geriatric Twitter Journal Clubs and GeriPal.
According to a Brigham and Women’s Hospital article, there are some effective clinical and educational strategies that can work to improve treatment of older people in healthcare. Some effective clinical strategies would be to “increase required geriatrics clinical time for residents” and “co-manage patients with geriatricians.” Working with geriatricians during a medical student’s education can “normalizes geriatric clinical care and geriatrics as a career choice,” therefore promoting entrance into the geriatric medicine specialty. This exposure and experience would highlight the importance of “the need to integrate knowledge of the physiology of aging into clinical reasoning” early on in a future physician’s medical education.
Some effective formal education strategies to improve the health outcomes of the older population is to expand the didactic learning for geriatric medicine, and develop and teach a standardized approach. An effective approach is called the 4Ms Framework of an Age-Friendly Health System. According to the Institute for Healthcare Improvement’s article “Age-Friendly Health Systems”, this method aims to provide high quality care to older adults using the 4Ms, “What Matters, Medication, Mentation, and Mobility.” The 1st M, “what matters,” emphasizes the importance of understanding and aligning the patient’s care plan with their specific healthcare outcome goals. The 2nd M, “medication,” refers to only using necessary medication and confirming it is used to contribute to the patient’s 1st M. The 3rd M, “mentation,” addresses the mental issues that can be common in older adults. Its purpose is to “prevent, identify, treat, and manage dementia, depression, and delirium across settings of care.” The 4th M, “mobility,” ensures the safe movement the older adult can perform daily to maintain function and to follow “what matters.” Using this method as a standardized geriatric medical education would promote improved healthcare outcomes for older adults.
Conclusion
There is an exponentially growing demand for physicians specializing in geriatrics and rural medicine. Due to the sparse healthcare resources and medical providers in rural medicine, institutions are taking strides to encourage students and rising medical professionals to practice in rural areas. Due to the growing older adult population, demands in specialties with predominantly geriatric patients will continue to increase, like palliative care. Geriatric medical education should be standardized and emphasized in all didactic and clinical medical education. While these specialties will expand due to population needs, plastic surgery is a specialty that may continue to increase due to population wants, with an increased interest in cosmetic plastic surgery over the past years.
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