Why senior physicians are important to the future of medicine with Gerald Harmon, MD

. 15 MIN READ

AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.

In today’s AMA Update, former AMA President Gerald Harmon, MD, joins to discuss health care workforce shortages and the value of older physicians. Dr. Harmon shares insights on his new role as interim dean at the University of South Carolina School of Medicine Columbia, his work as vice president of medical affairs at Tidelands Health in Pawleys Island, South Carolina, and advice on staying active in medicine as a doctor over 65. AMA Chief Experience Officer Todd Unger hosts.

Speaker

  • Gerald Harmon, MD, vice president of medical affairs, Tidelands Health

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Unger: Hello and welcome to the AMA Update video and podcast. Today we're talking about workforce shortages and the value of older physicians in meeting that challenge. Here to discuss the issue is Dr. Gerald Harmon, interim dean of the University of South Carolina School of Medicine in Columbia, South Carolina, and a former AMA president, or in his own words, a quote, "recovering AMA president." I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Harmon, it's great to see you. How have you been?

Dr. Harmon: Todd, funny you should ask. I found a new role, in addition to being recovering president from the AMA. Just this month I've begun a new role in my career, that of chief academic officer at a health care system and interim dean of the University of South Carolina School of Medicine in Columbia, South Carolina.

Unger: Congratulations. That's big news.

Dr. Harmon: Well, it's big news. It's an unanticipated career move for me. I was approached about it and I looked at the qualifications, the expectations. And I felt like it was a match made—if not in heaven, at least in the stars for me.

Unger: Well, I'm sure, when reviewing your resume, they were impressed by quite a few of your accomplishments. You've got 35 years as a practicing family physician, assistant surgeon general for the U.S. Air Force, chief physician for the National Guard Bureau, and most recently, of course, AMA president. That's not even the half of it. You certainly have earned the right to retire, but you're taking on an entirely new chapter. What led to that?

Dr. Harmon: I think it's the realization that I still have an opportunity to share my lived experiences with others. The term "doctor" is derived from the Latin term meaning to carry, meaning to teach. And I really feel that I'm still able to teach, to share my lived experiences, to educate and provide guidelines, if not mentorship, for a generation of physicians in training and even practicing physicians. So the role of an academic officer, and yet still maintaining my clinical teaching opportunity, it was just really too good to be true. So I really could not say no to that opportunity.

Unger: How's it feel to kind of transition out of practice and into that teaching and leading role?

Dr. Harmon: Well, the role of academic dean is one that I have not experienced. I've been a college professor and taught—literally, taught—hands-on, not giving grades and written evaluations to students, resident physicians and other health care professionals—nurses, X-ray techs, ultrasound techs, physician assistants. Been an educator, a hands-on educator for most of my 35 and 40 years of practice. So it's not an unfamiliar role.

The trappings of academia are not to be under-evaluated. I'm learning—I used the analogy, not through a fire hose, but through a bucket brigade. I've asked the folks to teach me one bucket of information at a time. So one department brings in their bucket, and the other department brings in their bucket, and director brings in theirs. And then I get, rather than getting overwhelmed and drowned by the fire hose, I get a bucket. So I get control, a little bit, of the data point. And then next week, we'll try another bucket.

Unger: It's interesting, Dr. Harmon, the terms on which you've come to your new chapter here. Concurrently, we know a lot of physicians, kind of motivated by the pandemic, chose to retire early or accelerate their retirement. Have you seen or heard this among your colleagues?

Dr. Harmon: I've seen it as recently as this past week, Todd, yes. And we have data that started mid-pandemic, probably the 2021-2022 data surveys that the AMA did that showed that 20%, one out of five physicians had said they're going to retire. They're going to retire in the next 24 months. We've seen it among other health care professionals, nurses particularly. 40% of nurses, 2 out of 5 said, I'm going to step down from my clinical role as a nurse in the next two years.

So yes, and I've seen it, as I mentioned, in the past week. I had a mid-career physician announce his retirement. He's a surgical specialist and he's right at 60 years old. He said, I'm going to retire from active practice. The pandemic has taught me that I have to value other things more than my practice. I'm in a position economically. Family-wise, he needs to spend more time with his family. So he's choosing to retire totally.

I had another, a good colleague of mine, family medicine. His spouse actually approached me a couple of months ago and said, you know, this pandemic has put a lot of stress on our family. And I've asked Dr. X, her spouse and one of my colleagues in my practice area, to cut back. Because he's spending much more time at the office. When he comes home, he's on the computer doing all this computer work that he didn't have time to do. He's so busy seeing an overwhelming number of patients. And so he's cutting back. He's having pressure from his family. He's got five children.

All of this has just put a lot of pressure on many aged physicians, but those in mid-career, 50 and older, are at high risk for feeling the stress as much as our younger generation.

Unger: And that's complicating, at a minimum, a trend that we're already seeing in terms of a shortage of physicians. In fact, a study from the Association of American Medical Colleges projects a shortfall of up to 124,000 physicians by the year 2034, citing drivers like what we just talked about, growing an aging population and an aging physician workforce combined.

As a former family medicine physician who served a very large rural population, what are your thoughts on that?

Dr. Harmon: Todd, you're right. That shortage of physicians is exacerbated exponentially, or at least, logarithmically, not just by adding addition and subtraction. Aging physicians—we talk about in the next decade, America's patients are going to age into ages 65 or older, which 34% now needing doctor care. And as many as 42% to 45% in the next decade are going to need medical care. And they need more care. You mentioned that shortage of physicians. These aging patients requiring a higher acuity of care, many of them are in rural areas, already underpopulated.

So the physicians that are aging out and retiring from the workforce do not leave a legion of physicians, health care workers that want to go into rural areas, that want to go into already underserved areas. So it's really going to be exponentially exacerbated in rural areas. Just like patients are getting older in that area, and yet we're not getting a growing population in rural areas. We're not seeing a growing population of health care workers go into those rural areas either.

So we have to come up with innovative technologies, innovative ideas, telehealth among them, team-based care to help meet the needs of our underserved rural areas in America.

Unger: So you've got an expanding or an aging population and you have an aging population of physicians too. And so that creates quite a gap. Can you put, just in terms of raw numbers, what that gap starts to look like?

Dr. Harmon: Let's say the current physician population takes care of 280,000 patients right now. Because of the aging of America getting a decade of age, with 34% now versus 42 to 45% in a decade, it's going to require—I think the numbers are, as you indicated, about 400,000. So it's a huge gap. In addition to the projection of just needing more docs, you're going to need more doctors serving this aging population.

Let me tell you. It's not just physicians. It's X-ray techs, it's nurses—not to mention about how nurses are retiring. Our hospital system already in rural America is stretched by not enough ultrasound technicians, not enough X-ray technicians, not enough laboratory technicians. Every health care system in America is already stretched because of a shortage of the entire spectrum of health care workers.

It's not only a perfect storm for the future. We're in the storm right now.

Unger: Now correcting or addressing this kind of physician shortage is going to obviously require a multipronged solution. But let's talk more specifically. How do you see older physicians fitting into the solutions—that solution? And why are they uniquely suited to caring for an aging population?

Dr. Harmon: It's interesting. I think there's no question that they'll at least be empathetic, if not sympathetic to the patients that come in. Just as we talk about Americans 65 and older representing 42% of the population, that demographic is reflected in the physician workforce with 42 to 45% of physicians being ages 65 also. So they'll have the same lived experiences. They'll be able to understand whether it's a joint musculoskeletal limitations, whether it's cognitive or perceived cognitive decline, or limitations in hearing and vision, or perhaps even the co-morbid diseases that we gain as we get older—cardiovascular disease, diabetic disease.

We talk about, and I've done podcasts that show that we have as many as 90 million Americans with prediabetes, and 85% to 90% don't even know they have it. So the aging of America is burdened with the burden of chronic disease also. What you'll find is that, as we age into that physician workforce, they can be empathetic, but they also have lived experiences. They have a skill set. They know how to diagnose.

Sometimes I like to think I and physicians in my age group can think and even make a diagnosis without some of the technology. We don't have to think, if this person is having a little difficulty with this organ system or that, I don't necessarily have to do an MRI, or a PET scan or any kind of laboratory tests. I can know that this rash is shingles. It's not contact dermatitis. But just because I've seen 35 or 40 years of patients, I have a mental index that I can help apply what I would call real human intelligence, not artificial intelligence to the diagnosis.

So I don't need to do all this testing. And I can be more efficient upfront with diagnosing and treating and reassuring that aging population.

Unger: That's a good segue. I want to talk to you a little bit more about this issue around technology. You're an active member of the Senior Physicians Section, which gives voice to and advocates on issues that impact senior physicians. And one of the things that's come up an awful lot lately—in fact, I've talked about AI, for instance, a number of time over the past few weeks—is this issue around how older physicians are going to do in terms of adapting to new technology. What's your advice on that and how can the AMA help?

Dr. Harmon: Well, you've seen me previously—and I have been on record when I've given lectures and discussions—we need to embrace this new technology. It's not going to go away. The artificial intelligence that we see—the AMA uses the term, and I agree with it more—augmented intelligence. Because it never fully replaces this computer right here. We have a certain judgment and decision-making capability that even the best machines are yet to learn.

But we need to embrace this technology. We don't need to defer progressing it. We don't need to defer utilizing it. We don't need to defer some of the electronic records that we speak with disdain about. It's a new technology. It's not going away. It will augment the delivery of care. It will make it safer, decrease errors, I think improve diagnostic accuracy.

So physicians really need to embrace it, get control of it. It's a tool, just like anything else. Just like using your stethoscope, like using your eyes, like being able to touch and examine folks. That's an augment to your skill set, not an impediment.

Unger: Dr. Harmon, last question. For physicians that come to a decision that they're no longer able to care for patients, what are the other ways that they can stay active in the profession? And why does it serve both the physician and the profession to keep that connection strong?

Dr. Harmon: Todd, everybody's making their own decisions in their own universe with their own data points. So if a physician might have questions about his or her competence, his or her safety, whether it's the operating room, whether it's the ambulatory environment where you're just diagnosing without necessarily doing instrumentation or procedures. There are some normal hesitations. All of us need to worry about that.

Number one, if you really are concerned, if you doubt your capabilities, whether it's cognitive or physical, talk to a colleague. Don't be embarrassed. And we have the same issues with behavioral health. When I'm talking to physician groups, I know we talk about physician burnout. We talk about the workforce issues and how we're getting discouraged. And we have data that shows over 40% of doctors have thought about their career choice—I mean, scary numbers.

Another reason I went into the dean world. I've got to impact this. I've got to tell these young physicians in training, you've got a better career ahead of you than you might see in the newspaper. I don't want you to discourage because my job as a physician leader, as an educator is to make sure we prepare their environment so they don't have to worry about, did I make the right career choice 20 or 30 years, or even just 10 years down the line.

But if I'm a physician, I'm a senior physician over 70, even over 60, and I'm worried about my capacity, talk to a colleague. What I do, I use the aviation analogy. We talked about me being on the Air Force. Go get a check ride. I do that for my piloting skills. I'm required to do it by the FAA regulations. But I do it for my own skill set. If I'm about to fly into what we call an instrument condition where it takes extra skills and experience, I get a check ride from the instructor. Cost a little bit of time, but it works.

The same thing can be done if you're a surgeon. Go and have someone proctor you. If you're doing a new procedure you haven't done in a long time, get proctored by it. Go work with another physician that you trust, one whose skills are very current. Make sure your skills are current with them. Ask them. They'll be pretty honest. I mean, it's all about safety. It's not about insulting your personal integrity. After all, you're doing it for the safety of your patient and the integrity of your profession. Get a check ride. Go talk to them.

You can, of course. If you say I want to cut back. I didn't pass my check ride, or I couldn't remember certain things or I think I might not deliver the level of care I want to give. Then you can still volunteer. You have a wealth of experience. You have decades, typically, of experience. You have a skill set that's impossible to reproduce. That's the reason we're worried about the shortage of physicians. It takes a decade or more to train physicians to become competent. So apply it in a volunteer organization. Work in extended care facilities. Work in school-based clinics. Work in free clinics.

We have, despite all the efforts at providing health care to the underserved, marginalized communities, economically disadvantaged communities, there are opportunities to share your learned experiences and your breadth and depth of knowledge with folks that are not able to pay for it. So volunteer. It's very rewarding. It serves an incredible amount of value to the state, community and the nation. All kinds of opportunities exist. Be a volunteer lecturer, perhaps. Any manner of opportunities to tell the world and train new doctors and other doctors in your lived experiences.

Unger: Dr. Harmon, you're always so inspiring and it's so much fun to talk with you. Thank you so much for joining us today. I hope we can get you back again soon if you can fit us into your schedule. You seem to get even busier.

We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.


Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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