Combating Coronavirus (COVID-19): Novel Solutions to the Growing Physician Shortage Crisis

The battle to combat the global spread of the respiratory disease designated as the coronavirus disease 2019 (COVID-19) is currently being fought on multiple fronts, with pharmaceutical companies and research teams around the world racing to develop a treatment and vaccine, while healthcare providers fight on the front lines in an attempt to quell the spread of the virus. However, with no viable treatment options on the immediate horizon, and vaccines still many months from development, the burden will fall on our already strained frontline healthcare professionals, who, not only face a shortage of beds and supplies within their healthcare systems[1] , but also a shortage of colleagues.

Even before the outbreak of COVID-19, the physician shortage in the United States was predicted to reach a shortfall of nearly 122,000 physicians by 2032.[2] Now, with the virus sickening a growing number of Americans, the shortage is expected to become even more pronounced, particularly in those medical fields vital to the treatment and prevention of COVID-19 in the most vulnerable patient populations – namely, those dealing with primary care medicine, including family medicine, internal medicine, and pediatrics.[3]

Faced with the exacerbation of both supplies and personnel shortages amid the growing outbreak[4], the United Kingdom (UK) Medical Schools Council (MSC) leadership recently proposed a novel solution in asking UK medical schools to “fast track” eligible final year students to become “provisionally registered by the General Medical Council (GMC)” in order to begin the professional practice of medicine.[5] Additionally, in Italy, one of the hardest hit regions in Europe, recent medical school students are now eligible to begin working as licensed physicians to help alleviate pressure in general practitioner offices, thereby allowing the more-seasoned physicians to transition to more intensive care settings, including hospitals.[6]

As cases of the virus have surged in the United States, American medical schools have followed the UK’s and Italy’s lead by allowing their students to graduate early to join in the fight against the growing pandemic.[7] In New York, which has been particularly hard hit by the virus, New York University (NYU) Grossman School of Medicine announced that students who wish to graduate early to fight the COVID-19 pandemic may do so.[8] The decision was reportedly made in response to Governor Cuomo’s directive to enlist more healthcare providers into the health system through the establishment of a “Surge Healthcare Force.” Although the Executive Order “allow[ing] any physician who will graduate in 2020 from an academic medical program accredited by a medical education accrediting agency for medical education by the Liaison Committee on Medical Education or the American Osteopathic Association, and has been accepted by an Accreditation Council for Graduate Medical Education accredited residency program within or outside of New York State to practice at any institution under the supervision of a licensed physician” was signed on April 7, 2020, by March 25, 2020 [9], 69 students had already volunteered.[10] Additionally, certain Massachusetts medical schools, including the University of Massachusetts Medical School, Boston University School of Medicine, and Tufts University School of Medicine, have formally announced the acceleration of their medical schools’ graduation dates in conjunction with the state of Massachusetts offering of expedited short-term licenses for fourthyear medical students[11] in order to allow the graduating students to aid in the efforts to combat the COVID-19 pandemic in the time preceding the start of their internships.

As the virus continues to wreak havoc on the American healthcare system, it appears likely that other medical schools could follow NYU’s lead. Should they do so, special consideration should be given to the level of supervision that must be provided to these newly graduated medical students. In particular, hospitals should be mindful of certain regulations concerning proper physician direct supervision of those recent medical student graduates (now acting as first-year residents), which is required in order to allow those teaching physicians to bill certain professional services under Medicare Part B.[12] Additionally, in general, compensation amounts paid to the teaching physicians for direct supervision services provided to the recent graduates should be consistent with fair market value. However, the recently issued blanket Stark waivers[13] may further complicate this issue. While the waivers, which are intended to expand the availability and capacity of healthcare workers, may be applicable to these scenarios, it is prudent for hospitals and health systems to review the specific facts and circumstances of their supervision arrangements to determine whether the blanket Stark waivers would apply, or whether other federal or state regulatory issues may still be present.

  FMV PITFALL: As our healthcare system faces a shortage of providers, new and novel solutions, such as those referenced herein, may be necessary in the fight against the growing COVID-19 pandemic. Our experts have significant experience valuing graduate medical education (GME) supervision arrangements and are uniquely positioned to help hospitals and health systems navigate these unique compensation arrangements.