The Decline and Fall of the Dabbler Model: The Perfect Storm

  As a society, we are currently embarking on an unprecedented era of healthcare with many challenges. There are a number of factors that are beyond our control that will have a significant impact on our ability to deliver timely, efficient quality care to our patients. Wound Care Centers are entering the Perfect Storm Era. This article will focus on the major components of this and the reality of what we will face in the Wound Care Industry. This article will examine the following factor and discuss potential impact on the industry:

  1. The Aging Population
  2. The Obesity Epidemic
  3. The Diabetes Epidemic
  4. Aging Provider Population.

The Aging Population:

  The United States experienced a dramatic increase in the number of births from 1946 to 1964 and this cohort has been subsequently referred to as the “baby boomers.” There were approximately 79 million births in United States during that period of time. This generation has had a significant impact on all aspects of commerce and culture throughout the United States at various points in their life cycle. We will see a dramatic impact and strain on the healthcare system as this population ages. In 2011 the first baby boomer turned 65, and there are currently approximately 40 million people over the age of 65. This number is projected to more than double to 81,000,000 by 2040.¹ This population also comes with much higher expectations for care and compared to previous generations will have much higher rates of obesity and diabetes. Overall, it is projected that the US population will grow from 310 million in 2010 to 439 million in 2050.² We are also seeing trends towards more chronic diseases in patients. This multi-morbid population will further increase demands on wound centers.

The Obesity Epidemic:

  Obesity is currently a very significant problem in the United States and places considerable stress on the health care system. It has the impact of reduced quality of life and increased risk for many serious chronic diseases and premature death. In 2001 the US Surgeon General issued a Call to Action to Prevent and Decrease Overweight and Obesity. In 2010, no state has met the Healthy People 2010 obesity target of 15% or less of total population. The self-reported overall prevalence of obesity among U.S. adults had increased 1.1 percentage points from 2007.³ The current prevalence of obesity in United States is 34% as defined by BMI greater than 30.⁴ The obese population will carry high rates of diabetes and are much more prone to lower extremity ulceration. Wound centers will be forced to deal with this problem and work to develop strategies to deliver the best care possible to this patient population.

The Diabetes Epidemic:

  According to the Centers for Disease Control and Prevention, currently 1 in 10 U.S. adults have diabetes. Compare this to population data from 1950 when less than 1 in 100 US adults had diabetes. The report predicts that the number of new diabetes cases each year will increase from 8 per 1,000 people in 2008, to 15 per 1,000 in 2050.

  According to a new analysis from the Centers for Disease Control and Prevention, as many as 1 in 3 U.S. adults could have diabetes by 2050 if current trends continue.⁵

  The prevalence is expected to rise sharply over the next 40 years based on 4 critical factors:
    1. An aging population, which is more likely to develop type 2 diabetes.
    2. Increases in minority groups that are at high risk for type 2 diabetes.
    3. Due to medical advanced people with diabetes are living longer.
    4. The current obesity treads.

  Wound care centers will be significantly impacted due to the fact that approximately 15% of all diabetics will develop a foot ulcer and as many as one quarter of those that develop ulcers will require amputations.

The Aging Provider Population:

  The Association of American Medical Colleges predicts that the United States is expected to face a shortage of approximately 130,000 Physicians by 2025. Potential reforms, such as universal health care coverage, will add to overall demand for doctors and increase the projected shortfall by as much 25 percent.⁶ An acute physician shortage will have a profound impact on health care access, quality, and costs. This will especially impact Americans who are already underserved. One of the reasons for the expected shortfall is related to an aging provider population with nearly one third of all physicians planning to retire in the next decade. Also, elderly patients have multiple chronic conditions which will mean they require more medical care. This will come at a time when access will be limited due to physician shortages. These changes will create a much larger multi-morbid group of patients that will need care and this demand will be combined with a lack of experienced providers.

  This article has defined some of the problems that will be faced by wound centers in the future. “The Perfect Storm” is coming and many factors are beyond our control. However, these big challenges can represent big opportunities for wound centers which take a solution-focused approach. Wound centers which focus on effective and efficient healthcare delivery will be rewarded in the new era.

  The next article in the series will focus on those factors that Wound Centers can improve and modify to achieve success. The “Pillars to Success” article will focus on solutions that can be implemented to prepare for the coming changes. Some of strategies will include adaptation of the full-time physician and midlevel provider model. The next article in the series will expand on why this approach is needed and how is will provide a higher level of care to rapidly changing demographic.

  Michael Molyneaux, MD graduated medical school at Dalhousie University in Halifax, Nova Scotia, Canada in 1996. He then completed a family practice residency and went on to work as an emergency room physician for 10 years. Dr. Molyneaux is board certified in family practice in both Canada and the United States, and has practiced in Canada, the United States, and New Zealand. He established his own clinical trial research company in 2005 and has been a principal investigator in a number of clinical trials. He took the position of full medical director of the Wound Center at Passavant Hospital in 2008 and devoted himself to full-time wound care and hyperbaric medicine. Dr. Molyneaux continues to do emergency medicine on a part-time basis.

  His position as medical director has allowed him to have both a clinical and administrative role within the hospital. Dr. Molyneaux feels it is very important for physicians to become more involved in both advisory and operational positions within hospitals. This will be particularly important in the new healthcare era as reimbursement and payment models change for both the hospitals and physicians.

  Apart from his duties as full-time wound clinician and medical director of the wound center, he currently sits on the Board of Directors for both the hospital and the physician organization to which he belongs. Dr. Molyneaux is a member of the medical executive and the current Vice President of the Medical Staff. He is also very involved in physician recruitment and performance improvement committee at the hospital and has worked together with the board and administration to establish a clear vision of alignment with large physician groups and the hospital.

References:

1. U.S. Department of Commerce Economics and Statistics Administration U.S. CENSUS BUREAU Washington, DC 20233.

2. Department of Health and Human Services, Administration of Aging.

3. US Department of Health and Human Services, Office of the Surgeon General.

4. Centers for Disease Control and Prevention.

5. JAMA 2010; 303(3):235-241.

6. AAMC Center for Workforce Studies, June 2010 Analysis.