The question most hospitals won't ask themselves

Fewer than one percent of patients have access to the top-tier level of care physicians train to deliver.

That number has driven every decision I have made since 2010, when my first military assignment put me in front of patients who had no path to care. Before that, I trained at Cleveland Clinic. Patients flew in from around the world for treatment that existed nowhere else.

It worked for the patients who could reach it. Most could not.

Patients exist everywhere. Physicians are concentrated in cities. The system was built to move patients toward care. Today, I work inside hospital systems across the country and see that same system still running.

Staffing is a visible problem every year, but it's a symptom of a patient access problem. Reliable access to physician coverage is the most persistent challenge facing hospital leaders. 

Preferred Pulse exists to move that conversation forward. Each issue brings clinical and operational perspective from someone who has stood at the bedside and inside the C-suite. We want to work with you to find answers today and respond to how things change tomorrow.

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The physician staffing model most hospitals still run was built for different conditions.

Centralized healthcare systems continue evolving, and we're still reversing a system that forces patients to travel to healthcare.

In the last few decades, treatment therapies expanded and specialties multiplied. Centers of excellence became synonymous with quality care, but we became good at providing care only if you could reach it.

The whole system was built around that premise.

Hospitals rebuilt their reputation through physician credibility and filled positions according to isolated needs. Many organizations are still operating at the awareness stage, posting positions and seeking responses for roles defined by titles rather than aligning to patient needs. A hospital posts for a cardiologist, waits for applications, and hires based on credentials.

If this is the first time you’ve examined this about your own approach to staffing, that’s why we’re here. Now is the best time to think differently about program scalability and matching patient needs to care. It’s how hospitals prevent future disruption. 

Obesity, heart disease, and cancer have risen every year since the 1970s. Hospitals that once ran 10-15% night staffing now run 30-40%. On-call coverage has collapsed—being on call has become another full shift.

The physician distribution problem and the rising patient volume problem are happening simultaneously.

Demand is outpacing supply (by 113k in 2028), and that’s not going to change. But we can begin to address the demand by reshaping the system. It’s what our team helps hospitals accomplish through our work.  

When I hear "we need an oncologist," we treat that as a symptom. One difficult patient transfer is not a patient population. We look at the data first.

Often the right answer is a hybrid physician, a generalist who can cover 80-95% of the patient population.

Patients rarely need a physician who can handle the most complex procedures. What most patients need is basic bread and butter vascular care that can be performed in the homes and communities they live in.

A highly specialized surgeon will find fewer advanced procedures, grow frustrated by the mismatch between their expertise and the community's needs, and leave due to low job satisfaction. Patients either don't get the care they need or face unrealistic wait times. The hospital then restarts the same recruitment cycle that never addressed culture fit or what the population actually requires.

As CMO at Preferred Solutions, I vet every physician placement personally. Where most companies send 10+ CVs and let the hospital decide who to choose, we start with the patient population data and work backward to the right provider profile. A provider that fits the hospital’s culture and patient needs, improves staff cohesion and patient outcomes at the same time. 

The physician shortage will continue growing through 2038. 

Executives are working tirelessly to address it but rely on old solutions that were designed to fix short term gaps.

Many hospitals are still operating with staffing models that, while once effective, now add strain for care teams and can impact patient outcomes. These challenges are increasingly recognized. 

With the right adjustments, there is a clear opportunity to build more sustainable, patient-centered approaches moving forward.

Let’s go to work.