Skilled nursing residents are likely to be hit especially hard by shortages of palliative care physicians over the next 25 years, says the co-author of a new Health Affairs study released Monday.

Arif Kamal, M.D., assistant professor of medicine at Duke Cancer Institute, projects the relative number of palliative care physicians will decline until 2045 due to both low supply and a growing number of Medicare patients living with life-threatening conditions. Forty percent of the palliative care workforce is 56 or older.

His solution: Create more multidisciplinary teams to provide supportive care and provide payment structures that recognize their influence on care.

“Specialty palliative care provides skilled nursing clinicians and staff an ‘extra layer of support’ in caring for patients with serious illnesses and comorbidities, debility, and complex psychosocial situations,” Kamal told McKnight’s. “The projected worsening of the palliative care physician workforce … puts access of skilled nursing facility patients at risk.”

The study, based on more than 2,000 surveys and various national data, projects a palliative care physician may need to visit up to 23 patients daily during the shortage period.

Kamal said patients who are not in the hospital or cannot travel to clinic appointments are at “greatest risk for having the least access to a specialist.”

To address the sustainability of the specialty palliative care workforce, the authors recommend dramatic growth in the number of new clinicians entering the field, including nurses, social workers and chaplains; passage of the Palliative Care and Hospice Education and Training Act; and payment models that “become less reliant on the services of physicians … and more focused on providing adequate support for a fully interdisciplinary team.”