The looming shortage of doctors

Not too long ago, the American Association of Medical Colleges unveiled a new print ad depicting a patient sitting alone and distressed in an exam room. The stark message: “By the time you notice America’s doctor shortage, it will be too late.”

A new round of ads released this month warns, “Careful what you cut.”

What many rural communities have known for years is increasingly catching up with everyone else: The supply of doctors won’t be enough to meet future demand.

The AAMC’s workforce estimates aren’t encouraging. By 2020, the U.S. is projected to have a shortfall of 90,000 doctors, according to data collected and analyzed by the AAMC Center for Workforce Studies.

Part of the shortage is on the demand side. As the baby-boom generation ages, there will be a dramatic increase in the number of Americans older than 65 – precisely the population that tends to use health care services the most. Easier access to health insurance, the result of the federal health care reform law, also is expected to bring millions of formerly uninsured patients into the system, many of them with pent-up health needs that will need addressing.

But the absolute number of doctors is also anticipated to decline in future years. Although at least half of the projected shortage is among primary care doctors, the other half will be among specialties not customarily thought of as being in short supply – surgeons, oncologists, endocrinologists and more.

In practical terms, what it means for patients is the likelihood of longer waits in the future to see a doctor, more difficulty obtaining timely appointments, and possibly delays in care that could have long-term health consequences.

This is obviously a vastly oversimplified picture of what’s happening in the U.S. physician workforce right now. It doesn’t even touch on the many other issues churning alongside the basic math of supply vs. demand – the number of physicians who will be retiring in the next decade, for instance, or the tendency for physicians to gravitate toward non-rural practice, or the soaring cost of a medical education, or the staggering educational debt that students accumulate and its impact on their choice of specialty.

There’s another factor, though, that much of the public may be less aware of: Federal funding for residency training, which all physicians go through after completing four years of medical school, has not increased to meet current demands. The result is a bottleneck that has reduced U.S. capacity to get physicians fully trained and into the workforce.

Physicians – and indeed all the health professions – have unique training needs. Although much of their initial learning takes place in the classroom, at some point they must be unleashed on actual, live patients to hone their skills. Without this hands-on experience, there’s no other way to become familiar with health and illness and the variety of ways these manifest themselves across the spectrum of patients. There’s no other way to become proficient at diagnosing, treating, prescribing and performing procedures.

It takes time, money and resources to provide the necessary programs and supervision at teaching hospitals where residency training takes place – which is why outside funding is so critical.

The Association of American Medical Colleges has ramped up its lobbying effort with Congress this year to eliminate a freeze on Medicare funding for residency training. The freeze has been in place since 1997 – a full 15 years. Even a relatively modest 15 percent increase would be enough for teaching hospitals to prepare 4,000 additional doctors per year, the AAMC argues. The AAMC estimates that 10,000 more doctors need to be trained annually to completely address the pending shortage.

Certainly there are other sources of residency funding – state governments, private businesses and the teaching hospitals themselves, to name a few. The number of residents in training in the U.S. in fact has grown despite the Medicare cap. State governments and cash-strapped hospitals may not be able to sustain this indefinitely, however, nor does a fragmented approach necessarily ensure that the right types and amounts of primary care doctors and specialists are being trained.

Redesigning the health care delivery system to make it more team-centered could help blunt some of the growing shortfall in the physician workforce, yet this is unlikely to be the total answer. Patient care will still demand the skills and training of a doctor.

Considering the success that physician practices here in rural central Minnesota have had in hiring new doctors the last couple of years, it may seem there’s no real urgency to address a looming shortage of doctors.

But what’s critical to keep in mind is that the pipeline from medical student to full-fledged physician is long – seven years at a minimum, and usually longer for subspecialists. Is it OK to delay action until the problem becomes more painfully evident? The AAMC says no: “The United States cannot afford to wait until the physician shortage takes full effect because by then, it will be too late.”

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