Physician Shortage Getting Worse

The wait in line at the fast-food restaurant is getting longer. So is the que at the check-out of your local grocery. The time you spend on hold, waiting to talk to a real person on the telephone seems endless for banks, airlines, the phone or electric company; you name it! All these situations are frustrating, but they don’t have much to do with real problems, like your health. What if you have to wait longer to see your doctor?

That’s what is happening more and more these days. Covid-19 has caused some of that waiting, but there’s a more ominous reason for this waiting – there just aren’t enough doctors. Elaine K. Howley, writing for Time magazine, says data published in 2020 by the Association of American Medical Colleges (AAMC) estimates that the U.S. could see a shortage of 54,100 to 139,000 physicians by 2033. The American Medical Association (AMA) estimates these numbers between 37,800 and 124,000 physicians over the same time period, a slightly more optimistic guess. But clearly there is a big problem looming and no quick way to fix it.

The shortfall is expected to span both primary and specialty care fields. “The physician shortage can justly be characterized as a looming public-health crisis, “says James Taylor, group president of the leadership solutions division at AMN Healthcare, the largest care staffing agency in the U.S. He adds that the types of shortages and poor access to care that have been common in rural and underserved urban areas for the past few decades will become more common nationwide. “Health care delayed is often health care denied, and a growing number of Americans are going to experience this unfortunate fact.” 

The greatest concern is primary care. A September 2021 report from the Kaiser Family Foundation noted that 83.7 million people in the U.S. live in a designated primary-care health professional shortage area (HPSA), and more than 14,800 practitioners are needed to remove the HPSA designation. Certain parts of the country – the West and South – will be more affected, and rural regions will be more severely short-staffed than urban or suburban regions, according to Dr. Stephen Frankel, a pulmonologist and the executive vice president of clinical affairs at National Jewish Health in Denver.

That’s bad news for many patients. Dr. John Baackes, CEO of L.A. Care Health Plan, the largest publicly operated health plan in the U.S., says, “If we’re not able to address the physician shortage, more patients will experience delays in access to primary care, a critical component to improving the health of our communities and reducing overall health care costs.” Lower income populations are expected to be the most impacted.

The lack of primary care physicians drives many people to emergency rooms when care is needed. The same is true of rising Medicaid enrollment, a reality created by ObamaCare and encouraged by the American Rescue Plan of the Biden Administration. They have increased eligibility ceilings for Medicaid and even eliminated income requirements as an emergency response to the Covid pandemic. The result of these two initiatives is millions of more Americans on Medicaid, but no corresponding increase in the number of primary physicians who will accept Medicaid patients. The inevitable result is more people seeking their primary care through emergency rooms.

What is causing the physician shortage?

“It’s hard to point your finger at one thing. It’s kind of a perfect storm of many things,” says Dr. Scott Holliday, associate dean of graduate medical education at the Ohio State University College of Medicine in Columbus. These factors are interconnected and complex, and they start with the journey to becoming a physician. They include time, cost, and availability of medical training.

Dr. Frankel says the issue boils down to “an increased demand and relatively fixed supply in the physician labor market” It takes time and money to train physicians and there are a limited number of medical schools in the U.S. which have not kept up with the demand for new physicians. Postgraduate training, internships and residencies, have also been limited for many years. The slots are funded by the Centers for Medicare and Medicaid Services (CMS), and no significant expansion in this funding has occurred since 1997. A modest increase in funding, enough to support 1,000 residency positions, was part of the Covid-19 relief bill passed in 2020.

The aging of the U.S. population is certainly contributing to the crisis. Older citizens require more medical care and the U.S. senior population is growing. “By 2035, there will be more seniors aged 65 or older than children aged 17 or younger – the first time this demographic imbalance has occurred in the nation’s history,” Taylor says. He says, “Older people see a physician at three or four times the rate of younger people and account for a highly disproportionate number of surgeries, diagnostic tests, and other medical procedures.” 

To make matters worse, many physicians are retiring earlier than previous generations. For some, the urgency to retire has grown recently, as burnout rates spiked during the pandemic. According to a March 2021 survey conducted by Merritt Hawkins for the Physicians Foundation, 38% of physicians said they would like to retire in the next year.

What’s the solution?

Sorry, there’s no simple solution. Here are some possible solutions mentioned in the article by Ms. Howley:

  • Increased funding – for more medical school and residency training slots
  • Debt relief – student loan forgiveness, especially to incentivize primary care physicians. Local communities in need of physicians should consider offering these.
  • Technology – to promote alternative medicine such as telemedicine to increase efficiency, especially in rural areas.
  • Expanding the care team – to include a more multidisciplinary care-team approach using nurse practitioners and physician assistants to fill in the gaps.
  • Reducing the paperwork burden – to make physicians more productive, spending more time with patients and less with paperwork. Delegate this work to others.
  • Boosting diversity and equity in medicine – (Time magazine had to include this. It’s not clear how the color of the doctor’s skin actually impacts the doctor shortage.)

 

Here’s my personal opinion:

  • When doctors can be sure they are in charge of the patient’s care, and not some government agency or the hospital system they work for;
  • When they are protected from the malpractice lawyers that advertise incessantly on television;
  • When people show them the respect they deserve for the many years of training and sacrifice necessary to receive their medical licenses;
  • When they are relieved of the mounting burden of paperwork and regulations necessary to get paid;
  • When the cost of their training doesn’t put them decades in debt;
  • When the workload doesn’t drive them to retire early and they can look forward to taking care of patients, again;
  • Then, and only then, will we solve our physician shortage problem. Until then, get ready to wait longer to see a doctor. But if socialized medicine ever gets through Congress, all bets are off.

One comment

  1. Thank you. We can relate to this one. It’s especially good

    Comment by Allen Higginbotham on September 12, 2022 at 8:15 am