You get a horrible cough. You call your primary care physician’s office and discover that he has just retired. You call 3 other doctors’ offices, and the closest physician is 25 miles from your home! You have newborn twins at home who need constant attention. What do you do? Where are all the doctors when you need them? Should you go to the minute clinic at CVS or Walmart? Do you call your dog Sparky’s vet for advice?
There are a number of serious challenges facing the American health system in the coming years. We seem to be so consumed by improving access to insurance and cutting healthcare costs, that we are forgetting that we will not have enough qualified providers to deliver this much-needed healthcare….unless we make some drastic changes. Our healthcare system will never improve in this country if there are no licensed physicians around to take care of millions of newly insured patients. The Emergency Rooms will still be overcrowded if there are no primary care doctors in sight.
What is going to happen now that the demand for healthcare is growing exponentially, but the supply of healthcare providers keeps dwindling? New research by the Association of American Medical Colleges (AAMC) suggests that the United States may face a shortage of between 46,000-90,000 physicians by 2025.
The shortage is expected to be particularly bad in the surgical subspecialties, but it will be felt across all specialties. The AAMC paper was created by economic forecasting firm IHS Inc. It estimates that the shortages will include:
- A shortage of between 12,500 and 31,100 primary care physicians
- A shortage of between 28,200 and 63,700 non-primary care physicians, including –
5,100 to 12,300 medical specialists
23,100 to 31,600 surgical specialists
2,400 to 20,200 other specialists (i.e. anesthesiology)
In support of the AAMC’s conclusions, a recent paper published in the Annals of Family Medicine this year entitled “Estimating the Residency Expansion Required to Avoid Projected Primary Care Physician Shortages by 2035” also predicts a large shortage of physicians in the coming decades. The paper found that 44,000 additional primary care physicians will be needed by 2035 and the current numbers of primary care physicians finishing residency will be unable to meet demand unless changes are made.
Physicians are starting to feel the strain of overwhelming patient demand for their services. A 2014 survey by The Physicians Foundation found that from the 20,000 physicians interviewed, 80% felt that they were already over-extended or at full capacity.
How serious is this issue?
The AAMC sees the doctor shortage to be such a serious issue that they even created an official website (http://www.thedoctorshortage.com/) to inform us about this and to encourage additional federal funding to train more doctors.
Causes of the Shortage: The AAMC highlights a number of key driving factors
1) Changing demographics in the American society: The American population is expected to grow from 316.5 million to over 347.3 million by 2025, which will drive demand for more physicians. Additionally, the aging “baby boomer” population will place more stress on the health care sector because of the services they require as they enter old age. By 2025, the number of people over the age of 65 is expected to grow by 46%, which will strongly drive demand for physician services.
2) The Affordable Care Act (ACA) expanding medical insurance coverage: Demand for medical services is expected to increase as more people gain access to health care insurance.
3) The age distribution of doctors: Physicians are also getting older and the “baby boomer” generation of physicians is getting ready to retire. The AAMC paper shares a graph that shows most doctors are aged 50 or older, with 58 being the most common age of physicians.
4) Immigration reform: The paper estimates that 11.4 million unauthorized immigrants were living in the U.S in 2012. As pathways to citizenship are developed for immigrants, they will gain access to insurance and will use the healthcare system more frequently.
America needs to get on the bandwagon and quickly find and implement solutions to this growing crisis. Increasing the number of residency slots and federal funding for medical degrees is perhaps the simplest way to address the doctor shortage. The AAMC suggests that the number of doctors trained each year needs to increase by 3,000 to meet the 2025 demand. If medical services are going to be improved in the coming years, that figure may be even higher.
While we increase the numbers of new medical school graduates, the geographic distribution of our physicians around the country needs to be more proportionate to patient demand. For example, do we really need over 120 ob-gyns cramped in Beverly Hills? Other areas in Los Angeles are desperate for doctors– Los Angeles was recently determined to have the second largest doctor shortage in the country. We need to encourage more scholarships and loan relief programs (like the New York State DANY funds) for medical graduates who agree to commit a certain amount of time to practice in our country’s most underserved areas.
Physicians need to be educated about how to hire (using medical job websites like DoctorCPR.com and staffing agencies) and integrate nurse practitioners and physician assistants into their practices to help support increasing patient flow and to increase office efficiency and access to care.
Another potential solution is to import more doctors from overseas. One source of well-trained doctors may be Cuba, which has one of the best patient-to-doctor ratios in the world. With the normalization of relations between Cuba and the United States, physicians from Cuba can help meet growing demand in the United States.
Technological innovation may also help reduce the impact of the doctor shortage. Through cutting edge virtual medicine platforms such as Healthtap (a telemedicine medicine platform which over 70,000 physicians use), we can help improve access to physicians dramatically. Patients from all over the country can consult with physicians from nearly all subspecialties within minutes on their smartphones and computers at an affordable rate.
America’s serious shortage of physicians may be great for doctors and other medical providers hunting for jobs and negotiating contracts. However, if our country does not address this problem quickly and intelligently, you may be forced to bark up the wrong tree for critical healthcare advice. Will you have to beg Sparky’s vet to help you decide whether your cough is a simple cold or a deadly pneumonia?