NakedHealth

The Coming Doctor Shortage

March 16, 2011 Public Policy
By Jen Talley

Amid the controversy swirling around federal healthcare reforms, a logistical question emerges. Will the U.S. have enough doctors to provide for the millions who may be newly insured under the law? According to the Association of American Medical Colleges (AAMC), if current training and graduation rates hold steady, the country could be looking at a shortage of up to 150,000 physicians  over the next 15 years.

The Doctor is Out

The marketplace doesn’t determine how many doctors the nation has, as it does for engineers, attorneys, and most other professions. Instead, it’s primarily a political decision. Congress provides federal funding to Medicare, which uses the funds to reimburse teaching hospitals for about two-thirds of the costs associated with residents. These costs include doctors’ salaries, malpractice insurance, equipment, and the added costs associated with time spent teaching local procedures and patient care.

In 1996, Congress put a cap on the amount Medicare could pay to hospitals, limiting it to about $11 billion annually on 100,000 medical residents, or roughly $110,000 per resident. The funding cap has remained unchanged and the number of residents has hovered at this level for the past 15 years, according to the Accreditation Council for Graduate Medical Education. Until Congress raises the funding level, Medicare cannot increase the amount it pays out for residencies — which means teaching hospitals have limited resources to boost their number of residents.

Demand

The greatest demand will be for primary-care doctors. These include general practitioners, internists, and pediatricians; these “family” doctors will play an ever larger role under the healthcare reforms in coordinating patient care. The U.S. currently has around 350,000 primary-care physicians, and the AAMC estimates a need for 45,000 more by 2020. The new healthcare laws do attempt to address this increase in demand by offering incentives for physicians choosing to go into the field of family medicine, including a 10 percent Medicare pay bump for primary-care doctors.

Supply

However, the number of medical-school students entering family medicine has declined over 50 percent since 1997, and fell over 25 percent between 2002 and 2007 alone.  One reason is purely economical: the average income for a general practitioner is somewhere in the mid-$100,000s. That’s a lot for the average American, but as most new doctors are shouldering two to three times that amount in medical school debt, the focus on more profitable, high-tech specialties is hardly surprising.

Another factor impacting the number of doctors is one based on miscalculation. In 1994 the American Medical Association predicted a surplus of over a hundred thousand doctors by the year 2000. As a result, medical schools began to limit the number of students entering, in order to prevent a glut of trained but unemployed physicians.

The Doctor Will See You — Eventually

But this surplus never materialized, due to the cap in resident funding and other factors, and now some schools have to work proactively to recruit students – particularly in the field of primary care. One such program at The Tufts University School of Medicine, near Boston, offers a $25,000 per year scholarship to students who agree to complete field training at family practices in rural Maine. There are currently only 36 slots in the program, however, and Tufts can’t require students to go into primary care after graduation.

Some states want to address the issue at the government level. A bill currently in the New Jersey House of Representatives would  require the Commissioner of Health and Senior Services to assess how medical residency programs can be developed in non-teaching hospitals, to increase the number of medical residency programs throughout the state, and to ensure the existence of medical residency programs in counties in the state that currently have few or no programs.

The National Health Service Corps, a program with a nationwide focus, offers scholarships and stipends as well as student loan repayments in exchange for five years of service in areas where the shortage of primary-care providers is most acute. This program received $2 million dollars in stimulus funds and currently has 7,500 health care practitioners (including physicians, nurses, and dentists) placed in under-served areas.

These programs are a drop in the bucket, however, compared to the already pressing need for doctors in some areas and the projected shortfalls in the coming decades. Some of a primary care doctor’s functions can be covered by other medical professionals, such as nurses and physician assistants, but nurses and assistants can’t take care of all of a patient’s needs — especially not when these professions also suffer personnel shortages. Without increases in recruitment and funding, your wait at the doctor’s office might get even longer than it already is.

Get more articles like this by email!

Email This Post