Fixing the Shortage of Doctors

A booming population and a staggering projected growth over the next quarter century will create a multitude of problems for this country, from infrastructure growth and education costs to health care issues. In fact, a potential disaster looms in the medical community. Even now Americans are starting to feel the effects and the first stirrings of danger. The problem? A shortage of doctors. This is not the first time that America has faced a potential doctor shortage, but this is the first time that the shortage is nearly inevitable due to a combination of causes that make up the perfect storm. In order to head off this disaster, the country needs more doctors by opening up residency slots.

Problem: A Shortage of Doctors

A huge issue in the medical community, and one that will only become more insurmountable if not addressed immediately, is a shortage of doctors in the United States. After some research, the Health Resources and Services Administration Bureau of Health Professions and the Journal of the Association of American Medical Colleges extrapolated some disturbing future trends. The Health Resources and Services Administration Bureau of Health Professions estimated that by 2020, the supply of physicians will grow by 14% while the demand will grow by 22%, resulting in a 49,000-doctor deficit. The Academic Medicine Journal of the Association of American Medical Colleges ran another model, finding that by 2025, there will be “a deficit of 159,300 physicians” (Sklar 1785), a staggering number. Although the doctor deficit numbers differ significantly, they both imply an intense doctor shortage in the near future. These statistics suggests a significant shortage of doctors that becomes a problem for not just the medical community but also everybody in the country due to negative consequences.

Having a shortage of doctors can have some very real, very dangerous consequences. For instance, any kind of disaster transmits to the medical community in some form through the trickle-down effect. “The advent of a new disease (AIDS) rapidly imposes unforeseen demands on the current physician stock” (Harris 80). New diseases, or even outbreaks of old diseases, put tremendous pressure on doctors if there are not enough of them to share the load. This is a very real issue that happens in small part every New Year’s Eve when emergency rooms fill up due to overcrowding, and it is not the only consequence.

Another negative consequence to a doctor shortage is a decline in medical innovation. Medical innovation is achieved, in part, through competition between health care professionals, whether it is a new technology or improved health care delivery. “More doctors have been the central stimulus to the growth of the HMOs and other prepayment schemes” (Harris 80). This example of improved health care delivery is just one possible benefit from a surplus of doctors. If not for these innovations directly related to a ready supply of physicians, the health care system would be a shadow of itself and many people would not have the means to receive the care they need, a sobering consequence.

Finally, another consequence of a shortage of doctors is a lack of geographic distribution. Before doctors became a booming career field they avoided practicing in rural areas because it was not financially sound. They could make more money in the denser cities. Now “An expansion in physician supply reduces the relative attractiveness of big-city practice, pushing the doctors to the periphery” (Harris 80). Simply put, the more doctors there are, the better served are the rural areas and the rural people. The shortage of doctors is again starting to negatively impact those living outside cities, which keeps them from getting the medical care they need. In order to head off these looming consequences, it is important to understand the causes.

Causes

Several causes factor into the doctor shortage crisis. One of the most notable of these causes is the retirement of baby boomers within the next few years. A huge cross-section of the population will be hanging up their stethoscopes and the doctor/population ratio will change significantly. Upon analyzing the impact of baby boomers on the medical field, the Annals of Surgery stated that “The baby boomers (those born between 1946 and 1964) are a wave of population density that will begin to hit retirement age in 2011” (Etzioni 170). This means that the shortage of doctors is not only significant because of the large baby boomer population, but only beginning. Over the next 18 years astonishing numbers of health practitioners will be retiring from the field, leaving a huge void and causing a shortage of doctors.

Another cause for a shortage of doctors is the relatively new trend of early retirement. Although typical retirement age for any profession is 65, recent studies show that younger doctors, in their 50s, are opting for early retirement or a significant change in their practices. This deficit will only increase due to “the increasing frequency of early retirement” (Cooper 147). Therefore, older, more experienced doctors are quitting the field of medicine. This contributes to the shortage of doctors, further complicating a precarious, delicate situation.

Longer life expectancies add to the confused tangle plaguing the medical community. Although doctors work to extend life and the quality of life, they inadvertently add to the problem of a shortage of doctors: people now live longer. According to a recent study, “life expectancy has increased from 66.7 years for individuals born in 1946 to 76.1 years for those born in 1996” (Etzioni 171). This means that a huge number of people will require medical care and doctors in a few years when before there was no market for it. Longer life expectancies add a further burden to an already short-staffed medical field.

Another compelling cause for the shortage of doctors is recent health insurance changes under the Affordable Care Act. The Affordable Care Act enables more people to receive health care, flooding the medical industry with customers. According to an article in Health Affairs, “the overall volume of ambulatory patient visits will increase 29 percent between 2005 and 2025” (Green 14). This means that a third more patients will need to be looked after, but the number of doctors needed to look after all these extra patients is not increasing accordingly. This issue further contributes to the deficit of doctors, an issue which is quickly degenerating into a crisis that needs solutions fast.

Solution: Create More Doctors

Several possible solutions exist that may help this country deal with its problem of a doctor deficit before it turns into disaster. One such solution in a Health Affairs article suggests that nonphysicians be more widely used in order to free up doctors for more intense cases. “The use of nonphysicians has the potential to offset completely the projected increase in demand for physician service” (Green 11). In essence the suggestion is that nurses and assistants take care of some of the patients within their scope of knowledge. However, there are several issues that make this solution impractical. First of all, whether or not a nonphysician has the experience and knowledge to help a patient, a patient would rather see a real doctor or he wants his child to see a real doctor. Also, in order to work, this solution must be used in conjunction with teams of physicians and electronic communication, which is quite a hefty order. Although the ideas are good, the logistics are not. Lastly, there is a serious problem with a nursing shortage as well.

The only real solution to the shortage of doctors is to increase the number of doctors, but the “how” is the tricky part. Catherine Rampell, who suggested the solution of making more doctors, tried to figure out why more doctors were not being churned out. At first she assumed that not enough students were enrolling or being admitted into medical research: “But when I looked into those numbers. I found that they are actually increasing noticeably. Enrollment is projected to rise by 30 percent between 2002 and 2017” (Rampbell BU5). Apparently more students are trying to become doctors, which means that there is a bottleneck elsewhere in the process of turning a student into a doctor. The “how” to the problem depends on finding where this bottleneck occurs.

Upon further research, Rampell found that it is the post-medical school step that is tripping up would-be doctors. Although new medical schools are opening and admissions are expanding, the residency slots are not. Residencies are “supervised, intensive, hazing-like, on-the job training programs that doctors are required to go through” which are largely subsidized by the government (Rampbell BU5). This means that there are only so many residency slots and not nearly enough for the new crush of medical students. In order to create more doctors, there needs to be more residency slots.

Creating more residency slots is the obvious solution, but it is not as easy as it seems. The government pays billions of dollars in residency programs each year. The average resident costs the government $112,642 per year and in an effort to decrease spending “Congress froze the number of subsidized positions in 1997” (Rampbell BU5). In essence, the government is preventing residencies from opening up and taking in the larger numbers of people who are clamoring to become doctors because of money. This is a cap that needs to be lifted, which means that medical professionals and the community need to gather data, petition the government, and hound lawmakers until it becomes a reality.

The biggest issue that critics have with lifting the residency cap and creating more doctors to fill the shortage is that those slots will not necessarily be filled by the doctors who need to fill them. In other words, certain kinds of doctors make hospitals more money than others. “The types of residencies with the most growth are not necessarily the ones that are most critical for the country’s public health needs” (Rampbell BU5). Rampell is implying that primary care physicians or pediatricians are less likely to get into a residency because they take so long train and during that training the hospitals lose money on them. Unfortunately, it is the primary care physicians and pediatricians that the health care system needs most desperately. Yet this issue can be overcome.

The ultimate solution, then, is for the government to not only raises the residency cap, but to create targeted subsidies for specific kinds of residencies. Instead of just dumping money into residencies, the government has a say as to where that money goes. It “needs to be directed in a more deliberate, intelligent way” (Rampbell BU5). In this way residency subsidies go to those professions in the medical field that the health care system desperately needs, like primary care physicians. This in turn motivates the hospitals to open their doors to the right kind of residents, which then creates more doctors and eventually fills the doctor deficiency.

Conclusion

The looming doctor shortage in the health care industry is a very real, very threatening problem that must be settled by creating more doctors by opening up residency slots. The consequences of this problem if it goes unchecked will be devastating. People will not get the care the need, especially during times of crisis or disaster. Medical innovation will grind down. Doctors will move out of rural areas, leaving the people without medical care. In order to plan a solution, it is important to understand the causes. Part of the decline in doctors in the retirement of baby boomers who make up a large part of the experienced medical field. Another part is the growing trend of early retirement among doctors. Meanwhile, longer life expectancies stretch doctors among more patients. The new Affordable Care Act also stretches doctors thin by flooding the market with new patients.

However, a solution is possible. While some professionals argue that a combination of using nonphysicians, teams of physicians, and electronic communication is the solution, it is also a logistical impossibility. The best solution to date is to simply create new doctors. Of course, this has its own set of problems because of the government cap on residency slots. Yet this can be overcome by Congress raising the cap and designating money to residency programs that will accept the doctors this country needs.

Works Cited

Cooper, R. A., T. E. Getzen, H. J. McKee, and P. Laud. "Economic And Demographic Trends Signal An Impending Physician Shortage." Health Affairs 21.1 (2002): 140-154. Print.

Etzioni, David A., Jerome H. Liu, Melinda A. Maggard, and Clifford Y. Ko. "The Aging Population And Its Impact On The Surgery Workforce."Annals of Surgery 238.2 (2003): 170-177. Print.

Green, L. V., S. Savin, and Y. Lu. "Primary Care Physician Shortages Could Be Eliminated Through Use Of Teams, Nonphysicians, And Electronic Communication." Health Affairs 32.1 (2013): 11-19. Print.

Harris, J E. "How Many Doctors Are Enough?." Health Affairs 5.4 (1986): 73-83. Print.

Rampbell, Catherine. "Solving the Shortage in Primary Care Doctors." The New York Times [New York City] 15 Dec. 2013, U.S. Edition ed., sec. Business Day: BU5. Print.

Sklar, David P.. "How Many Doctors Will We Need? A Special Issue on the Physician Workforce." Academic Medicine 88.12 (2013): 1785-1787. Print.