Why the physician shortage is worse than you think

Only a generation ago, medical students thought about what specialty to choose simply in terms of what interested them most.  All doctors made a comfortable income; money wasn’t a primary motivator.  There was a sense that cardiac surgeons or neurosurgeons could make more than most other physicians, but in fairness their training was much harder and longer.  Internal medicine was held up to us as the most prestigious and intellectually rigorous of the specialties, and was highly attractive to medical students who are a competitive lot at baseline.

For kids growing up in the 1960s and 70s, there was also a strong impetus toward doing work that benefited society.  We remembered the civil rights era, the rise of feminism, and the start of the Peace Corps.  The women who made up the first major wave of female physicians in the United States were determined to prove themselves as deserving of medical school admission as any of the men, by working as hard and achieving as much or more.

As a medical student in the 1980s, I considered a number of specialty options.  Pulmonary internal medicine and critical care were my favorite rotations.  On the other hand, anesthesiology involved critical decision-making in real time, and a great deal of pulmonary physiology—all those ventilators to manage.  Besides, anesthesiologists work in the operating room.  This can be a good or bad thing, depending on how much you like operating rooms and the company of surgeons.  From my point of view it was fine.

At the time there was a shortage of American-trained anesthesiologists, urgent enough that the American Society of Anesthesiologists paid me a generous stipend to do an eight-week clerkship in anesthesiology one summer in hopes of recruiting me into the specialty.  So when I chose anesthesiology, I had the fun of entering a specialty I enjoyed, and the gratification of working in an underserved field.

How times have changed.  Today the most competitive residency positions are in dermatology and radiology. Though we clearly need excellent radiologists and dermatologists, I have to wonder if part of the motivation for many of the medical students who choose these fields could be something other than a passion for the specialty—perhaps the controllable schedules, or lack of emergencies.  Meanwhile, big-city residency positions in general surgery and neurosurgery, which in the past would have been highly sought after, go unfilled.

Everyone hears about the shortage of primary care physicians, who by all accounts are financially undervalued, but how many Americans realize that a critical shortage of specialists is looming ahead in just a few years?  The 77 million babies born in the boom years between 1946 and 1964 are reaching the age of 65 at the rate of 10,000 per day.  They need primary care physicians to manage their overall health care.  But they’ll also need orthopedic surgeons to fix their hip fractures, cardiac and vascular surgeons to open their blocked arteries, and cardiologists to treat their faltering heart rhythms.  They’ll need surgeons to remove their lung cancers, breast cancers, and colon cancers, and medical oncologists to manage the cancers that aren’t amenable to surgery.

By 2015, the Association of American Medical Colleges estimates that the shortage of specialists will match or exceed the shortage of primary care physicians.  Cardiothoracic surgeons aren’t being trained fast enough to keep up with retirements.  Critical shortages of general surgeons are forcing rural hospitals to close, since every emergency room needs a general surgeon on call.  While we have enough general pediatricians—since U.S. birth rates have been flat since the 1970s—there’s a serious lack of pediatric pulmonologists and endocrinologists.

Physicians are working less than they used to—evidence shows that as compensation declines, the motivation to work harder declines too.  A decrease of just four hours a week in the average physician work week amounts to a loss of 36,000 physician FTEs per year.  Today, a recent survey shows that 44% of female physicians in large groups now work part time.  In today’s economy, universities can’t afford to increase their medical school class sizes substantially.  And Congress is unwilling to increase Medicare funding to expand the number of residency spaces.  We may face a shortage of 130,000 physicians by 2025, or even more if young physicians continue the trend to work less.  We can import physicians from abroad, but third-world countries can ill afford to lose them.

It will be interesting to see if the next generation of medical students will step up to the plate.  Will they continue to flock to the specialties that offer the most controllable schedules and the best “work-life balance”—a concept that doesn’t deserve the reverence it gets?  Or will they elect to work in the specialties where they’re really needed?  We’ll see.  In the meantime, my advice to the baby boomers is to stay healthy—there’s no telling who’ll be practicing medicine, or what kind of medicine they’ll choose to practice, a few years down the road.

Karen S. Sibert is an Associate Professor of Anesthesiology, Cedars-Sinai Medical Center.  She blogs at A Penned Point.

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  • civisisus

    Innumerable evaluations tell us that large percentages of care, particularly of care rendered by specialists, is unnecessary at best, but Dr Siebert’s cursory analysis/forecast blithely ignores that evidence. Her dire warnings of severe shortages of specialists appear to assume that with respect to the current state of health care, all is for the best in the best of all possible words. 


    • MuddyWaterz

      “Unecessary at best”?

      I think that’s a bit of an overstatement, and I question your supporting evidence. However, if you truly believe this fact, you can thank the lawyers for the extra testing, or for the referral to the specialist in the first place. Primary care doctors don’t like exposure to lawsuits either.

      By the way, what is a piffle?

  • Caroline Pilgrim

    One argument I have heard a lot lately helps to explain the shorter hours of doctors: women work less.  I think the reality that there are a substantial increase in female applicants to medical schools and are getting accepted because often they are more qualified than their male counterparts.  As a future Physician Assistant, I understand that with my desire to be a mother, working less overtime part of the package my future employer needs to be aware of.  The fact that female doctors work less cannot be understated.  http://www.businessweek.com/magazine/content/08_17/b4081104183847.htm   

  • rrrster

    This would carry more weight if it wasn’t coming from a gas monkey

  • buzzkillersmith

    I think (but can’t prove) that a big part of the PCP simply has to do with the internet. Dang internet.  Pre-internet, info about the lifestyle and salary discrepancies was harder to find, but now it’s a quick Google search.  Pre-internet, you were thought to be a fool if you went into PC; now all doubt has been removed.

  • caduceusblogger

    I think this should have been called, ” A Specialist Who Makes A Lot of Money and Works Relatively Few Hours Criticizes Younger Doctors For Wanting to Do The Same.” And go. . .

    • Jonathan Govette

      Becoming a doctor is becoming harder and harder, more regulations, more “Bills” and almost impossible to have a social life, I have many friends that are doctors and its definitely no picnic 

      Its harder to build great relationships with other doctors, both for referrals and for knowledge sharing, peoples time is becoming the most valuable asset and its hard to find.

    • MuddyWaterz


  • http://twitter.com/KarenSibertMD Karen Sibert MD

    And yet how few people want to have surgery and invasive diagnostic procedures without anesthesia…

    I as well as many other anesthesiologists, except for those who restrict practice to ambulatory surgery centers, work 50+ hour weeks–the population of patients needing diagnostic and therapeutic procedures of all kinds just keeps growing. It’s fine to say that there are too many procedures, but when you break your hip it needs to be fixed.  When your colon cancer or lung cancer is diagnosed, it needs to come out.  And you need people who know how to take care of all those problems, including anesthesiologists who know how to ventilate one lung while the other one is removed or resected. Wishing that things were different isn’t a solution.  Nearly all older people get sick eventually, and the fastest growing population group is those over 75.

    Data on the shortage of specialist physicians as well as primary care physicians comes from the Center for Workforce Studies at the Association of American Medical Colleges.  Here’s their conclusion:  “The decline in the FTE physician-to-population ratio is a function both of the new entrants keeping up with neither exits nor the ordinary growth in physician supply needed for a growing population, as well as a projected decline in average hours worked due to the changing demographics of the physician workforce.” 

    I wouldn’t call that criticizing the young; it’s a statement of fact. 

  • Bradley Evans

    The odd thing is, in the UK, there’s an oversupply of doctors (http://bit.ly/IUT50Y). 

  • Omar Jawaid

    You’ve addressed the symptom, not the cause.  The problem is that the surgery lifestyle is simply ridiculous compared to dozens of other specialties out there.  It takes a uniquely driven person to want to wake up at 3am to pre-round their patients.  Surgery is a love-it-or-hate-it field and most med students know whether or not they want to do surgery before they even enroll.  I knew that I didn’t want to do surgery before I enrolled.  The small population of students that keep surgery open as an option gets further dwindled during surgery rotations.  It’s no fun waking up at 3am day-in and day-out.  Secondly, we cut out a significant number of those driven people when we decided to allow women into medical school.  Yes, it may sound sexist, but women value their time differently than men.  Because of the logistics of child-rearing, women simply cannot devote 70, 80 hour work weeks, unless she is willing to go childless, a prospect that is extremely unpopular among most women.  Now, we are graduating between 40-50% of all physicians as women, who’s very value of time is different than a man’s.  Is it any wonder than we will have a surgeon shortage?  Secondly, there’s simply more fun shit to do nowadays than there was 40 years ago.  People value their free time much more and as a result, the crazy lifestyle of a surgeon is simply not as appealing as before.

    And I find it absolutely hypocritical that an anesthesiologist is telling the next generation of students to become surgeons when anesthesiology was one of the first lifestyle specialties.

  • Cataract_doctor

    I’m an ophthalmologist in the uk. My father was an obgyn surgeon. After I graduated I had to decide what I wanted to do in the early 1990′s. Primary care wasn’t exciting enough. If I wanted a hospital career I decided to think what I wanted when I was 40. I did not want to be making career threatening decisions at 4am like my dad. I wanted something intellectually stimulating with a good work life balance and good remuneration. Eyes seemed to fit the profile.

  • andymc12342003

    “it will be interesting to see if the next generation of medical students
    will step up to the plate.  Will they continue to flock to the
    specialties that offer the most controllable schedules and the best
    “work-life balance”

    I work with med students every day and you’re assessment is a little off. Balance is an issue but med students mostly flock to the specialties that pay the most  money. The rankings of recent residency applications correlate almost exactly with income of the respective specialists post residency. I agree with you about the past students. I think todays med student are much more astute than many of us give them credit for- more astute than I was. They see the PCP/specialist contrast up close in  a better way than any one else.

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    And yet I remember the 1990′s and what happened to the job market for anesthesiologists and radiologists and various other specialties.

    The market disappeared in a couple years.

    It can disappear again.

    And I’ll say again. There’s no physician shortage. There’s a shortage of physicians willing to be screwed.

    • http://pulse.yahoo.com/_6C65YWGCC7P5C6CGMMBK7VMFXE JenniferL

      Yes, there is absolutely no physician shortage.

      There is however a massive shortage of physicians willing to work for less than the cost of doing business.

      There is also a colossal shortage of physicians willing to be brutalized by corrupt, unaccountable bureaucrats and the lawyer industry.

  • http://www.facebook.com/people/Jason-Simpson/100001631757606 Jason Simpson

    Karen talks a big game about fixing the doc shortage, yet she ignores the reality of CRNAs infiltrating anesthesia.  One day her job is going to be done by a midlevel.  Absolutely amazing that something as fancy/sophisticated as giving gas can be done equally well by a person who has less than one third the training of an anesthesiologist

    • http://twitter.com/KarenSibertMD Karen Sibert MD

       Funny thing about that.  President Clinton supported independent CRNA practice, but a cardiac anesthesiologist (Dr. Robert Sladen) personally provided anesthesia for his heart surgery.  Same for Gov. Schwarzenegger:  another cardiac anesthesiologist (Dr. Steven Haddy) personally provided anesthesia for his heart surgery, twice.  The anesthesia care team, where nurse anesthetists are supervised by anesthesiologists, has a long record of safe practice.  Nurse anesthetists practicing alone “equally well”?  I don’t think so.

      • Omar Jawaid

        Your post makes no logical sense.  In fact, it’s a perfect example of a non sequitur.  Just because Clinton/Arnold took board certified anesthesiologists over CRNAs doesn’t automatically exempt CRNAs from practicing independently.  The rich and famous will always have their choice of top doctors, regardless of the practices and norms of the society at large.  

        The major point is that if it can be proven that CRNAs provide no worse outcomes for the vast majority of patients, then we will see major encroachment of CRNAs into anesthesiologist territory.  The issue comes down to whether or not CRNAs provide no worse care than board-certified anesthesiologists.  Not whether or not mega multi-millionaires can afford the best doctors in the business.

      • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

         You may know this, I don’t know………President Clinton’s mother was a CRNA.

        • Molly_Rn

          So what!!! This is ridiculous. Everything turns to politics and is STUPID. This whole blog is becoming just political posturing and worthless.

          • http://pulse.yahoo.com/_GJCNF5QLKW7ROYAZZGB7HFH57Y jamesp

            Said the RN who pontificated that  GP Docs are responsible for bad outcomes. (You never retracted your outrageous accusations against non board cert. Docs on Dr Linda Burke Galloway’s post- and neither did she)

          • Molly_Rn

            I never pontificated with the generality that GP docs are responsible for bad outcomes. I prefer board certified docs because they were able to have the education and discipline to pass the boards. That doesn’t mean that ALL GP’s have bad outcomes. Is this about Rand Paul and his own private boarding system?

      • http://www.facebook.com/people/Jason-Simpson/100001631757606 Jason Simpson

        Karen is just angry that her home state of California opted out of supervision requirements for CRNAs.  A CRNA in that state can do anything an anesthesiologist does, with absolutely ZERO supervision from an MD.

  • http://twitter.com/KarenSibertMD Karen Sibert MD

     Actually, female applicants to medical schools have declined somewhat since 2003.  That year, they peaked at just over 50%, and since then have declined to about 47%.  I know of no data to support the assertion that they are more qualified than their male counterparts.  Female med school matriculants in 2011 were also 47%.  You are correct that female physicians work less on average, and this obviously contributes to the shortfall in FTEs.  However, it is perfectly possible to combine a full-time career with motherhood, as thousands of women in all fields will attest.  You may find this link of interest:  http://apennedpoint.com/a-letter-to-the-next-generation/

    I do think it’s a shame for young women to downscale their career aspirations for children they don’t yet have by partners that they perhaps haven’t met.  It’s a wonderful thing to have work that you love; figure out what you really want to do, and the rest can follow.  Good luck!

    • Omar Jawaid

      47% is still a hell of a lot more than the 10-20% it was 40/50 years ago.

      And you basically just made a case why women shouldn’t be in medicine, based on the criteria you have put out.  They DO value their time differently and as a result, they choose to work part-time, in less time-demanding specialties and view these compromises as fulfilling.  Not every women can be super-Mom, working 60, 70, 80 hour work weeks and still providing quality care for their children nor willing to make the sacrifices necessary.

      In fact, you are a perfect example of the compromises a woman has to make.  You work in anesthesiology, not surgery.  Anesthesiologists are able to better control their hours compared to surgeons.  It was one of the first “shift-work” specialties to emerge in the ’80s and ’90s.  It’s one of the poster-childs of lifestyle specialties, because it provides high pay, stable hours and a good work-life balance.  It’s why you were able to make time for your son’s tonsillectomy.  It’s the freaking A in ROAD, the list of specialties notorious (famous?) in medical school for providing a great balance between life and money.

    • http://pulse.yahoo.com/_GJCNF5QLKW7ROYAZZGB7HFH57Y jamesp

      Doc, I appaud your calm professional deneanor in answering your critics. Even then, I must agree w/those who say there is only a shortage of PCP Docs willing to be screwed.

  • http://9pillsonline.com/ viagra09

    I think there is also a colossal shortage of physicians willing to be brutalized
    by corrupt, unaccountable bureaucrats and the lawyer industry.

  • kjindal

    there are plenty of bright young people graduating med school and entering residency every year. The problem is STAYING in a career (either primary care or subspecialization) say 10 years afterwards.  After taking out women (the vast majority of those graduating DO NOT stay in full time doctoring)and  administrative types(MBAs, medical “directors” etc., ie. those monday morning & armchair quarterbacks telling us what a lousy job we’re doing with patient care etc.), then maybe you can say we have a shortage. 

    So the problem isn’t in the numbers, it’s incentivizing those that can see patients to do so.

    • http://www.mywhitecoatisonfire.com/ Lumi St. Claire

      This is actually an outstanding point.  Medical schools (both domestic and abroad) are graduating hundreds of eager, motivated, and passionate physicians every year.  For all it’s challenges, training isn’t what breaks most physicians – it’s all the bureaucracy one has to deal with in everyday practice.  

  • Doc BestDeal

         I think this is pure……. There are thousands of young doctors including myself waiting to get into a residency. Having qualified all necessary boards to get into a residency program and having applied to hundreds of programs and mostly targeting rural programs , we have had no luck.
     If you workk at Sinai-cedars you should be knowing how many applicants apply for the 6-8 positions in any speciality you have at your hospital.

                     “And Congress is unwilling to increase Medicare funding to expand the number of residency spaces. We may face a shortage of 130,000 physicians by 2025, or even more if young physicians continue the trend to work less. We can import physicians from abroad, but third-world countries can ill afford to lose them”.

       The 1st sentence is right thats why so many IMG’s never get into a residency and YES even Primary care !The second sentence that you have added I guess is total ignorance!!! You have no clue what you are talking by contradicting your own statement, if residency slots are not increased how can foreign grads get residency ?? I guess you are outdated and you should stop writing or blogging…..You should go and first talk with your hospitals residency program director and find out the facts for yourself.  And I think ALL OF YOU should stop beating the drum of physician shortage and primary care shortage until all desrving doctors who are eligible to get into residencies get a residency.

    • http://twitter.com/LadyYumcha Diane Medici

      Where do IMGs come off with such a sense of entitlement to U.S. medical training, when so many American medical school graduates are having the same difficulties getting into desirable residency slots.

      • Doc BestDeal

        Nobody is even talking about desirable residency slots, keep all the desirables you want and BTW, IMG’s don’t even apply for the desirable slots, like dermat, optho, ortho or radio.
        The sense of entitlement comes as many of them are now permanent residents and naturalized citizens! If all the greedy AMG’s want to get into the above 4-5 specialities of course its gonna be competitive and difficult. That has nothing to do with family practice or rural FM. I think you need to read properly before answering..

        • MuddyWaterz

          There are 2 simple reasons why FMG’s are less desirable than American medical graduates:

          1) a perception that the medical school training is not equal.

          2) cultural and, often times, language barrier.

          That is all.

  • http://makethislookawesome.blogspot.in/ PamC

    It’s pretty simple – follow the money. The pay-out schedule according to medicare is how insurance companies set their pay-out schedules. And somewhere in the 1980s, an economist decided that pay-outs should be based on how expensive the education of the doctor was, so the more specialized, the more highly paid. *THAT* is why there’s a GP shortage: All of the hassle, none of the reward.

    • http://pulse.yahoo.com/_B6T377P35O5S62WOK53ET2BQX4 Eric

      Follow the money, indeed.  Many physicians now are in practices “owned” by hospitals which pay a salary.  This has happened in our rural area and when 4 of the 5 physicians in the internal medicine group left for other practices where they got to have more patient time  and less administrative chores plus having to act as hospitalists one week out of five, there have so far been no replacements. Naturally the hospital wants to get as much work for the least pay that it can since the bottom line is what matters to them. . Doctors have expressed interest and been interviewed, but have decided to go elsewhere where the workload and pay are more attractive.  

  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    This is a legitimate article by a practitioner and teacher for many years if this is the same Dr who wrote the op ed piece in the NY Times. The criteria for being accepted into a specialty program should still be taking the best qualified candidates.  I am sure there are numerous qualified candidates who apply for fellowship training programs in specialty medicine and get rejected and closed out whether they are American medical graduates or foreign medical graduates. 
    What is needed is a complete and thorough evaluation of the countries short term and long term workforce needs accompanied by a policy decision of whether the future of US health care will be comprised of well trained generalists in medicine and nursing supported by sufficient specialists or whether the system will be  top heavy with procedural oriented specialists?  I believe we need to screen for candidates who will put in long hours, are comfortable with seeing and caring for patients longitudinally over years and who have the potential to balance and juggle the time and energy requirements of personal and professional life.
    The primary care workforce shortage is due to undervaluation of cognitive services, fear of not being able to pay for educational loans and support your family during the child rearing years, lack of respect for the practice of general care by a small but significant element of higher earning specialty physicians many of whom are coddled and promoted by hospital, pharmaceutical and equipment manufacturing industries. This includes academic physicians and medical administrative types as well.   We certainly need a sufficient supply of experienced and qualified doctors and PAs and ARNPs in the different medical and surgical specialties as well as in primary care.
    As part of the workforce evaluation project we need to look at what it is we want in the training of a physician and which schools and post graduate programs provide that regardless of their location on this planet. The decision makers can not be politicians promoting workforce changes to populate their proposed legislative health care policy changes. Community leaders, religious leaders are as qualified as MDPhd’s to discuss what they are looking for in a doctor and how they wish to be treated by their physicians.
    I am sure Dr Silbert did not seek to create a firestorm over the foreign medical graduate vs the US trained graduate.  Over my thirty years of practice I have had the privilege of working with physicians trained all over the world and have found brilliant gems of colleagues regardless of their place of birth or medical school diploma. Much has to do with their personal pride and determination to be the best that they can be.

  • SomeDerm

    ” Meanwhile, big-city residency positions in general surgery and
    neurosurgery, which in the past would have been highly sought after, go

    This is 100% patently false.

    Looking at data from the 2011 match (the most recent data available), 1,108 categorical general surgery positions were offered through the match, and 1,106 (or 99.82%) filled through the match.  Meanwhile, 205 American MD applicants who applied for general surgery positions failed to match.

    Similarly, there were 195 neurosurgery positions available, of which 192 filled through the match; 28 American MD applicants failed to match.

    I can guarantee that both of the open general surgery positions and all three neurosurgical positions were snapped up in the scramble within a matter of hours if not minutes.  There is no crisis of unfilled surgical residency programs.

  • DavidBehar

    This is academic doctor bs. When there is a shortage of a product or service, its price rises. Physician income has stagnated for the past fifteen years. There is no shortage.

    What there might be are lazy, spoiled, entitled doctors from a cry baby self centered generation. 

    • MuddyWaterz

      The same could be said for the entire country. Everyone is self-centered, spoiled, and entitled, and above-all LAZY. Why are young doctors any different? Why should I work harder for decreasing reimbursements, with 100% liability if I fail? For the “good” of the country? In fact, it’s been my experience that most of the money in medicine has been earned by the older generation of docs, who have sucked the system dry for the rest of us. Imagine STARTING your career in your early 30′s, $200K in debt, and being greeted by financial uncertainty and the hostility toward doctors that you see all over KevinMD. It baffles me why anyone goes into medicine anymore.

      But, it’s absolutely pointless to argue. As my original point concluded, we are all self-centered and entitled, and therefore incapable of change.

    • MarcGarfield_DPM

       “When there is a shortage of a product or service, its price rises.
      Physician income has stagnated for the past fifteen years. There is no
      shortage. ”
      The above is true in a free market, WE DO NOT HAVE A FREE MARKET IN MEDICINE AND CAN ONLY CONTROL THE COSTS OF SERVICES THAT ARE NOT COVERED.  THAT IS HOW PHYSICIANS ARE TAKING CONTROL THEIR FINANCES.   This is another reason why Derm is popular.  They have more free market options to remain viable.
      The author never even mentioned that as more doctors tend to their private pay patients they will schedule less time for insured patients that limit and withhold reimbursement for months or even years (as with State employee plans of Illinois) and require paperwork that exceeds the actual treatment time.
      Lastly as younger physicians are pummeled with loan debts, malpractice premiums and face ICD transitions, medicare paycuts (Always followed by private insurance cuts), and requirements for more expensive certified staffing, and equipment,  many will have to find the most lucrative specialties and many will have to re-enter the residency matches consuming more of those limited residencies.

    • http://twitter.com/DoctorPullen Edward Pullen

      David,  Are you aware that the medical reimbursement system is not remotely free-market, and trying to apply free-market principles to it is bogus.  You may think physicians are cry-babies and self-centered, but we are not stupid enough to think we operate in a market-driven physician payment system.  

      • DavidBehar

         While pay is set by government and employers who buy insurance, there are aspects of free market forces. 1) increased productivity in the form of shorter hospital stays, more meds, less surgery; 2) innovation is the key to maintaining high value and prices with medical methods exempted from patent law, one must innovate to get rich, get results to get referrals; 3) fee for service should be the model for the entire nation, and not salaries. Salaries have an inherent conflict of interest. The less I do, the better off I am. Under fee for service, the more I do for you, the better off I am. With medical savings accounts, the patients will do their own pre-authorizations. They will also lose money if they get sick, and will be motivated by money to stay healthier.

        There is no squeezing the balloon. Even in fully Commie systems, one must do a lot of under the table tipping to get any care. So the fee for service is just under the table, but inescapable. British surgeons go home at 5 PM, even when faced with emergency surgeries. Whip out 500 quid, I bet the doc stays late to remove the ice pick from your head, without making you wait the average 6 days it takes to get emergency surgery in England. So access drops when prices drop. No one is going without access in the US. Biggest health care problem in the US is non-adherence to treatment by the patient, not the lack of treatment.

        The sources of the doctor’s worry about shortages all have conflicts of interests. They do better if medical student numbers increase and doctor memberships in organizations increase. They have not disclosed this conflict in their conclusions. They and the author of the article lack credibility and may be trying to fool the public.


    Once again Dr. Sibert comes to this subject from a cockeyed view.  The relative need for or lack of physicians is cyclical and in the end works itself out.  Some of us would argue that we need fewer primary care physicians because much if not most of the surveillance can be done with good supervision of well trained nurse practitioners (operant words or good supervision and well trained).   
    What study shows 44% of women physicians work part time?  We surveyed women ENTs and the vast majority work full time with only a short interval (average 5 months per career) where they work “part time”.  Since part time was self defined, most of these part timers meant anything from 40 hours a week to 20 hours a week. 
    The data is flawed and like most attempts at predicting physician shortages or gluts, is simplified for sensationalism.  Dr. Sibert, you pointed pen is getting dull.

    • http://twitter.com/KarenSibertMD Karen Sibert MD

      I don’t make up the numbers.  The physician shortage data comes from public sources:  the AAMC and the ACGME.  The 44% of women in large groups working part time comes from an annual survey done by the American Medical Group Association and Cejka Search.  This data is widely reported.  While there’s no doubt that shortages of physicians show cyclical variation, the increasing shortage of FTEs doesn’t show any signs of receding given the increase in the elderly population, the retirement of many baby-boomer physicians, and the tendency of younger physicians to work less.

  • Awunsh

    great read with very interesting perspectives. I would add another catalyst to this potential challenge. ACA is going to add some 40 million patients into insured status. Which in turn will take these patients out of the ED and into the clinical networks practicing routine and maintenance care for the first time, prjected to add 300 to 500 million annual encounters. So in essence burdening an already challenged number of providers (doctors) to keep up. These projections say that the ACA alone will create a shortage of 75,000 doctors, especially GP by 2018.

  • http://profile.yahoo.com/RP7QBRAYN2HWC5STGR7TCHQHWY paul

    So I guess we might want to increase the number of FMGs from 25% in the system nationally and open up the doors for them to join us here in practice?

  • http://profiles.google.com/mittmanpa David Mittman

    WOW. An anesthesiologist is worried about primary care and who practices it. Even the last line says much; ” In the meantime, my advice to the baby boomers is to stay healthy—there’s no telling who’ll be practicing medicine, or what kind of medicine they’ll choose to practice, a few years down the road.” With all due respect to Dr. Sibert, it is painfully hard to promote health and even harder to get paid for it. 
    I’ll tell you that there are and will be plenty of PAs and NPs practicing primary care and practicing it well. We don’t need more IMGs we need to re-think the way medical services are provided. How about a one year postgraduate residency for NPs and PAs in primary care/family practice? My PA colleagues are in residency programs in neurosurgery, CT surgery, urology, ortho and many more specialties. They do what the residents do and do it well. They offer continuity as the residents move from hospital to hospital. Funny, few family practice residencies include NPs and PAs? In any case, we all need to sit down and plan for a future that includes a mix of professionals providing care. We are all here to stay and we have to learn how to work together and to make the system better. CRNAs also. No one is going away.
    Two more things……..
    Many of the physicians I met along the way said that they did not want to do primary care because it was something that they felt NPs and PAs did well. They felt it was boring and that the salary provided would not allow them to re-coup their investment in their medical school tuition and loans during residency.
    Secondly, it’s hard to get new PAs and NPs into primary care as specialties pay more, have more procedures that are billable, have physicians that want to work with them and much more. The same attractiveness of the specialties attracts all clinicians. It’s a problem.
    Anyway, interesting reading sand thanks Dr. Silbert for writing.
    Dave Mittman, PA, DFAAPA

  • Sophie Zhou

    The AAMC has called for an increase in the enrollment at medical schools – up 30% by 2015. Do you think this might alleviate some of the issues or will students, burdened by heavy debt, still turn to dermatology and such? 

    - alittlehappi.blogspot.com

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