Why the physician shortage is a perfect storm

In the past few years, the small rural community where I practice has seen five primary care physicians close their practice.  This phenomenon is not an anomaly.

Why do doctors close their practices?  There are many reasons.  Doctors can be broken down into demographics like everyone else.

Baby Boomers

Most of my boomer patients are not retiring right now.  In fact, they are financially hurting and looking for work, or for a second job.  So why are virtually all of your Boomer doctors contemplating full or partial retirement, and why are so many following through with it?  For many of them, it stems from job satisfaction.  Gone are the days of autonomy in their work and fair reimbursement.  Professional status has taken a sting, respect from patients has diminished, and administrative burdens have escalated sharply.  Things are just different, not as much fun, and less rewarding than they used to be.  The declining reimbursement and increasing expenses are not worth the hard work and long hours.

One of my recently retired colleagues told me, “I thought I would miss it, I don’t.  I miss the patients, but I don’t miss the government interference.”  He added, comically, “I will say I would much rather be a healthcare provider than a healthcare consumer!”

And with that comment, he forecasts a trend in American medicine.  Boomers make up a huge segment of our society and they make up a huge segment of our physician workforce.  As that huge percentage of wise, experienced doctors transitions from healthcare provider to healthcare consumer, they will be replaced by a smaller percentage of physicians.  That is: fewer, younger, and greener doctors will replace them to take care of more elderly patients than this country has ever seen before.  It is a perfect storm for a physician shortage.

Predictable?  Yes.  This is an expected consequence of American demographics.  Since it takes more than ten years to properly train a doctor of medicine, we should be aware of this and brace for the impact.

Have we prepared for the doctor shortage?  Of course not.  We are talking about your government here.  Instead, the Federal Government has interjected itself in between you and your doctor.  In spite of ubiquitous protests from virtually every physician group, the Federal Government passed the socialistic and unconstitutional “Affordable Care Act”.  The State of Texas has done no better.

Texas cut Medicaid incentives.  Cuts are a good thing.  I would like to see the government eventually cut itself out of healthcare, because when government is the primary payor source and it cuts payment to physicians who can barely keep their doors open, it is the patients who suffer the negative consequences (definition: default).  So, communities like mine who are losing doctors on a near annual basis, cannot recruit their replacement physicians and the patients cannot find a doctor.  Texas also cut funding to training your physicians, cut funding to medical schools, cut residency slots in Texas forcing Texas medical school graduates to leave the state for training.  If the government is going to fund healthcare, it must go all-in.  Government cuts, like government spending, are politically motivated, not patient motivated.  In this case, they were also short-sighted.  At least Texas’ Governor could tell the nation how well he could balance his state’s budget when he decided to run for President.

But, it is well known in medicine that wherever a physician does his residency training, he or she is almost guaranteed to open a practice in that same state.  This is due to many factors, such as familiarity with the medical community, networking, and the red tape and time involved with getting a Texas medical license (often times it takes up to a year after sending in your application and after the State of Texas cashes your fee payment).

The Government’s answer is always to grow itself.  Now its plan is to start planting the seeds to force physicians to see Medicare patients in order to maintain their license (definition: serfdom).  This will lead to an even further disillusioned physician workforce and more attrition.

Returning medicine to free market principles would be a much better approach.  Once Obamacare is fully implemented, expect a mass exodus of physicians out of medicine and into anything else that peaks their interests both in terms of serving others and intellectual stimulation.  Remember, these are some of the brightest, most productive, driven members of society who have already proven their mettle.  One thing the Federal Government’s central planners cannot control is Human Action.

We need our Boomer doctors to keep taking care of us.  We should set the table in a way that allows for them to choose to stay rather than choose to leave.  It saddens me to see a 58 year-old physician retire due to government meddling in the patient/doctor relationship.  That is one of the reasons I am running for Congress, to empower patients and physicians to dictate their own care.

For an example of free market medical care, consider Lasik eye surgery, which the government does not pay for.  What has happened to the cost, efficiency, and quality of this procedure over the last few years compared to medical services that the government pays for?

Generation X

Ah, my favorite generation.  Generation X has a reputation of being like the honey badger…”don’t care…takes what it wants”.

But this is not entirely accurate.  If you currently have a physician that falls into the Generation X demographic, you would be well advised to hang on to them.  GenX doctors are not able to retire yet, though many would like to.  We still have medical school loans.  Many of us have chosen to practice in rural areas in return for loan forgiveness.  For political reasons, the State of Texas defaulted on us in 2011, cutting those programs out from under us after we were already established.  Is it any wonder we are skeptical of the government?  We are professional, but disillusionment will occur and attrition will soon follow.

As a rule, GenX physicians love our patients, our peers, nurses, staff and our work.  But times are different now, and we refuse to work 80-hour workweeks like the Boomers did at our age.  It drives our Hospital Administrators crazy.  But, we crave a moment’s peace.  Like everyone, we strive for work/life balance.  We also have more female physicians than the Boomer generation, and we want to be mothers and fathers and soccer coaches and church choir members, etc.  So, what you see is more part time work arrangements.  GenX has a lot of doctors, but we work fewer hours and see fewer patients per capita than the Boomers did at our age.  It is a perfect storm for a physician shortage.

Millenials

The jury is still out on this demographic.  My opinion is that the Millennials will have more knowledge than any previous generation of physicians but less time to use that knowledge for patient benefit.  The college bubble, caused by easy credit from the Federal Reserve, has contributed to a four fold increase in medical school tuition in the last 15 years, so these doctors will enter a workforce in which they work harder and faster than their predecessors, make less money, and have more debt to pay off during their careers.  It will lead to disillusionment.  The best and brightest will choose other careers that don’t involve government-fettered patient care.  Or they will simply choose to do something with their lives other than practice medicine.

A perfect storm is brewing.  A physician shortage is coming.  Not only will we see a mass physician exodus while our elderly population is exploding, but with increased government intrusion into your healthcare, we will see rural hospitals begin to close their doors as well.  The Central Planners in our government need to be taken to school and educated on the consequences of their flawed economic policies, and we need to return to free market principles in which the patient is the decision maker and the physician is once again allowed to serve them in a way their medical training suggests.

Patrick W. Hisel is a family physician who can be reached at Patrick Hisel for Congress.

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