There is controversy about whether or not there will be a doctor shortage in the near future. I wonder why there is so much speculation. The Association of American Medical Colleges estimates that we will be short 90,000 physicians by 2020 and 130,000 physicians by 2025. If things stay as they are now, of course there will be a shortage. The number of patients is increasing while the number of doctors is decreasing. It is a matter of mathematics.
According to the Center for Disease Control (CDC), half of all adults have at least one chronic medical conditions, one-fourth of them have two or more chronic medical conditions. Chronic medical conditions require more services and care.
Medical complications increase as we get older. 10,000 baby boomers turn 65 years old every day and will do so through 2029. The geriatric population will double within two decades. The complexity of our patients and the amount of care needed is rapidly increasing.
The uninsured become insured
More than 40 million Americans did not have access to health insurance prior to the Affordable Care Act. With mandates requiring insurance coverage for 2014, more Americans will be added to the existing health-care roster. Doctors are being asked to see an increased number of patients in one fell swoop.
Increased number of insured patients + increased number of geriatric patients = Increased total patients + increased complexity of patients
Doctors in practice
There are 893,851 doctors practicing in the U.S. according to a September 2014 report by the Henry J. Kaiser Family Foundation. As it stands today, 1 in 3 of those doctors are over 50 years old, and 1 in 4 is over 60 years old. That means that at least 25 percent of the physician work force could be retiring in the next 5 years. That would be a loss of more than 223,000 doctors in that time.
A survey of 20,000 physicians in 2013 shows that 62 percent of them expected to retire even sooner, within the next 1 to 3 years, irrespective of their age or medical specialty. 55 percent of them stated they would scale back their hours due to their frustrations with the increasing demands of medicine. Our doctors are burning out under the reams of red tape and regulations.
The number of medical school positions has increased. In 2002, there were 125 U.S. medical schools and today there are 141, resulting in a 30 percent increase in medical school graduates. By the 2016 to 2017 school year, there will be 21,434 graduates per year. The problem? These graduates may have an MD after their name, but they are not qualified to practice medicine.
These graduates need to complete residency training programs, but the number of residency slots has remained relatively stagnant since 1997. The Balanced Budget Act of 1997 capped Medicare’s funding to U.S. graduate medical education (GME), the largest source of funding to these programs. States may contribute to GME positions as well but do so by a much narrower margin. Money is needed to provide salaries to these residents as well as contribute to any additional costs to their training, including the costs of liability insurance and payment to the teaching hospitals for supervision.
There are also osteopathic medical school graduates and foreign medical school graduates to account for. In 2014, more than 40,000 applicants competed for 26,678 entry level residency positions. You do the math. Adding 30 percent more medical students has been a stop-gap solution to train more physicians, but it is an ineffective measure if their training cannot be completed.
Increased number of doctors retiring + same number of resident training positions = Doctor shortage
Many people have argued that nurse practitioners (NP) and physician assistants (PA) can take the role from doctors to fill the gap. There remains a great deal of controversy over this issue. While many NPs and PAs are qualified to care for patients without physician supervision, their training is less extensive than that of a physician. This may make it more challenging for them to care for more complicated patients. With an increasing elderly population, there will be more of these complicated patients. Also, many states require that a physician supervise care offered by these providers.
Only 84 percent of NPs chose primary care as their specialty in 2012 and only one-third of PAs did the same. Even if we replaced physician roles with NPs and PAs, these providers are as susceptible to burnout as our physicians. Many are still not entering the primary care work force where they would be most needed. We could still face a shortage for America’s health-care needs.
What we need is for the red rape and regulations to be reassessed. Bureaucrats are burning out our doctors so they are less likely to stay in the health care system. Is meaningful use improving how electronic health records are utilized? No, it is turning physicians into data crunchers staring at screens rather than empathizers at the bedside. Is pay for performance criteria improving quality of care? No, it is penalizing doctors who give quality care but whose patients may have a more difficult time complying with treatment plans. Is the SGR formula saving our country from a worsening deficit? Of course not. Let’s boost dollars to GME residency programs to strengthen our work force.
Medicine needs to be about people, not numbers. It needs to be about patient care, not paperwork. Doctors are left fighting battles for their patients on the front lines while administrative demands mount on the back end. We need health-care reform that focuses on how the system cares for people more than about dollars and cents. We cannot let doctors work with their hands tied behind their backs or we will continue to lose them. American citizens are the ones who suffer when they cannot get the care they need.
Tanya Feke is founder, Diagnosis Life.
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