lIf you’ve recently had to wait longer for a doctor than in the past, it may not be because of the COVID-19 pandemic. America’s shortage of doctors is only going to get worse – a worrying situation that could lead to worse health outcomes for many patients.
Data published in 2020 by the Association of American Medical Colleges estimates that the U.S. could see a shortage of 54,100 to 139,000 physicians by 2033. That shortage is expected to include both primary and specialized care.
“The physician shortage can rightly be characterized as a looming public health crisis,” said James Taylor, Group Chairman of the Leadership Solutions Division at AMN Healthcare, the largest healthcare staffing agency in the US.
He adds that the types of shortages and poor access to care that have been common in rural and deprived urban areas in recent decades will become more common across the country. “Delayed health care is often denied, and a growing number of Americans will experience this unfortunate fact.”
How bad will it get?
The severity of the problem varies from specialty to specialty, Dr. Stephen Frankel, a pulmonologist and the executive vice president of clinical affairs at National Jewish Health in Denver. Neurology and psychiatry, as well as pulmonary and critical care medicine, are heading for greater deficiencies than some other specialties, in part related to the kind of complex, chronic conditions the aging American population must deal with.
However, primary care is the main focus. A September 2021 report from the Kaiser Family Foundation noted that 83.7 million people in the U.S. live in a designated area with a shortage of primary care health professionals (HPSA), and it would take more than 14,800 practitioners to remove the HPSA designation. .
There are also regional differences in the severity of the problem. “Certain parts of the country — the west and south — will be more affected, and rural regions will have more severe staff shortages than urban or suburban regions,” Frankel says.
That is bad news for many patients. dr. John Baackes, CEO of LA Care Health Plan, the largest government-administered health plan in the US, said: “Unable to address the physician shortage, more patients will experience delays in accessing primary care, a critical component to improving the health of our communities and lowering overall health care costs.” Especially marginalized and low-income populations will be affected.
Difficulty accessing primary care is putting additional pressure on emergency departments, which have been battered by the COVID-19 pandemic for the past two years. “When people face persistent barriers to care, emergency treatment may become the last option,” Baackes says.
That increases costs and is especially a major problem in low-care areas, where “many patients simply don’t see a doctor until their problem becomes critical and they go to the emergency room. This is the least optimal way to provide care,” notes Taylor.
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Drivers of the shortage
So what causes this dire problem? “It’s hard to point your finger at one thing. It’s kind of a perfect storm of many things,” says Dr. Scott Holliday, associate dean of graduate medical education at Ohio State University (OSU) College of Medicine in Columbus. These factors are interrelated and complex, and they begin the journey to become a doctor. They include time, cost and availability of medical training. For Frankel, the problem comes down to “increased demand and a relatively steady supply in the job market for doctors. Educating new doctors is a time consuming and expensive process, and there are only so many medical schools in the US, with so many seats,” that have failed to keep up with the demand for doctors.
The requirement for postgraduate training – internships and residencies – has also limited the number of physicians who can enter the field each year. These hands-on training periods, which can last for several years after medical school, are necessary before a doctor can begin practicing in a particular specialty, explains Frankel. The slots are funded by the Centers for Medicare & Medicaid Services, and there has been no significant expansion of this funding since 1997. bill passed in 2020.)
Part of the problem stems from the way the American population is shifting. “By 2035, there will be more seniors aged 65 or older than children 17 or younger — the first time this demographic imbalance has occurred in the country’s history,” Taylor said. This is important because “older people are three or four times more likely to see a doctor than younger people and are responsible for a very disproportionate number of surgeries, diagnostic tests, and other medical procedures.”
This increase in older, sicker patients requiring more complex medical care is occurring simultaneously with the aging of the healthcare population itself. “We’re facing a cliff in retirement for physicians,” Taylor says — with many active licensed physicians in the US who are 60 years of age or older.
For some, the urgency to retire has increased recently as burnout rates spiked during the pandemic. According to a March 2021 survey conducted by Merritt Hawkins for the Physicians Foundation, 38% of doctors said they would like to retire next year.
The health of the nation is also a factor, Taylor says. According to the U.S. Centers for Disease Control and Prevention, 6 in 10 adults have one or more chronic conditions such as diabetes, cancer, heart disease, lung disease or Alzheimer’s disease, “all of which should be treated and managed by doctors.” Poverty, unemployment, lack of proper nutrition, poor housing and other social factors also contribute to the demand for care.
Frankel adds that the expansion of access to health insurance that has occurred over the past decade means more people can afford to get care. This has also contributed to the number of people who want to book an appointment.
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Because the problem is multifactorial, there is no easy answer to the looming shortage of doctors. Instead, a robust and innovative multi-track approach is required. These efforts should include the following:
Increased funding. Despite the funding challenges imposed by the federal government, some hospital systems have worked to provide more places to stay through other funding sources. These fragmented efforts have helped in certain areas, leading to incremental changes, Holliday says. But more needs to be done, because they “have not kept up with population growth in the US, and are taking hospitals or medical schools [the cost burden] on their bottom.”
Debt relief. Student loan forgiveness should be part of the conversation, especially when it comes to lower-paying specialties like primary care.
“I didn’t have wealthy parents when I went to medical school,” Holliday says, “but my student loans were nothing compared to what people are getting out of medical school now,” which averages about $200,000, according to the Education Data Initiative. “That’s pretty scary, and that alone makes a lot of people afraid to start taking drugs.”
Some states, municipalities and hospital systems use incentive programs that help new doctors pay off their loans to attract talent. For example, in 2018, LA Care launched its Elevating the Safety Net program, which aims to recruit more doctors for positions in vulnerable, low-income communities in Los Angeles County. The program includes a variety of recruitment and retention tools, including grants, grants, and loan repayment.
A federal funding program that would reduce the overall cost of medical school is often hailed as an important part of the solution to the physician shortage.
Technology. The increased adoption of telemedicine is a benefit of the COVID-19 pandemic. This has expanded the reach of some doctors who can now meet patients in remote locations, as well as those who have mobility or transportation issues. While telemedicine has limitations and is not appropriate for every medical situation, it can ease the burden on overbooked physicians while providing access to care for certain underserved patients.
Expansion of the care team. The transition from medicine to a more multidisciplinary approach to healthcare teams is often cited as an important part of solving the physician shortage. “The main reason the physician shortage hasn’t had an even greater impact on patients is that advanced practice professionals, such as nurse practitioners and physician assistants, have filled in the gaps and have taken some of the pressure off the system,” Taylor says. Expect to see more of these professionals, especially in primary care, where they support doctors and expand their reach.
Less paperwork. Modern medical billing requires a lot of data entry and paperwork, which may not be the best use of a doctor’s time. Taylor says delegating these less complex tasks to other professionals in the field, such as medical scribes, can free up doctors’ time.
Promoting diversity and equality in medicine. Increasing the number of doctors of color should be part of the solution. “The amount of diversity is better than it was, but it’s not where it needs to be yet,” Holliday says. According to a 2021 study in the Journal of General Internal Medicine that was based on 2018 data, 5.4% of doctors are black. Of them, 2.6% are male and 2.8% are female. In all categories of race and ethnicity, much work remains to be done to address inequalities in the system.
Efforts aimed at improving diversity and equality in all fields of medicine must begin well before a prospective physician is old enough to enroll in medical school. For example, medical students and residents of the OSU College of Medicine speak at local Columbus elementary schools about pursuing careers in science and health care, Holliday says.
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Hope for improvement
As complex as the physician shortage problem is, it’s not insurmountable, Baackes says. For example, a July 2020 report from the California Health Care Foundation that used data from 2014 found that 11.2 million people in the state lived in an HPSA. A report from the Kaiser Family Foundation in September 2021 found that number had dwindled to about 7.8 million. Baackes says this 31% reduction from 2014 to 2021 shows that California has made progress in addressing its physician shortage. The state has implemented many strategies, such as expanding technology, to address the shortage of doctors. But more needs to be done. “It’s about having the bandwidth to provide good patient care,” says Holliday. “We don’t want our patients to have poor outcomes and struggle to find the right healthcare provider for their needs.”
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