Physicians in America: The Acute Shortages and What Can be Done
There is no denying that there is going to be a major issue in the coming years regarding the ability of doctors to cover all the healthcare needs that our society will possess. A simple look at the data reveals some sobering facts.
According to a Wall Street Journal article dated August 2010, there will be a shortage of 150,000 doctors in the next 15 years. The baby boomers that are now all entering retirement will provide a major pressure on the healthcare system as they are entering the time of their lives where health issues become more prevalent. Finally, the healthcare reform is about to expand coverage of many millions of Americans who went uninsured and thus most likely never went to hospitals to take care of illnesses. These forces create a dangerous problem that, if not resolved, may force many to be under-served in the future.
There are several things that I think can be addressed in terms of growing the base of medical doctors that exist in our workforce. A key issue with the shortage of doctors is the limited number of residency programs that are necessary to get students prepared to be physicians. The limited number of residency slots has a trickle-down effect. When the Residency training programs can only accept a certain number of slots, this forces medical schools to also keep their admissions statistics at an incredibly low rate. As an example, the University of Michigan Medical School, in 2011, received 5267 applicants for the class of 2015. Of this, the eventual class size was 170. This is an astonishing 3.2% of all those who applied. I find it hard to believe that the remaining 93% of applicants didn’t fit the bill of a student who would succeed at the Michigan medical school. But the school is forced to keep admissions low because every student needs to match to a residency program. Residency is a requisite to get the necessary licensing to practice medicine in this country.
Why are the Residency Programs in Such Short Supply?
As with everything, it has to do with funding. The average funding required to support one Residency program is a whopping $220,000. Much of this is supported by Medicare but they can only foot so much of the bill. We need to find alternative sources to funding that can continue to sustain and grow the residency training program. More conscious budgeting from the government should allow a certain dollar figure to be earmarked every year to either support Medicare or directly support the hospitals to add more residency slots. Alternatively, there should be more incentives to motivate hospitals to become teaching hospitals. Perhaps the American Medical Association, in conjunction with large research organizations (i.e. NIH) and medical device companies (i.e. Medtronic), can provide first access to new technologies or ground-breaking research to those hospitals willing to support residency programs. Hospitals that receive this type of national attention for unveiling the newest innovations in the medical field will also draw more patients and encourage more learning for the residents. This only serves to improve the quality of physicians in the future, making for a win-win solution. I strongly believe these ideas will allow more hospitals to adopt a teaching style and begin to adequately supply the needed residents to take care of our aging population.
Another big issue that the work force shortage will experience is this notion of medical specialty. Two significant facts: ~60 million Americans lack access to primary care physicians and while 56% of patient visits are due to primary care purposes, 37% of the doctor workforce is PCP.
This needs to be fixed. Why, one might ask, is primary care such an unpopular field? After all, when most people think of doctors, they think of someone who is directly communicating with the patient and handling issues such as colds, sprains, and all common healthcare ailments. One quick look at the average income might reveal some of the answer. PCP’s make considerably less (as a comparison – $183,400 for a PCP compared to $385,141 for a cardiologist) And even if one argues that physicians shouldn’t be going into medicine for the money and thus this sort of creates a natural screening/selection process to find the doctors that truly care about improving one’s health, the reality is that medical education is very expensive and the delayed income (many physicians don’t receive their first actual pay-check until in their 30’s) doesn’t help matters. Physicians can’t afford to go into primary care even if they want to because they’ll struggle paying their loans.
What Needs to be Changed
I think there needs to be a better distribution of income among the specialties. While I understand that certain specialties require more intensive procedures and demand more on the healthcare system, I feel that the disparity is far greater than should be to cover some of these additional expenses for other specialties such as radiology and oncology. One could also argue that the PCP should receive some of the profit that a specialist makes in doing their own procedure because many times, the PCP is the responsible party who referred the patient to the specialist. The PCP is the gatekeeper typically for every patient who enters the healthcare system so the PCP has a huge responsibility to properly identify the root cause of the patient and refer him/her to the right specialist. This is no easy task and could be a life-or-death decision. Finally, Medicare is partly responsible for the huge variances in pay because of how much they pay doctors for different procedures. Even if the PCP spends the same amount of time and delivers the same quality of service to the patient as a gastroenterologist, the gastroenterologist may receive on the order of 4 to 5 times more than the PCP from Medicare. This needs to be evaluated/analyzed and better reimbursements need to be issued by Medicare to ensure that there is less parity between how much they pay different specialists.
Finally, the lure of new cutting-edge technology makes many young doctors, especially those of Generation Y, jump to specialties like radiology or cardiology that use the best ‘toys’ in healthcare. PCP is considered less of a technology or procedural-driven practice. Perhaps residency programs can better craft the primary care physician training to ensure that these doctors also get ample opportunity to do certain procedures that incorporate certain technologies in their practice of medicine. While this may be difficult to do just by the nature of how one delivers family medicine, residency directors should keep open relationships with medical device companies, research institutions, and innovative centers that are trying to introduce more technology to deliver even the most standard of care. There are innovative projects, such as a quantifiable balance mat that measures a person’s balance to monitor vertigo that is produced by a start-up called iShoe, which allow PCPs to do their jobs with interesting, innovative, and new-age devices.
 National Association of Community Health Centers. March 2009. Primary Care Access: An Essential Building Block of Health Reform.
Health Resources and Services Administration, Bureau of Health Professions. The physician work-force. Rockville MD: HRSA, Dec 2008.
 Primary-Care Doctor Shortage May Undermine Reform Efforts No Quick Fix as Demand Already Exceeds Supply By Ashley Halsey III