Doctor Shortage Or An Inefficient System?

“There’s a physician shortage.” You can not work in the healthcare industry without hearing that statement, or cliche, as some are calling it. We’ve even written about the doctor shortage on our sites. It makes sense. The Association of American Medical Colleges (AAMC) released their new physician workforce report in April of this year, which confirmed a looming doctor shortage.

But now people are starting to rethink this alleged shortage. Other healthcare organizations like the Institue of Medicine (IOM) are telling the country that we don’t have a shortage. Instead, we have a distribution issue that boils down to an inefficient use of our mid-level practitioners.

Let’s explore both sides of the argument and look at some possible solutions to the healthcare staffing issue in this country.

Arguments Supporting the Doctor Shortage

In their physician workforce report, the AAMC projected that by 2025, there will be a shortfall between 46,100 and 90,400 doctors. By 2025 in primary care, you can expect shortages between 12,500 and 31,100 physicians. This means in about ten years, the nation could see a shortage of around 130,000 doctors. According to the AAMC, there are not enough new doctors to keep up with the changing demographics of the nation.

By the year 2050, the population of adults aged 65 and older will reach an estimated 83.7 million people. This is nearly double the 2012 estimate of 43.1 million. This means two things: older doctors are retiring and a larger percentage of the population is going to need more healthcare in the near future. Baby boomers are becoming eligible for Medicare at a rate of around 10,000 boomers a day. Without enough doctors to replace the retiring ones and the shortage, how will we be able to care for our citizens?

The Affordable Care Act was implemented in 2010, and now, 17 million more Americans now have health insurance. The ACA requires about 16,000 to 17,000 more physicians than would be required without it. With a physician shortage looming and more people needing healthcare, how could it get any worse? Well, one study of 1,000 physicians found about one-third of doctors were considering leaving the medical industry due to the ACA. Nearly 45 percent of physicians are inclined to leave the profession in private practices.

All of these reasons would indicate that a severe doctor shortage is coming soon. The effects on the American healthcare system would be devastating. But, are these numbers really as bad as they seem? Other organizations do not seem to think so.

Inefficient Distribution, Not Shortage Issues

The Institute of Medicine’s (IOM) 2014 analysis of graduate medical education contradicts the AAMC’s beliefs. Their expert panel stated, “Concerns that the nation faces a looming physician shortage, particularly in primary care specialties, are common. The committee did not find credible evidence to support such claims.

The IOM believes the system is inefficient. Our healthcare system is heavily reliant on doctors instead of the mid-level practitioners like physician assistants. These mid-level practitioners are just as effective in primary care settings and some studies have shown that patients prefer nurse practitioners over doctors.

Some fear that the AAMC is not accounting for things like telehealth, new drugs, and new devices. Fortunately, new medical innovations are able to help maintain quality patient care and lessen the need for physician visits.

There are other issues that make it seem like we have a doctor shortage. In parts of the country, especially in popular cities, there are sometimes and an overabundance of doctors. Why? One reason is that ACA reimbursements are based on where you live. Doctors that live in big cities get more money because of living expenses. This creates an incentive, however, for physicians to choose to live in big cities over rural areas.

Another reason why it seems we have a physician shortage is because we have a poor ratio of specialized doctors to general doctors. Specialized doctors tend to make more money, and when you have hundreds of thousands of dollars in medical school loans, the choice to specialize is easy.

Is There a Solution?

There are multiple ways to implement changes to help improve the pending healthcare crisis. One way to do this is to invest and train in more physicians like the AAMC suggests. Another way is to change the way healthcare services and resources are distributed. However, there are issues with both of these solutions.

If there is more investment in training more physicians and then the healthcare system changes, you will have thousands of people that have wasted valuable time and finances for a skill set that will no longer be needed. On the other hand, it’s not acceptable to put patients at risk by not training enough doctors because we think the system will change.

Isn’t there a possibility that the AAMC has a self-interest in saying there is a physician shortage? That narrative allows them to move more money towards the schools and hospitals the association represents. We have to also remember that it is because of a shortage that you have innovators coming up with new improvements to healthcare, using technology.

It will certainly be interesting to see how the United States handles the upcoming physician crisis. Will we allow the healthcare system to remain inefficient and try to hire more people? Or will we use the healthcare personnel we have and create a more productive healthcare system that leverage technology to ensure quality patient care? Most importantly, what changes do doctors want to see in the healthcare landscape to help make their jobs a little easier?


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