Back in the 1980s, “experts” told us that we were training too many physicians. We needed to decrease the number of medical students or else we would face a glut! Now they have looked again at the data and essentially said – oops – we made some incorrect assumptions.

Medical miscalculation creates doctor shortage

Bodiford experienced what many Americans may soon face: a shortage of physicians that makes it hard to find convenient, quality health care. The shortage will worsen as 79 million baby boomers reach retirement age and demand more medical care unless the nation starts producing more doctors, according to several new studies.

The country needs to train 3,000 to 10,000 more physicians a year — up from the current 25,000 — to meet the growing medical needs of an aging, wealthy nation, the studies say. Because it takes 10 years to train a doctor, the nation will have a shortage of 85,000 to 200,000 doctors in 2020 unless action is taken soon.

The predictions of a doctor shortage represent an abrupt about-face for the medical profession. For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians. In 1994, the Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000.

“It didn’t happen,” says Harvard University medical professor David Blumenthal, author of a New England Journal of Medicinearticle on the doctor supply. “Physicians aren’t driving taxis. In fact, we’re all gainfully employed, earning good incomes, and new physicians are getting two, three or four job offers.”

The nation now has about 800,000 active physicians, up from 500,000 20 years ago. They’ve been kept busy by a growing population and new procedures ranging from heart stents to liposuction.

But unless more medical students begin training soon, the supply of physicians will begin to shrink in about 10 years when doctors from the baby boom generation retire in large numbers.

“Almost everyone agrees we need more physicians,” says Carl Getto, chairman of the Council on Graduate Medical Education, a panel Congress created to recommend how many doctors the nation needs. “The debate is over how many.”

Getto’s advocacy of more doctors is remarkable because his advisory committee and its predecessor have been instrumental since the 1980s in efforts to restrict the supply of new physicians. In a new study sent to Congress, the council reverses that policy and recommends training 3,000 more doctors a year in U.S. medical schools.

Several problems caused their mistake. Imagine playing quarterback and throwing the ball to a receiver running down the field. If we throw the ball to where he is right now, we will underthrow him (we could calculate how much by knowing his speed and how fast the ball will get to the spot where he right now). Medical care has not remained static over the past 20 years. We can do more to help patients, however, this does require increased physician intensity. Medical progress results in more physician visits. Patients live longer with chronic diseases, and thus we provide more care.

The portion of U.S. income spent on health care rose from 8.8% in 1980 to 15.4% in 2004 and will reach 18.7% in 2014, according to Medicare estimates. That means more doctors are needed, whether it’s for hip replacements or prescribing new drugs.

Demographic changes in the medical profession also contribute to the need for more physicians. Nearly half of new physicians are women, and studies show they work an average of 25% fewer hours than male physicians, Cooper says.

Physicians older than 55 work about 15% less than younger doctors. And medical residents have been limited to 80-hour weeks since 2003, ending decades of 100-plus-hour weeks.

Most worrisome, the retirement of baby boom physicians means the number of doctors will start falling just as the first baby boomer turns 70 in 2016, says Ed Salsberg, a workforce specialist at the Association of American Medical Colleges.

So what happens now? The first recommendation is to increase medical school enrollment by 15%. Along with this recommendation we must have increased funding for residencies by Medicare. For several years we have had restrictions on residency slots – an attempt to control specialty production. Like all experiments with artificial controls, these restrictions have unintended consequences.

Some bureaucrats would like to control each detail of medical training and practice – how many students we train, which residencies they can do, where they can practice. These concepts will not work in our society.

Economics are the only solution to a doctor shortage, whether we consider the overall shortage, or focus on shortages in certain areas. Until medical economics make more sense, we will continue to have local shortages. We will also have too few physicians entering the important lower paying fields like family medicine, general internal medicine and general pediatrics. Medical students and residents are (as we say in medical school) undifferentiated stem cells. They can develop into a wide variety of specialists and subspecialists. While some (I’m included in this category) find a compelling career immediately (it took 1 week on my 3rd year medicine rotation to understand that I was an internist), others will weigh multiple factors in choosing. These factors include lifestyle, accumulated debt, geography, intellectual satisfaction, emotional satisfaction. Estimated financial rewards remain an important factor for many medical students. Our artifical price controlled payment system drives students away from some specialties that our society needs.

I hope that as we address the coming doctor shortage we can put pressure on payors to rethink their reimbursement schemes. Unless we do so, 20 years from now we will still be complaining about a shortage of primary care physicians.

Related posts:

1. The doctor shortage (hat tip to @FutureDocs and @efalchuk)
2. Health care reform should address student debt
3. Time – what the suits do not understand
4. Cantwell introduces Senate version
5. Work hours – medical student perspective

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