Itf you’ve recently had to wait longer to see a doctor than you used to, that may not be entirely because of the COVID-19 pandemic. America is experiencing a physician shortage, and it’s only expected to get worse—a concerning situation that could lead to poorer health outcomes for many patients.
The Association of American Medical Colleges published data in 2020 that estimates the U.S. might face a shortage of 56,100-139,000 doctors by 2033. This shortage is likely to affect both specialty and primary care.
“The physician shortage can justly be characterized as a looming public-health crisis,” says James Taylor, group president of the leadership solutions division at AMN Healthcare, the largest health care staffing agency in the U.S.
He also said that national shortages will be more prevalent. “Health care delayed is often health care denied, and a growing number of Americans are going to experience this unfortunate fact.”
It could get worse.
According to Dr. Stephen Frankel (a Pulmonologist who is also the Executive Vice President of Clinical Affairs at National Jewish Health Denver), the severity of this problem differs from one specialty to the next. Neurology and psychiatry, as well as pulmonary and critical-care medicine, are headed for larger shortfalls than some other specialties, which is in part related to the type of complex, chronic conditions America’s aging population must manage.
Primary care, however is of greatest concern. According to the Kaiser Family Foundation, 83.7 million Americans are located in designated areas of shortage in primary care (HPSA). To remove this designation, more than 14,800 doctors will need to be trained.
Regional variations exist in the degree of the problem. “Certain parts of the country—the West and South—will be more affected, and rural regions will be more severely short-staffed than urban or suburban regions,” Frankel says.
That’s bad news for many patients. Dr. John Baackes, CEO of L.A. Care Health Plan, the largest publicly operated health plan in the U.S., says, “If we’re not able to address the physician shortage, more patients will experience delays in access to primary care, a critical component to improving the health of our communities and reducing overall health care costs.” Marginalized and low-income populations will be especially impacted.
The difficulty in accessing primary healthcare places additional stress on emergency departments. They have already been ravaged by the COVID-19 virus pandemic of the past two year. “When people are met with persistent barriers to care, emergency treatment can become the option of last resort,” Baackes says.
That increases costs and is an especially big problem in underserved areas where “many patients simply don’t see a physician until their problem becomes critical and they go to the emergency room. This is the least optimal method of providing care,” Taylor notes.
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The shortage’s drivers
So what’s causing 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 the Ohio State University (OSU) College of Medicine in Columbus. All these elements are connected and complicated, and all of them start at the beginning of your journey towards becoming a physician. These factors include cost and time as well as the availability of training. For Frankel, the issue boils down to “an increased demand and relatively fixed supply in the physician labor market. Training new physicians is a time-consuming and expensive process, and there are only so many medical schools in the U.S., with so many seats,” and which have not kept up with the demand for physicians.
The requirement for postgraduate training—internships and residencies—has also limited the number of physicians who can enter the field each year. Frankel says that this practical training period can take several years and is necessary before a doctor can practice in any given specialty. The slots are funded by the Centers for Medicare & Medicaid Services, and no significant expansion in this funding has occurred since 1997. (A modest increase in funding—enough to support 1,000 residency positions across the U.S.—was part of a COVID-19 relief bill passed in 2020.)
Part of the issue stems from the way America’s population is shifting. “By 2035, there will be more seniors aged 65 or older than children aged 17 or younger—the first time this demographic imbalance has occurred in the nation’s history,” Taylor says. This is significant because “older people see a physician at three or four times the rate of younger people and account for a highly disproportionate number of surgeries, diagnostic tests, and other medical procedures.”
The aging population is causing a rise in the number of older and sicker patients, who require more complicated medical care. “We’re facing a physician retirement cliff,” Taylor says—with many actively licensed physicians in the U.S. age 60 or older.
As the number of people who are unable to work has increased, some feel the need to get out of the workforce. Merritt Hawkins conducted a survey in March 2021 for the Physicians Foundation and found that 38% of doctors would love to retire within the next 12 months.
Taylor also believes that the health and well-being of the country is a major factor. 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, “all of which must be treated and managed by physicians.” 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 coverage that’s occurred over the past decade means more people can afford to get care. The number of patients looking for appointments has increased.
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Solutions possible
Because the problem is multifactorial, there’s no simple answer to fixing the looming physician shortage. A multipronged, innovative approach is needed to solve the problem. They must be inclusive of:
Increased funding Although the federal government is imposing funding limitations, many hospital systems continue to work with funding partners to offer more residency slots. Holliday states that these incremental efforts have led to improvements in some areas. But more needs to be done, as they “have not kept up with the population growth in the U.S., and hospitals or medical schools are taking [the cost burden] on their bottom line.”
Get debt relief.The conversation should include student-loan forgiveness, particularly when it concerns lower-paying specialty such as 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 folks are coming out of medical school with now,” which averages around $200,000, according to the Education Data Initiative. “That’s pretty scary, and that alone frightens a lot of individuals from going into medicine.”
Incentives programs have been used by some states and municipalities to help physicians repay their loans. L.A. Care’s Elevating the Safety Net program was launched in 2018 to help more doctors get jobs in low-income and vulnerable communities within Los Angeles County. This program offers a range of retention and recruitment tools including grants and scholarships.
It is frequently argued that a federal funding program would help reduce the burden on medical school tuition. This could be the key to solving the physician shortage.
Technology.The COVID-19 pandemic has had one positive: Telemedicine is now more widely accepted. Telemedicine has allowed some doctors to reach patients who live far away, or who are unable to travel. While telemedicine has limitations and isn’t appropriate for every medical situation, it can help ease the burden on overbooked physicians while providing access to care for certain underserved patients.
• Expanding care staff.The key component to solving the physician shortage is moving medicine towards a multidisciplinary and care-team model. “The primary reason the physician shortage has not had even more impact on patients is that advanced practice professionals, such as nurse practitioners and physician assistants, are filling in the gaps and have taken some of the pressure off the system,” Taylor says. You will see these professionals more often, particularly in primary-care offices, where they support doctors and expand their reach.
The reduction of the paperwork burden. Modern medical billing requires a lot of data entry and paperwork, which may not be the best use of a physician’s time. Taylor states that doctors may be able to delegate more complex tasks to professionals such as medical writers.
Promoting diversity and equity within medicinePart of the solution should include increasing the number and diversity of doctors who are of color. “The amount of diversity is better than it was, but still isn’t where it needs to be,” Holliday says. A 2021 study by Holliday in the Journal of General Internal MedicineBased on 2018, 5.4% of doctors are Black. There are 2.6% men and 2.8% women among them. Across race and ethnicity categories, there’s still a lot of work to be done to address inequity in the system.
Before a potential doctor can enroll at medical school, it is important to make efforts to improve diversity and equity in medicine. Holliday states that OSU College of Medicine medical residents speak to Columbus grade school students about future careers in health and science.
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There is hope!
As complex as the physician-shortage problem is, it’s not insurmountable, Baackes says. A July 2020 report by the California Health Care Foundation, which used 2014 data to determine the number of people living in HPSAs in California found 11.2 million. According to a Kaiser Family Foundation report, this figure has dropped to approximately 7.8 millions as of September 20, 21. Baackes claims that the 31% decrease in physician shortage between 2014 and 2021 is a sign that California has progressed. In order to combat the physician shortage, many strategies have been implemented by California, including expanding technology. But more needs to be done.“It’s about having the bandwidth to provide good patient care,” Holliday says. “We don’t want our patients to have poor outcomes and to struggle to get the right provider for their needs.”
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