Doctor Shortage Adds to Healthcare Woes
In an already sick healthcare system, what impact will a doctor shortage have on its prognosis? That’s one question that faces the medical profession, lawmakers, and healthcare consumers alike. Another is, what are we going to do about this shortage of doctors?
Earlier this year, the Obama administration expressed alarm at the growing doctor shortage, with the president remarking in a New York Times article that “We’re not producing enough primary care physicians. The costs of medical education are so high that people feel that they’ve got to specialize.” The average cost of a medical school education is $140,000 to $200,000.
The area with the greatest need is general practice, a group that includes family medicine, primary care, general practice, general internists, and general pediatricians. The shortage of doctors in this category is both acute and seemingly chronic. If healthcare is eventually extended to the majority of the currently uninsured in the United States, the shortage of doctors will grow even larger.
How large is the doctor shortage? Since 1997, the number of US medical school students entering primary care has declined 51.8 percent, according to the American Academy of Family Physicians. The Academy is predicting the country will be short 40,000 family physicians in 2020. Geriatricians, who are needed to care for the rising number of Baby Boomers, are expected to be in short supply as well, with only about 8,000 available by 2030 when four times that number will be needed.
One reason for the lack of attraction to primary care is that Medicare payments to these physicians is low compared with reimbursements going to specialists. They also enjoy longer days, less glamour, and more administrative responsibilities. Geriatricians are in a similar situation, with many of their tasks involving health care that is not reimbursed, such as counseling patients on medication use and incontinence issues and coordinating care programs.
Several proposed solutions to the doctor shortage are being tossed around. One is to increase enrollment in medical schools and residency training programs. It takes an average of 10 to 11 years to educate a physician, so this will do little to alleviate the acute doctor shortage. The Association of American Medical Colleges is promoting a 30 percent increase in enrollment in medical schools, which would eventually release 5,000 additional doctors into the healthcare scene each year.
An increase in the number and use of nurse practitioners and physician assistants is another way to address the doctor shortage. To encourage primary care physicians, the Medicare Payment Advisory Commission has recommended an increase in payments for many primary care services of up to 10 percent. Congress may even consider bills that could help doctors who choose primary care with some kind of debt relief.
In an ailing healthcare environment, a doctor shortage is a formidable hurdle that must be conquered if we are to have a chance at coming through on the promise of health care—and not just health insurance--for all. Having health care coverage does one little good if there is no one there to deliver it.
New York Times April 26, 2009
USA Today August 16, 2009