With the health care system already in a state of crisis, some are clamoring about an oncoming shortage of physicians, just as Americans are likely to need more and better health care. What is the problem and how bad will it get? This report examines the roots of the coming shortage and what’s being done about it.   

Fifty-six million Americans—nearly a fifth of the country’s population—do not have a regular doctor because they live in an area without a physician, roughly equivalent to a shortage of 60,000 primary care professionals.1

This is a problem that spans the entire nation. In the panhandle and plains areas of Texas , for instance, fully 27 counties do not have a single physician. For Texas on the whole, a shortage of 4,500 doctors is projected by 2015.2 Such shortages are essentially mirrored in the national scene at large: insufficient numbers of doctors, with projections that the problem is getting worse, not better.

A large number of experts—from both governmental and physician organizations--expect the physician shortage to deepen over the coming decade. There is general agreement that a shortage is currently in effect and likely to worsen, though estimates vary as to the degree of the shortage.  On one hand, the Department of Health and Human Services’ Health Resources and Services Administration projects a shortfall of 55,000 physicians in 2020 with shortages to be greatest in the non-primary care specialties,3 while the Health Policy Institute of the Medical College of Wisconsin estimates a need of 200,000 additional doctors by the same time.4

The current impact

The physician shortage is not solely a problem for the next decade or so: the effects are being felt across the nation right now and have been for some time. A 2003 survey of hospital physician recruitment trends found that eighty-five percent of the hospitals surveyed were actively recruiting physicians. Fifty-six percent of those not actively recruiting reported that they planned to do so within the next six months. A majority of respondents found that physician recruitment was more difficult and time-consuming than it had been in previous times.5

A more recent study by a physician search firm supports these findings, with hospitals reporting increased hiring of physicians onto hospital staff in attempts to head off competition from other health care systems in the face of insufficient supply. The study also found an increase in incentives offered to primary care and specialty physicians, with average salary offers to primary care physicians up eleven percent over past years with significant gains in other specialties. Additionally, signing bonuses for new physician hires—once a rarity in the field—have now become standard, with seventy-two percent of respondents offering signing bonuses in their recruiting, up from fifty percent just four years ago.6

These trends fly in the face of earlier predictions by industry analysts that projected a surplus of physicians by this time. These projections are now seen to have failed to take into account the effects of managed care as well as the aging population’s need for physicians.

Reasons for the shortage

The root causes of the current and coming physician shortfall can be essentially summed up in three words: supply, demand, and distribution. With regards to supply, the issue is simply that not enough doctors are entering the system. From 2002 to 2013, medical school enrollment is expected to be up 20%, and approximately 3,400 new students are expected to enter the system per year. In addition, four new medical colleges have been accredited since the moratorium on new accreditations was lifted, with six more slated for accreditation in the near future. However, fully one-third of physicians in the current population are over the age of 55. In the coming years, these physicians are highly likely to retire or greatly reduce their working hours. This figure is greater than the number of doctors expected to enter the field in the coming years, resulting in the proposed shortfall.7

In terms of demand, the culprit is the aging U.S. population. The number of people over the age of 65 will double over the next 30 years, drastically increasing the demand for physicians in geriatric and related fields. Even if the demand for geriatricians were met, this would, of course, result in deficiencies in other fields. In addition to this, people are generally living longer and requiring more medical care as they age, thus they are going to the doctor more frequently, which results in an increased patient load.

In the case of distribution, the primary factor would seem to be the state of the American payer system. Lower reimbursement rates for primary and geriatric care, in addition to higher pay in specialist fields, means that doctors are going into more lucrative fields at higher rates. Even with recent trends indicating an uptick in primary care physician hiring, there is an insufficient population of primary care and geriatric care physicians, the fields most affected by the physician shortage. 8

In addition to the aforementioned factors, other factors come into play in causing the physician shortage. Twenty percent of Americans live in “Health Professional Shortage Areas,” largely rural areas underserved by doctors who are not keen on the rural life or the financial problems incident to it. Furthermore, the new generation of medical students seems to be less likely to wish to devote the long hours of practice traditionally expected of doctors, preferring instead to maintain an active social life in addition to a healthy career. The AMA also reports that female doctors—who now make up more than 50% of the medical resident pool—work eighteen percent fewer hours per week than male physicians, which has a significant impact on physician availability.9

Addressing the shortage

Efforts are underway in various parts of the healthcare world to address the problem. The American Association of Medical Colleges, for example, has called for a thirty percent increase in medical school enrollments by 2015—an increase that would result in an additional 5,000 new M.D. students annually.10 In addition, the AAMC recommends:11

• Increasing the National Health Service Corps awards by at least 1,500 per year to help meet the need for physicians who care for underserved populations.

• Examining ways to develop a formal, voluntary process for assessing medical schools outside the U.S. that primarily enroll Americans and a mechanism that could oversee the U.S. clinical training of medical students enrolled in foreign medical schools.

• Actively assisting medical education and training in other countries, especially those in less developed countries.

Efforts are also underway by government and university systems to remove a number of barriers to entering the medical profession, or at least alleviate some of the pressure on existing doctors:

• In Maryland, where some counties are experiencing “critical shortages”—with 13 fewer doctors per 100,000 patients than the state average—hospitals have joined eCare programs, wherein Delaware-based physicians electronically monitor critical care patients and report anomalies and emergencies to onsite nursing staff. Officials have also undertaken to increase the number of slots available in state medical schools, though that may not take effect for a number of years.
  
  
• Indiana University has instituted plans to grow medical school enrollment statewide by 30%. This will be done with the aid of a $5 million injection of funding by the state. Indiana projects a shortfall of 1,975 doctors by the year 2015.
  
  
• Action has also been taken on the federal level, with the introduction of the United States Physician Shortage Elimination Act of 2007. Though the bill is currently stalled in committee, if passed, it would:12

• Authorize appropriations to carry out the National Health Service Corps Scholarship Program and Loan Repayment Program and assist individuals from disadvantaged backgrounds to undertake education to enter a health profession.
  
  
• Allow the Secretary of Health and Human Services to make grants to community health centers to establish new or alternative-campus accredited medical residency training programs. 
  
  
• Allow the Secretary to make grants to increase primary health care capabilities through the construction, expansion, or renovation of facilities.

There is little consensus in the health care world as to the degree to which these measures will positively impact the oncoming shortfall. Some argue for greater inclusion of physician assistants in the process to alleviate the workload on physicians, while others claim the expansion of the medical student population is impossible without concurrent expansions of the medical school instructor population and a greater number of residencies in hospitals across the nation.

Questions also remain as to the impact that future changes to the national health care system will have on supply and demand, not to mention technological advances. Though there are few certain answers, it is generally agreed upon that the American healthcare system, with regards to its supply of physicians, is at the beginning of a period where cooperation between patient, governmental, professional, and other organizations will be required to make it through, and flexibility  will lead to the largest dividends.