Alarm bells have been sounding for years about the shortage of physicians in the United States. Based on recent studies, those bells have become sirens.
The Association of American Medical Colleges (AAMC) has long been warning about this quandary, but the most current data suggests a serious tipping point is about to be reached.
Within a decade, it is expected the country will experience a shortage of somewhere between 54,000 and 139,000 physicians. Many of these will be primary care physicians (PCPs), critical professionals on the frontline of the healthcare system.
In some areas of the country, that tipping point is in the rearview mirror. A study this spring in the Annals of Internal Medicine estimates that 7,200 lives a year are lost due to the lack of access to PCPs.
Most of those lives lost occur in underserved counties, that is, where there is less than one physician available for every 3,500 people.
Obviously, geography figures in here, as rural counties are disproportionately understaffed. But economics, as always, has a role in this situation. With the cost of medical school, physicians often choose specialized fields in order to more quickly retire six-figure education loans. The new reality is that fewer medical students are choosing the PCP route: of the 18,000 most recent graduates, only 25 percent were aiming at that level of practice.
“There are few incentives to go into primary care,” said Sanjay Basu, MD, Director of Research at Harvard Medical School Center for Primary Care. “Pay tends to be lower, burnout rates higher, and prestige lower.”
This declining number causes repercussions across the entire healthcare apparatus. That’s because PCPs offer a foundational service: preventative care, early identification of serious illness, and appropriate medication management saves lives, and it also staves off more complicated procedures which stress already over-stressed resources.
“We pay less for prevention than treatment,” Dr. Basu said.
Snarling all these matters further is the factor the AAMC contends is the most important dynamic in this equation — we are getting older. As the population ages, there is an increasing prevalence of chronic disease; seniors have a much higher rate of demand for medical care than any other demographic.
The Baby Boomers, now into their seventies, are going to pressure healthcare delivery in ways never before seen. “It’s going to impact virtually every sector and specialty, with the possible exceptions of OB and pediatrics,” Geriatrician Maura Brennan, MD, stated. “We’re going to see increasing numbers of old people. Not all of those folks are going to be frail and complicated, but there will be an increasing number of people with multiple medical problems.”
The patients are not alone in aging — practicing physicians are also on-the-clock. The average age of a physician today is 52, but 15% are older than 65.
The inevitable wave of physician retirement will reconfigure the paradigm in an unpredictable manner.
Hastening retirement is the contemporary environment in which physicians operate: flat or declining reimbursement, ever increasing regulation, and massive paperwork have significantly lowered morale in the medical community. According to a survey conducted by Merritt Hawkins, “over 60 percent of physicians 46 and older have negative feelings about the current state of the medical profession, while 54 percent either feel somewhat negative or very negative about the future….”
Consider also the savage impact the Wu Han virus has had on depleting medical care services. Whatever volatile conditions existed prior to the first quarter of 2020 have become immeasurably worse. “The Covid-19 pandemic has highlighted many of the deepest disparities in health and access to healthcare service,” AAMC President and CEO David Skorton, MD declared. “It has exposed vulnerabilities.”
Covid-19, despite its devastating nature, provided a glimpse of a tool which will prove useful in the future — the increased use and acceptance of telehealth. Its potential for improved access for underserved regions is promising.
But “promising” isn’t a comprehensive resolution: much more sustained attention by both the private and public sectors is mandatory to avoid an approaching train wreck.
Again, Dr. Skorton: “Addressing the physician shortage requires a multipronged solution that starts with educating physicians to meet America’s needs…now more than ever, the nation must make a long-term investment in the healthcare workforce. The time to act is now.”