Substantial physician shortage expected over next decade

Issue: May 10, 2015

A national shortage of between 46,000 and 90,000 physicians is projected by 2025, affecting primary care, surgical care and other medical specialties, according to a report released by the Association of American Medical Colleges.

Perspective from Robert Centor, MD, MACP

“The doctor shortage is real — it’s significant — and it’s particularly serious for the kind of medical care that our aging population is going to need,” Darrell G. Kirch, MD, AAMC president and CEO, said in a press release.

Darrell G. Kirch

In collaboration with IHS — a publicly traded company that provides comprehensive economic modeling and forecasting services — the AAMC published a report on the projected future supply and demand of physicians in the United States. The report pinpoints key trends that are likely to affect heath care services and physician demands, such as retirement, mortality patterns, specialty mix and demographics of new physicians, current numbers and work patterns in patient care hours. Individual specialties were categorized as primary care, medical specialties, surgical specialties and “other” specialties.

Physician demand has a projected growth of between 11% and 17%, while physician supply is projected at 9% growth. These trends will lead to a shortage of 46,100 to 90,400 physicians by 2025. Specifically, shortages are projected to be between 12,500 and 31,100 for PCPs and between 28,200 and 63,700 for nonprimary care physicians. These shortfalls are expected despite anticipated increases in advanced practice registered nurses (APRNs) and physician assistants (PAs). The projected physician shortage could be in the lower range and hinge on the growth supply of APRNs and PAs.

Researchers said the Affordable Care Act, which expanded coverage to nearly 26 million previous uninsured people, is likely to be the cause of a projected 2% increase in physician demand. This projects a demand increase of 3.2% in surgical specialties, 2% in primary care, 1.7% in medical specialties and 1.5% in all “other” specialties.

“The trends from these data are clear — the physician shortage will grow over the next 10 years under every likely scenario,” Kirch said in the release. “Because training a doctor takes between 5 and 10 years, we must act now, in 2015, if we are going to avoid serious physician shortages in 2025.

“The solution requires a multipronged approach: Continuing to innovate and be more efficient in the way care is delivered, as well as increased federal support for graduate medical education to train at least 3,000 more doctors a year to meet the heath care needs of our nation’s growing and aging population.” – by Casey Hower

Reference:

IHS/Association of American Medical Colleges. The complexities of physician supply and demand report: Projections from 2013 to 2015. 2015; Available at: https://www.aamc.org/download/426242/data/ihsreportdownload.pdf.

Disclosure: The researchers report no relevant financial disclosures.

Perspective

Robert Centor, MD, MACP

The physician shortage has been true for 20 years. This has to do with how uncomfortable this job is becoming, from an administrative point of view. The job is tremendous; it is a great privilege to be a primary care physician. But the insurance companies, which include both private and government insurance, administrative hassles, new computer concerns, all of these are making this job, for some physicians, less pleasurable.

Medical schools have done a great job at increasing the number of students, both MD and DO programs, along with international graduates that want to come here to train. The looming factor is the lack of residency slots.

More and more physicians are employed rather than in private practice, which has a huge effect also. If someone hires me to be an outpatient internist, they also tell me how many patients I am supposed to see, so we have this ongoing conflict. Instead of being paid to do a job, we are paid piece-meal for the number of patients we see. And that means that if I am not in charge and someone else is deciding how to pay me, they influence me to see patients too fast. If I see patients too fast, I am less satisfied because it takes a certain amount of time to do the job right, and if you can’t spend enough time, it feels like you’ve lost control, and when that happens you feel burnt-out. So not only are less people choosing to go into these fields, but they are also retiring earlier because, for many physicians, all the burdens really get to them.

We also need to train more doctors. Everyone told us we needed more doctors. The AAMC [American Association of Medical Colleges], to their credit, started increasing the number of medical students, we started creating new medical schools and DOs are creating new schools. Most medical schools have increased their enrollment. But then you get to the match and we have a significant number of U.S. graduates who can’t find an internship.

We can’t give people the care they deserve if we don’t have proper training, and right now the lack of training slots is really hampering us. The medical community needs to find funding for more training slots. The only thing stopping us from expanding residency slots is funding. Residencies get most of their funding from CMS combined Medicare/Medicaid services, and they have a cap on how many residency training slots can be offered. We have to be more creative. This is a debate in the medical community, because IOM says we have enough slots; those of us in academic medicine disagree. But as long as we have that debate, it is going to be hard to increase those slot numbers.

Robert Centor, MD, MACP

Chair, ACP Board of Regents

Disclosures: No products or companies are mentioned that would require financial disclosure.