The United States is facing what could be a deadly shortage of doctors.
A report from the Association of American Medical Colleges (AAMC) a shortfall of 90,000 U.S. physicians by 2025, and the report estimates there will be a critical need for doctors to treat an aging population increasingly subject to chronic diseases in need of specialized care.
Darrell G. Kirch, AAMC’s president and chief executive, told reporters during a telephone news briefing U.S. medical patients are growing older and sicker, living longer with chronic diseases such as cancer, and this is driving an increase in demand.
Unless creative, cost-effective solutions can be found, the looming shortage of doctors could undermine patient care all across the country. The problem is particularly severe in the Midwest and Florida, says Dr. Charles Lockwood, dean of the Morsani College of Medicine and senior vice president of the University of South Florida Health in Tampa.
“Caps on federally funded graduate medical education slots haven’t changed since 1997, even while [numbers of] medical school graduates have grown substantially,” Lockwood said. “That means there are simply not enough [graduate medical education] spots in Florida for all or most of Florida’s medical students to stay here for their residency training, so we are essentially exporting a critical resource already in serious short supply.”
Barriers to Entry a Concern
Devon Herrick, a senior fellow and health care researcher at the National Center for Policy Analysis, says the free market can ease the doctor shortage.
“The medical establishment has long sought to restrict the supply of physicians to keep salaries high. It needs to get out of the way,” Herrick said.
“Scope of practice laws need to be changed in many states,” Herrick said. “Nurse practitioners and physician assistants need a path to independent practice or semi-autonomy, rather than servitude to doctors. Dental hygienists need to be allowed some independent practice. Alaska even allows dental technicians a level of independent practice; mostly they are allowed to treat Inuit, because of a shortage of dentists.”
Herrick also recommends increasing residencies, especially in primary care and other vital specialties.
“There are foreign medical graduates who want a residency in the United States but cannot find one,” Herrick said.
Herrick also says we should remove state and local regulations that inhibit doctors and nurse practitioners from offering services.
“Boston actively fought MinuteClinic when CVS wanted to open 11 clinics in the Boston area,” said Herrick. “The Boston health department didn’t think a nurse in a 10×10 box was the type of care Bostonians needed. Why not allow CVS and patients to decide that?”
Market Distortions Cited
Government-planned, third-party payment systems have created ingrained market distortions and caused an excessive demand in health care, says Dr. Roger Stark, a health care policy analyst at the Washington Policy Center and a retired physician. When someone else pays, there is no incentive for patients to question the price or quantity of services consumed in their care, he says.
“To correct these distortions, we must allow the health care market, not central planners, to determine the number of doctors needed,” Stark said. “We can do this by removing employers and government—except for safety-net programs for the most needy—from health care financing and allowing patients to control their own health care dollars.
“We can accomplish this by changing the tax code, encouraging the use of high-deductible health insurance, encouraging the use of health savings accounts, allowing the interstate purchase of health insurance to increase competition, and means-testing Medicare,” Stark said.
Ken Artz ([email protected]) is managing editor of Health Care News.
“Final Report: The Complexities of Physician Supply and Demand: Projections from 2013 to 2025,” produced by IHS Inc. for the Association of American Medical Colleges, March 2015:https://www.aamc.org/download/426242/data/ihsreportdownload.pdf