The Doctor Can’t See You Now

As Baby Boomers celebrate their 65th birthdays at the rate of one every eight seconds, the nation’s physician shortage is growing. “This is not a surprise, of course, but I hope that the oft-repeated statistic will force our nation and our government to face the harsh reality of America’s current physician shortage, our growing underserved populations, and the dismal issue of access for those newly insured after 2014 under provisions of the Patient Protection and Affordable Care Act,” said Cecil B. Wilson, M.D., and president of the American Medical Association (AMA).

According to Wilson, the AMA anticipates that the nation will be short by at least 125,000 physicians by 2025.  This year, 22 states and 17 medical specialty organizations are reporting dwindling numbers of practitioners.  Many physicians have so many patients that they have to limit the number of Medicare enrollees they can see because reimbursement rates are not high enough to make a profit.  “For decades, we have watched the physician population move into cities and high-population areas, leaving vast areas of this country woefully underserved,” Dr. Wilson said.  “There still is a primary-care shortage — at least partially because pay differentials for primary-care physicians make it even more difficult to repay medical school debts, which average $155,000.  We see an even larger shortage in the Hispanic, black and other minority communities — partly because of high medical school costs but also because there are few role models for those kids.  And then there is 2014, the year of shrinking access.  That year, when the full provisions of the health reform law kick in, we will see 32 million more patients — people who up to now have been uninsured and often without a physician.”

Complicating the situation is the fact that the Department of Health and Human Services estimates that as many as 33 percent of physicians practicing today will retire over the next 10 years.

The outlook for primary-care physicians is especially grim, according to the Association of American Colleges (AAMC). The AAMC estimates that the nation will need an estimated 45,000 primary-care physicians and 46,000 surgeons and medical specialists once the new healthcare law is fully implemented.  “It’s certainly the worst (shortage) that we’ll have seen in the last 30 years,” said AAMC chief advocacy officer Atul Grover.  “For the first time since the 1930s, our number (of physicians) per capita will start to drop in the next couple of years.  That’s fewer doctors per person, but at the same time, since people are aging and have more chronic illnesses, each person is going to need more healthcare.  That’s a pretty bad situation.”

At present, the United States has 709,700 physicians (in all specialties) with a demand for 723,400 – that’s a shortfall of 13,700 doctors.  By comparison, in 2020, there will be 759,800 physicians (in all specialties) with a need for 851,300 physicians; essentially that represents 91,500 too few doctors.  Once healthcare reform kicks in, 32 million more Americans will have access to medical insurance and 36 million to Medicare.  “As more people get insured, they are going to seek out the care they probably should have been getting all along but haven’t been able to necessarily access.  That’s why those numbers look worse in the next 10 years than we previously had estimated,” Grover said.

Peter J. Weiss, M.D., respectfully disagrees.  In fact, he thinks that the physician shortage is all in the AMA’s Dr. Wilson’s head. “It’s simple, when the doctor supply goes up — the amount of care, and the profits, rise too,” according to Weiss.  “I’m not blaming physicians for this problem, the causes of inappropriate care are complex, but if we just got rid of unnecessary care, would we have a ‘physician shortage?’  Lastly, historically doctors have acted aggressively to protect their turf – both as a profession and within specialties.  How much routine healthcare could be rendered by nurse practitioners, nurses, pharmacists and other more numerous and less costly providers?  Studies suggest that a huge fraction of care doesn’t need to be rendered by a doctor, but what prevents this?  You know the answer — the physician lobby.”

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