Posts Tagged ‘physician shortage’

Everybody’s Warming to Telemedicine

Tuesday, May 15th, 2012

Tired of feeling sick but worried about the cost of a doctor’s visit? A rural Minnesota woman recently logged onto an Internet site run by NowClinic Online Care, a subsidiary of health insurer UnitedHealthcare, and “met” with a doctor in Texas.  According to Kaiser Health News, after talking with the physician via text message and by telephone, the woman was diagnosed with an upper-respiratory infection and prescribed an antibiotic.  .The doctor’s “visit” cost just $45.  “I was as suspicious as anyone about getting treated over the computer,” said the woman, who did not have healthcare insurance.  “But I could not have been happier with the service.”

NowClinic, which debuted in 2010 and currently operates in 22 states, is part of the upsurge of Web- and telephone-based medical services that experts believe is transforming the delivery of primary healthcare.  The movement gives consumers easier access to reasonably priced, round-the-clock care for routine problems — often without having to leave home or work.

Insurers such as UnitedHealthcare, Aetna and Cigna, and employers such as General Electric and Delta Air Lines are getting on board, advocating telemedicine as a way to make doctor “visits” cheaper and more easily available.  Proponents also see it as an answer to a deteriorating physician shortage.  Nevertheless some physician and consumer groups worry about the trend.  “Getting medical advice over a computer or telephone is appropriate only when patients already know their doctors,” said Glen Stream, president of the American Academy of Family Physicians.  “Even for a minor illness, I think people are going to be shortchanged.”

Carmen Balber, a spokeswoman for Santa Monica-based Consumer Watchdog, is concerned that lower co-payments will cause people to see doctors or nurses online just to save money.  “People will choose the more economical option, even if it is not the option they want,” she said.

Employers are getting mostly positive reviews.  “Our employees just love the convenience, the low cost and the efficiency,” said Lynn Zonakis, managing director of health strategy and resources at Delta Air Lines, which offers NowClinic for $10 a consultation.

The global telemedicine business is projected to almost triple to $27.3 billion in 2016, according to a report by BBC Research.  “Virtual care is a form of communication whose time has come and can be instrumental in fixing our current state of affairs within the healthcare system,” said Robert L. Smith, a family doctor in Canandaigua, NY, and co-founder of NowDox, a telemedicine consulting firm.  The field developed gradually over four decades as a way to deliver care to geographically isolated patients.  That’s changed over the past 10 years thanks to the development of high-speed communications networks and the push to cut health costs.  “It’s the wave of the future,” said Joe Kvedar, director of the Center for Connected Health, founded by Harvard Medical School.

Just one major hurdle remains: Many state medical boards make it complicated for doctors to practice telemedicine, particularly interstate care, by requiring a prior doctor-patient relationship, according to Gary Capistrant, senior director of public policy at the American Telemedicine Association.  “The situation seems to be getting worse, not better.”  He cited a 2010 ruling by the Texas Medical Board that effectively blocked a physician from treating new patients via telemedicine.  The sole exception is in cases where the patient has been referred by another physician who evaluated him or her in person.  “It’s about accountability,” said Dr. Humayun Chaudhry, CEO of the Federation of State Medical Boards.  State boards insist on licensing doctors treating patients in their states so that if patients are injured, they have a state agency they can go to for help.

“We want to enable telemedicine to flourish, but at the end of the day we want patients protected,” Chaudhry said.

OptumHealth, a UnitedHealth Group subsidiary that operates the NowClinic, said it leaves it to physicians to determine if they can diagnose a patient via computer.  “This is not intended to replace the intimacy of the doctor-patient relationship,” said Chris Stidman, senior vice president.  The company did not reveal the number of people have used the service or how many physicians it employs.

Medical School Enrollment on the Rise

Tuesday, November 1st, 2011

More young Americans are deciding to become physicians during a tough jobs market, even though they tend not to choose the high-demand primary care.  American medical schools were pleased when they received a record number of applications in 2011.  Applicants increased by 1,178, or 2.8 percent, according to the Association of American Medical Colleges (AAMC).  Fully 43,919 men and women applied to U.S. medical schools this year, including 32,654 first-time applicants, according to the Washington, D.C.-based AAMC.  First-year enrollment increased by three percent to 19,230, a rise of 18,665 when compared with 2010.

A vital highlight is the larger number of African-American applicants, following a 0.2 percent decline in 2010.  Those numbers grew by 4.7 percent to 3,640 in 2011, while enrollees rose by 1.9 percent to 1,375.  The number of Hispanic/Latino applicants also grew by 5.7 percent to 3,459, with enrollment rising by 6.1 percent to 1,633.  Asians comprised 22.7 percent of the total applicant pool; applicants who identified themselves as white made up 62.3 percent of the total.

Meanwhile, first-time female applicants grew 3.3 percent to 15,953, while female enrollment increased by 3.2 percent to 9,037.  The number of first-time male applicants increased by 1.9 percent for a total of 16,698 applications with 10,193 enrollees, a 2.9 percent increase when compared with 2010.  AAMC said medical schools attract well-qualified applicants, noting their academic profiles included an average grade-point average of 3.5 and an MCAT score of 29.

“We are very pleased that medicine continues to be an attractive career choice at a time when our healthcare system faces many challenges, including a growing need for doctors coupled with a serious physician shortage in the near future,” said Darrell G. Kirch, M.D., AAMC president and CEO.  “At the same time the number of applicants is on the rise, we also are encouraged that the pool of medical school applicants and enrollees continues to be more diverse.  This diversity will be important as these new doctors go out into communities across the country to meet the health care needs of all Americans.

“U.S. medical schools have been responding to the nation’s health challenges by finding ways not only to select the right individuals for medicine, but also to educate and train more doctors for the future.  However, to increase the nation’s supply of physicians, the number of residency training positions at teaching hospitals must also increase to accommodate the growth in the number of students in U.S. medical schools.  We are very concerned that proposals to decrease federal support of graduate medical education will exacerbate the physician shortage, which is expected to reach 90,000 by 2020,” Kirch said.

Wait a minute!  The Council on Physician and Nurse Supply disagrees, noting that the U.S. will be short 200,000 physicians by 2020. “According to recent data, physician demand seems to be a real crisis,” said Onyx M.D. CEO and Chairman Robert Moghim, M.D.  “Not only is the overall physician shortage a major problem but certain specialties will be hit harder than others, especially primary-care specialists.”

In fact, the AMA announced that the number of primary-care physicians (PCPs) could decrease by 35,000 to 40,000 by 2025.  Apparently PCPs are becoming increasingly frustrated in many areas of their practice.  “Dealing with third-party payers, governmental red tape, slowness in receiving reimbursement and increased time spent with non-clinical paperwork seems to be driving this discontent,” said Monty McKentry, VP of Client Services & Recruitment at Onyx M.D.  He notes that, “These factors may be the cause of the newly reported data from the Journal of the American Medical Association that only two percent of current medical students intend to go into primary care.”

To make this situation even worse, there is a growing concern that one new physician entering the work force may not equal the productivity of a retiring physician.  This can be attributed to a cultural shift to a better work-life balance, shorter working hours and increased demand for more part-time work.  With the anticipated shortage in primary-care physicians, demand will increase for short-term coverage or locum tenens (a place-holder).  “We anticipate a wide variety of new opportunities as primary care physicians look for other alternatives such as locum tenens, Moghim said.”

Finally, Kirch highlighted programs that provide scholarships and loan forgiveness in exchange for working as general practitioners in the nation’s underserved areas.  According to Kirch, more funding is needed for these programs, and payments to primary-care physicians for services should be increased.

Is the Physician Shortage Easing?

Wednesday, June 29th, 2011

The current physician shortage has implications in terms of a lack of medical care for a greater number of insured patients over the next few years, physician workload, and difficulties with recruitment.  There is, however, hope on the horizon.  Enrollment in family residency programs rose in 2011, rising 11 percent from 2010.  The University of California, San Francisco (UCSF), saw a 20 to 25 percent increase in medical applicants, according to Kaiser Health News. “Primary care has always had the strongest connection with public service and a public health agenda,” said Andy Bindman, professor of medicine at UCSF and chief of general medicine at San Francisco General Hospital.

According to Kaiser Health News’ Jenny Gold, “As the shortage of primary care doctors worsens in the U.S., experts are carefully tracking the interest of today’s medical students and residents in primary care, to see if a new generation of family doctors might be emerging.  By 2020, the Association of American Medical Colleges predicts that the country will be short 45,000 primary care physicians.  Some say the focus on primary care in the federal health overhaul law, called the Affordable Care Act, deserves much of the credit for rising interest in family medicine.”

Where will future doctors come from?  Today’s teenagers show little interest in healthcare and science careers, according to an online survey by Harris Interactive for University of Sciences. Forty-nine percent of 9th to 12th graders definitely or probably would not consider a career in healthcare or science, an 8.9 percent increase from the previous year.  Sixty percent of younger teens (age 13 – 15) also said they were not interested.  The survey found that those who were interested in pursuing healthcare- and science-based careers were primarily women and minorities.  Respondents interested in healthcare careers cited reasons, including financial motivations (“earning good money”), general interest, and public service (“want to help people”).  “It is essential that the sciences remain top of mind for America’s teenagers,” said Russell J. DiGate, Ph.D, provost at University of the Sciences.

The fact that states are slashing their budgets could force medical schools to cut back on admissions in 2012 is making a bad situation worse.  Texas medical schools are facing $500 million in combined cuts in the 2012-13 academic year, making them unable to fully fund students already enrolled, reports the Texas Tribune.  These schools are poised to see state payments for medical education fall by more than $12,000 per student per year, putting future admissions on the chopping block.

Some sources are not so certain that an end to the physician shortage is at hand.  Twenty-three percent of general internists and 40 percent of subspecialists are not renewing their internal medicine board certification,  according to research from the Journal of American Physicians and Surgeons. Older physicians especially will stop practicing than recertify, faced with extensive requirements and time commitments.  According a 2009 Association of American Physicians and Surgeons (AAPS) survey, just 30 percent reported that recertification improved their performance; just 22 percent would voluntarily do it again.

“This number will most likely increase as these processes become more expensive and more time-consuming, and continue not to reflect clinical practice,” Dr. Martin Dubravec said.  “Recertification has become a cottage industry of bureaucrats and testing agencies, dragging with them a few university physicians,” said AAPS President Lee Hieb.  “Accrediting bodies increasingly require continuous physician competency, and more boards require certification.  Hesitant physicians exiting practice could pose a significant problem that would leave a vacuum for physicians during times of shortage.”

“We cannot afford to drive our most seasoned, experienced physicians into early retirement,” said AAPS executive director Jane M. Orient, M.D. “They simply cannot be replaced.”

The Doctor Can’t See You Now

Tuesday, February 22nd, 2011

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.”

Watson Supercomputer Could Revolutionize Medicine

Monday, February 21st, 2011

There has been significant buzz about the IBM supercomputer Watson’s recent appearances on the television quiz show “Jeopardy” and whether the machine will beat Ken Jennings and Brad Rutter, the program’s two superstars. While Watson’s celebrity may be cemented by its television appearances, the supercomputer also has the possibility to transform medicine.  Writing in USA Today, Yong Suh, a medical student at the Johns Hopkins University School of Medicine, says that “The company that revolutionized the personal computer industry in the 20th century has the potential to do the same for healthcare in the 21st century.”  Watson was the victor, winning with a commanding lead of $77,147.

According to Suh, “Performing well on ‘Jeopardy’ and diagnosing sick patients have similar prerequisites: a broad fund of knowledge, ability to process subtlety and ambiguity in natural language, efficient time management, and probabilistic assessment of different possibilities.  Like ‘Jeopardy’ clues, a patient’s symptoms, medical history, physical exam findings and laboratory results present clues that must be synthesized into a differential diagnosis.  While computer systems to assist clinical decision-making have existed for decades, adoption of legacy systems has been hindered by rigid algorithms that require translation of natural language into machine language and heavy reliance on user input.”

Watson has the ability to address two serious problems in healthcare today: deaths due to medical errors and shortage of physicians.  The Institute of Medicine (IOM) has reported that as many as 98,000 deaths a year are due to medical errors – making them the fifth leading cause of death.  Misdiagnosis is frequently the result of cognitive errors physicians make.  Watson’s advanced memory and ability to process information means it can analyze all medical evidence, and minimize bias when making diagnoses.  In terms of the physician shortage, Watson could become a significant technology that forces the medical community to rethink how patients interact with healthcare providers and how the delivery system is organized.

A somewhat contrary view of Watson’s potential for enhancing healthcare is presented by Fahmida Y. Rashid on the website “Medical Center.”  According to Rashid, “Of course, the enormity of the hardware and the algorithmic advances required to make a truly ‘revolutionary’ tool such as this are obviously staggering. Considering that it takes 10 racks of multiprocessor IBM servers with 15 terabytes of memory and a team of varied domain experts writing algorithms for several years to accomplish the NLP advances and lookups to answer ‘Jeopardy’ style trivia questions, one can only imagine what a truly useful cybernetic medical assistance system would look like.  It should also be remembered that Watson does not think.  Humans do.  I believe a machine even close to passing a ‘New England Journal of Medicine Turing test’ (a measure of a machine’s ability to demonstrate intelligence will be a long time in coming.  Until then, we should be encouraging better support for human physicians struggling to use their medical expertise in a sea of bureaucracy, stress and overwork (part of which will increasingly be a struggle with mission-hostile health IT).”

More and more frequently, physicians are using hand-held devices – such as smart phones – to access information on their patients.  This way, they do not have to rely on memory to determine exactly what medications a particular patient is taking.

Johns Hopkins’ Suh also notes that “The prospect of using Watson in medicine also raises some difficult questions.  What will be the new roles for physicians, nurses, technicians and other healthcare professionals when the current hierarchy, delineated by varying levels of medical knowledge, is flattened by an intelligent machine?  What will be the impact on the practice of humanistic medicine?  How will patient outcomes be affected by patient-machine interactions? Who will be held accountable for medical errors that arise from decisions made by a machine?”  Only time will tell.

Dr. David Donnersberger on Solving the Primary Care Crisis

Wednesday, November 3rd, 2010

Is concierge medicine the answer to healthcare?  Listen to Dr. David Donnersberger’s podcast.  Physicians who practice concierge medicine are reimbursed for spending significant time with their patients, knowing them extremely well and following them closely through every hospitalization.  This is the opinion of Dr. David Donnersberger, an internal-medicine specialist in private practice in Winnetka, IL, who is affiliated with the University of Chicago’s Pritzker School of Medicine.  In a recent interview for the Alter+Care Inspire Podcasts, Dr. Donnersberger described boutique or concierge VIP medicine as a return to a personal approach to healthcare where the physician knows the patient, their social situation and their health history.

In concierge practices, patients pay a flat annual fee and receive an expanded suite of services that includes the ability to call the physician on his cell phone at any time, obtain same-day appointments and – most importantly – receive personal care from the primary-care doctor when hospitalized.  Dr. Donnersberger notes that the current reimbursement system pays more to the radiologist and the radiology department for a chest X-ray than for an hour-long conversation and annual physical exam of the patient in the doctor’s office.  He believes that more information can be gleaned from that extensive conversation and physical exam, and serves as the starting point for years of personalized healthcare.

Practitioners of concierge medicine tend to have smaller practices than other physicians.  While a typical primary-care physician may have 2,000 to 2,500 patients, Dr. Donnersberger and his three partners have a smaller load of between 1,200 and 1,500 individuals.  Dr. Donnersberger’s practice is a hybrid – one which accepts patients who pay the upfront flat fee as well as others who rely on their healthcare insurance for reimbursement.  Concierge medicine’s most powerful tool is its ability to control costs.  Knowledge of a patient’s medical history can save money because the physician is keenly aware of pre-existing conditions that become crucial whenever that individual is hospitalized. This in-depth knowledge also saves the healthcare system thousands of dollars of workups that otherwise would have to be performed.

Healthcare Reform Underscores Primary-Care Physician Shortage

Wednesday, April 28th, 2010

United States faces a shortage of 40,000 primary-care physicians over the next 10 years.  As the ink dries on President Barack Obama’s landmark healthcare reform legislation, the nation is facing a physician shortage that will only worsen in coming years as 32 million Americans who previously lacked coverage obtain insurance coverage.  A recent report predicts a shortfall of approximately 40,000 primary-care physicians over the next 10 years. A provision in the new law is intended to provide a boon to the profession, ranging from bonus payments to expanded community health centers that will pick up the slack.

For patients, one possible solution could be a medical home, which would improve access with a physician-led team of nurses, physician assistants and disease educators.  “A lot of things can be done in the team fashion where you don’t need the patient to see the physician every three months,: according to Dr. Sam Jones of Fairfax Family Practice Centers in Virginia.  “We think it’s the right thing to do.  We were going to do this regardless of what happens with healthcare reform.”

Just 30 percent of American doctors are in primary care, with 65 million Americans living in areas designated as having a shortage of these physicians.  More than 16,600 new physicians are needed to close this gap in these mostly rural regions, according to the federal government.  One provision of the new healthcare bill is a 10 percent Medicare bonus for primary-care physicians who choose to practice in these underserved regions.

Does the High Cost of Medical School Deter Would-Be Physicians?

Tuesday, March 2nd, 2010

Dr. Michelle Bisutti will be paying off new student loans for medical school until she’s 70.  One reason for the nation’s physician shortage could be the cost of attending medical school.  Columbus, OH, family practitioner Dr. Michelle Bisutti ended up owing $550,000, thanks to a combination of putting off loan payments, default charges and compounding interest rates. “Maybe half of it was my fault because I didn’t look at the fine print,” Dr. Bisutti said.  “But this is just outrageous now.”

As tuitions soar, many attending medical school borrow significant dollars to pay for their education.  Unfortunately, student loans are one of the most toxic debts in existence and require extreme consumer caution and – as Dr. Bisutti learned the hard way – responsibility.  Additionally, the idea of not paying back student loans is virtually impossible because collection agencies typically are tapped to recover the money.  While lenders may trim payments, it is virtually impossible to have fees or principals waived.

Martha Holler, a spokesperson for SLM Corporation (also known as Sallie Mae), the nation’s largest private student lender, notes that loan terms, including interest rates, are disclosed “multiple times and in multiples ways”.  Sallie Mae’s website provides easy access to repayment tools and account information.

Dr. Bisutti is unhappy about the number of student loans she took, the missed payments deferring payments and the fact she didn’t completely fill out required paperwork.  Still, she didn’t like that the variable interest rates soared from three to 11 percent while she was in medical school.  She borrowed the maximum $152,000 from the federal government, took private loans from Sallie Mae, as well as two $20,000 loans from Wells Fargo & Company.  Ultimately, Dr. Bisutti’s father – who had co-signed the loans – agreed to pay $550 a month for one year.  Dr. Bisutti entered into a rehabilitation agreement on her defaulted federal loans, which now have a $31,942 collection cost.  She pays every month on those loans – now totaling $202,399 – at a rate of $990 a month.  Only $100 of that pays the original balance; the remainder pays the interest rates.  Dr. Bisutti’s federal loans will be paid off in 351 months.  At that time, the 41-year-old physician will be 70 years old.

Healthcare’s Best-Kept Secret: Nurse Practitioners

Thursday, August 13th, 2009

If healthcare reform is to successfully overcome the realities of Washington politics, there is one problem in covering the millions of Americans who lack insurance coverage – the physician shortage.  Currently, there is a 30 percent shortage of primary-care physicians, and with less than 10 percent of 2008 medical school graduates choosing that career track.  When Massachusetts enacted mandates for universal health insurance in 2006, the state’s primary-care physicians48019286 were overwhelmed.  A similar scenario could occur on a national scale.

Nurse practitioners — who have advanced nursing degrees, are licensed by the state and often are allowed to prescribe medications — may fill that void because they can treat and diagnose patients at less cost than physicians.  Medicare reimburses nurse practitioners at 80 percent of what they pay doctors for similar services.

Nurse practitioners are vital to healthcare reform because they focus on patient-centered care and preventive medicine.  The House of Representatives has listed nurse practitioners as primary-care providers on their healthcare reform legislation bill.  The profession lobbied intensely to include this legislative language so they can play an important role in a revamped health system.

“We seem to be healthcare’s best-kept secret,” said Jan Powers, health policy director for the Academy of Nurse Practitioners.  Although nurse practitioners typically have less medical education than physicians, they are well trained in skills such as bedside manner and counseling.  “In the United States, we are so physician-centric in our health system.  But it should be about wellness and prevention, not about procedures and disease management,” said Rebecca Patton, president of the American Nursing Association.

Recession Forces Physicians to Rethink Retirement

Tuesday, June 16th, 2009

The recession and its impact on investment portfolios, as well as declining Medicare and Medicaid reimbursements, are making physicians rethink their retirement dates.

Some physicians have seen their stock markets portfolios fall by as much as 50 percent.  In today’s economy, selling practices might not bring the anticipated profit, according to William Jessee, M.D., president and CEO of the Medical Group Management Association.  “I look at my 401(k) and think ‘Okay, I just turned 62, and 70 is starting to look like a better retirement field,'” Dr. Jessee said.20071003_nest_egg_18

A 2007 survey of 1,200 physicians found that 48 percent aged 50 to 65 were planning to retire, find non-clinical jobs, work part-time, close their practices to new patients and/or substantially reduce their patient load.  Since the survey was conducted, Americans’ retirement funds have lost as much as $2 trillion.

“It has not been entertaining watching all my hard-earned money disappear,” according to Jeffrey Sankoff, 41, a Denver physician.  “But I’ve got about 10 to 15 years before I need to worry because my 401(k) will just sit there and eventually recover and grow.  Those physicians closer to retirement age – hopefully their portfolio is balanced in such as way that this catastrophe won’t have as big of an impact as it’s had on me.”

The silver lining in these deferred retirements is that they could prevent a physician shortage, a result of medical schools capping their enrollments at 16,000 students per year because they believed that managed care would create a glut.  It is estimated the shortage could be as much as 250,000 physicians in the next 10 years.