Ken’s Take: Whenever my family talks about how the healthcare system is broken, the conversation usually centers on how hard it is to get an appointment to see a doctor. Turns out, doctors are in short supply – it’s not just an illusion. And, healthcare reform proposals add to demand (more people insured to get more services), but don’t add to the supply of doctors and other medical professionals.
Side note: A friend reminded me that MDs are among the 45 million uninsureds – they often comp services to each other, so don’t need garden variety health insurance. That’s about 1 million out of the 45 million.
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Excerpted from USA TODAY, Medical miscalculation creates doctor shortage, March 21,2005
Many Americans may soon face a shortage of physicians that makes it hard to find convenient, quality health care. The shortage will worsen as 79 million baby boomers reach retirement age and demand more medical care unless the nation starts producing more doctors, according to several new studies.
The country needs to train 3,000 to 10,000 more physicians a year — up from the current 25,000 — to meet the growing medical needs of an aging, wealthy nation, the studies say. Because it takes 10 years to train a doctor, the nation will have a shortage of 85,000 to 200,000 doctors in 2020 unless action is taken soon.
The predictions of a doctor shortage represent an abrupt about-face for the medical profession. For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians.
The nation now has about 800,000 active physicians, up from 500,000 20 years ago. They’ve been kept busy by a growing population and new procedures ranging from heart stents to liposuction.
But unless more medical students begin training soon, the supply of physicians will begin to shrink in about 10 years when doctors from the baby boom generation retire in large numbers.
“Almost everyone agrees we need more physicians … The debate is over how many.”
The United States dramatically expanded the number of doctors being trained in the 1960s and 1970s, creating two new physicians for every one that retired.
Today, new physicians roughly equal the number of doctors retiring. Within a decade, baby boom doctors licensed in the 1960s, 1970s and 1980s will retire in large numbers that will outstrip the 25,000 new doctors produced every year.
The marketplace doesn’t determine how many doctors the nation has, as it does for engineers, pilots and other professions. The number of doctors is a political decision, heavily influenced by doctors themselves.
Congress controls the supply of physicians by how much federal funding it provides for medical residencies — the graduate training required of all doctors.
To become a physician, students spend four years in medical school. Graduates then spend three to seven years training as residents, usually treating patients under supervision at a hospital.
Medicare, which provides health care to the nation’s seniors, also is the primary federal agency that controls the supply of doctors. It reimburses hospitals for the cost of training medical residents.
The government spends about $11 billion annually on 100,000 medical residents, or roughly $110,000 per resident.
In 1997, to save money and prevent a doctor glut, Congress capped the number of residents that Medicare will pay for at about 80,000 a year. Another 20,000 residents are financed by the Veterans Administration and Medicaid, the state-federal health care program for the poor. Teaching hospitals pay for a small number of residents without government assistance.
Demographic changes in the medical profession also contribute to the need for more physicians. Nearly half of new physicians are women, who work an average of 25% fewer hours than male physicians, Cooper says.
Physicians older than 55 work about 15% less than younger doctors.
Most worrisome, the retirement of baby boom physicians means the number of doctors will start falling just as the first baby boomer turns 70 in 2016.
Because physicians are affluent and in short supply, they tend to locate where they want to live — not necessarily where the most patients are.
Particularly scarce are old-fashioned specialists — general surgeons, radiologists, anesthesiologists — who have a wide range of duties.
Doctors gravitate to high-paying practices — such as sports medicine and total body scans — that serve the wealthy and well-insured at the expense of Medicare patients and others.
“This is a desperate situation. And we need to act now because it takes a long time to train a doctor.”
The U.S. stopped opening medical schools in the 1980s because of the predicted surplus of doctors.
Florida State University’s College of Medicine, the first new medical school since 1982, will graduate its first class this year. Arizona, Nevada, California and Florida are considering opening additional medical schools. Other states are considering expanding theirs.
http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm
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