The U.S. is headed for a potential crisis in terms of doctors that will be needed to service the growing population, and some would have us believe that expanded health care is to blame. Is that assertion grounded in reality, or simple partisan rhetoric? Let’s look at the facts.
HOW BIG IS THE PROBLEM?
In 2006, the Association of American Medical Colleges (AAMC) estimated that the shortage of practicing physicians would reach 91,500 by 2020 unless measures are taken to correct the shortage. Their recommendations include expanding medical programs in the U.S. by 30% and expanding residency opportunities to accept the additional influx of prospective doctors.
THE AGING POPULATION
Following World War II, when all the young men returned home in a triumphant wave, birth rates exploded. Nine months later, 3.4 million babies were born. As a result, 1946 saw a 20% increase in population over previ- ous years, and the Baby Boomer generation was on the rise. The birth rate continued to rise every year thereafter until 1964, when the number of newborns finally started to subside and the population explosion waned. More than 76 million American children came into the world during those two decades, representing 40% of the total population. During the late 1950s, 60s, and 70s, the greatest generation achieved adulthood, the economy was strong, and the middle class thrived.
In 2010, the first of the boomers turned 65. Over the next twenty years, 10,000 people will turn 65 every day. By 2030, the number of retirement- aged people will swell to more than 80 million. This will influence the doc- tor shortage in several ways. Approximately 40% of all practicing doctors are currently over 55, and according to the Deloitte 2013 Survey of U.S. Physicians, 60% of them are planning early retirement. That many physicians retiring at once will result in a significant gap in the workforce.
RISING HEALTH CONCERNS
Adding to the problem, baby boomers are living longer, but are not becom- ing more healthy. Approximately 21 million people entering retirement are expected to be obese, and 14 million will have diabetes. Cancer is on the rise, and heart disease is still a major factor among seniors. In terms of care and cost, all of the major health concerns are far more prevalent in older people. Chronic diseases account for 75% of all health care costs and result in 7 out of ten deaths.
Another contributing factor to the doctor shortage is, simply stated, Congressional priorities. “From 1980 to 2005, the population of the United States grew by 70 million people, an increase of 31 percent,” Karl Altenburger, MD, a board member of the Physicians Foundation told Healthcare Finance News. “During that same time, no increase in the num- ber of doctors has been produced.”
Medicare traditionally helps launch new doctors with subsidies to teaching hos- pitals to cover the cost of training and keep hospital technology up-to-date. The Balanced Budget Act of 1997 capped Medicare funds at 1996 levels for most teaching hospitals. This has not been addressed in a meaningful way since, and as a result, teaching hospitals are unable to expand their programs to new residency programs. The ACA did not eliminate the cap, but allowed for an 8% increase, funding training for 300 additional new physicians per year. It’s a start, but the need is far greater. Roughly 10,000 new physicians per year are needed to meet per capita demand.
Without available residency programs, expanding medical schools are reluc- tant to add programs, leaving many frustrated medical students to attend schools in other countries. About 90% of medical school applicants who are turned away and head overseas wind up in Caribbean medical schools, but when they return home they face the lack of residency positions, along with incoming international students.
THE ACA EFFECT
The Affordable Health Care Act (ACA) provides affordable medical insurance to the working poor – people who make too much money to qualify for Medicaid, are too young to qualify for Medicare, are not provided insurance by their employers, and who cannot afford exorbitant private insurance. An estimated additional 32 million people, about 10% of the U.S. population, will benefit from health insurance as a result of the law. It’s a big number, until you look down the road. More people insured today means better preventative care and better control of epidemic outbreaks. Expensive chronic issues like obesity, heart disease, some cancers, and diabetes are more likely to be caught early and addressed, possibly even prevented; potentially saving billions in taxpayer dollars. For low-income families, being able to see a doctor for non-emergency health-care provides better doctor-patient relationships and gives the doctor an opportunity to educate patients about lifestyle choices and early warning signs.
More affordable healthcare will also result in better compliance. Patients who do not adhere to their prescribed medical regimen are costly…the estimated cost of nonadherence ranges from $100 billion to $300 billion per year, a figure that encompasses avoidable hospitalizations, premature death, and admittance to hospice and nursing homes. Insuring more people and lowering the cost of visits and medications is estimated to save billions in avoidable costs. Barriers to adherence include lack of health insurance, associated cots, inadequate follow-up, poor patient understanding, and psychological problems such as depression. The ACA is certainly a contributor to the doctor shortage, but hardly the sole or even the main cause. It can take nearly a decade to train a physician, and the baby boomer retirement age should have come as no surprise to any- one. Balancing the budget is an admirable goal, but blaming Obamacare for causing the shortage is demonstrably false, and repealing the law will not solve the problem.
AN UNFORTUNATE CONSEQUENCE
Today, 25% of our high-paying physician jobs are filled by doctors native to other countries, while decent wage manufacturing jobs are shipped overseas and kids with Bachelor’s degrees are bagging groceries and flipping burgers. If and when Congress does get around to addressing the issue, and the residency programs are funded for more students, the initial students are most likely to be attracted from international schools. With all the bad press surrounding outsourcing, it is grand irony that Congress would continue to ignore this issue. Residency programs should have been expanded to meet foreseeable need at least ten years ago.
THE EVOLVING MEDICAL LANDSCAPE
One response to the doctor shortage is fairly straightforward and already in action. Some states, like South Carolina, allow nurse practitioners to practice inde- pendently if they are in contact with a doctor within a certain distance who is available by phone during operating hours. By shifting routine healthcare to NPs, widely separated rural populations can be better served and doctors can focus on issues that require more expertise.
Technology comes into play with medical teams and patients communicating via telehealth, and there’s a growing trend toward teamwork, with one doctor overseeing a staff of NPs and RNs who absorb the bulk routine care, consulting the doctor as necessary.
For aspiring med students, this can be viewed as a huge opportunity in the not- so-distant future. Student loan debt is at the forefront of the national conscious- ness, and if the current Congress members do not act to ease the burden, their replacements certainly will. The government also must eventually come around to the residency issue.
As part of the healthcare law, in 2010, the Comptroller General of the United States appointed the first 15 members to the National Health Care Workforce Commission. The purpose of this commission is to analyze the medical work-force, identify needs and worker distribution, evaluate education and training, make recommendations to improve coordination at federal, state, and local levels, and make recommendations for innovative ways to address the needs of a growing population, new technologies, and other factors that affect medical care. Three years later, no funding has been appropriated for the commission, so its members have never held a meeting and the mission has yet to begin.
Growing public awareness of the problem will eventually influence policy decisions. Congress cannot ignore the problem forever. Once solutions are implemented and medical residency programs have expanded, we’ll need as many American students in or ready for medical school as possible. Today’s students will take medicine in a whole new direction; this generation cut their teeth on crowdsourcing, technology, and collaboration. They bring a refreshing new attitude to the table, along with the innovative skills to tackle tomorrow’s healthcare challenges.
About the Author: Sherry Gray is a freelance writer who lives in the Orlando, FL area. Science, politics, and medicine are her favorite topics to write about and obsess over.