Warnings of doctor shortage go unheeded
February 16, 2011 — The shortage of doctors in the United States — already a problem for millions of Americans who live in areas where it is difficult to get an appointment or access to emergency care, and millions more who suffer long wait times only to have abbreviated visits with their physicians — is almost certainly going to become much worse over the next 10 to 20 years.
The current shortage
As of September 2009, at least 80 million Americans lived in areas with a shortage of medical practitioners in at least one field, according the Health Resources and Services Administration. Many of those areas have a lack of access to primary care doctors, dentists, or mental health professionals. In 2006, 30 percent of U.S. counties lacked a single surgeon, according to the American College of Surgeons. Shortages have also been reported in several other fields in recent years, including pediatrics, radiology, and endocrinology.
Additionally, a 2009 survey by the health care consulting firm Merritt Hawkins showed that — even in more than a dozen cities with high physician-to-population ratios — physician appointment wait times had risen considerably, and across a number of specialties, since 2005.
Having failed to increase medical school or residency slots significantly in recent years, the U.S. — with a still growing and fast-aging patient population, and now face-to-face with an impending wave of physician retirements — is poised to suffer even more serious physician shortages in the next decade, with estimates ranging from 90,000 to 200,000 fewer doctors than will be needed.
And because it takes a very long time to yield new doctors from any policy decision aimed at increasing the number of doctors being trained in medical school and the number of residency positions at which those medical schools graduates can get their post-graduate training, the window within which Congress and the medical community can act to avert the onset of a serious shortage is closing rapidly.
Nevertheless, efforts to increase the physician supply in recent years have met with opposition from members of both political parties, and even from some segments of the medical community itself. The result has been a sustained political logjam, leaving advocates worried that before the political will to address the problem develops, the consequences of inaction will be all too apparent.
Physician and patient demographics
Whether considering the projection from the Association of American Medical Colleges (AAMC) of an overall physician shortage of more than 90,000 by the year 2020, or the 2009 report prepared on behalf of the Physicians Foundation put that number at 200,000 by the year 2025, it is not difficult to understand the fundamental reasoning behind these numbers.
First, the number of new physicians entering the workforce each year has not increased dramatically for over two decades.
Second, the U.S. population has been growing substantially — from less than 250 million in 1990 to more than 300 million today, and to a projected 357 million in 2025 and 439 million in 2050.
Third, the number of people over the age of 65 is rising sharply — from about 31 million (12.6 percent of the population) in 1990, to a projected 64 million or so (17.9 percent of the population) in 2025. According to the AAMC, those between 65 and 74 use health care services at a rate more than twice that of those under 65.
Finally, the pool of working physicians is about to decline dramatically. Currently, there are about 800,000 doctors practicing in the United States. And those doctors are getting older and will be retiring in massive numbers. The AAMC estimates that approximately 250,000 physicians will retire within the next ten years — nearly one-third of all physicians.
In other words, in the next 10-15 years, the U.S. will have many more patients, a greater percentage of whom will need more medical care. Without more new physicians entering the workforce than there are older physician retiring, there will be fewer doctors to care for all those patients.