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AN IMPERFECT FORECAST:
Is today’s waiting-room inconvenience tomorrow’s physician shortage? // Is the current crop of med students too sparse to cope with an aging population? // Or does the entire system need to change?

Are We Running Out of Doctors?

By Linda Keslar // Summer 2007
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Doctor shortage

Derek Shapton/Masterfile

When Rosemarie Peelle learned it would be eight weeks before she could see her neurologist about her nagging neck pain, she knew what to do. Peelle asked her husband, Kenneth, president of the Massachusetts Medical Society, to pull a few strings. He called the doctor, who agreed to see Peelle the next day.

That’s how it’s sometimes done. But for patients lacking connections, it has become increasingly difficult to schedule an office visit or even to find a doctor. A survey by Merritt, Hawkins & Associates, a physician search firm, found that patients in 15 large cities waited an average of more than three weeks to schedule a gynecological checkup. According to a 2006 study in the Journal of the American Academy of Dermatology, the mean wait time to get a changing mole checked out in Boston was 73.4 days. It has even reached the point at which having an in may not get you in. “Even for physicians and trustees, it’s increasingly difficult to get primary care appointments for family and friends,” says internist Brit Nicholson, chief medical officer of the Massachusetts General Hospital (MGH) in Boston.

Many experts worry that such reports, though anecdotal, foretell an impending crisis, a national shortage of physicians that will worsen just when an aging population most needs ready access to medical care. At least one estimate predicts the physician shortfall could reach 200,000 by 2020, almost a quarter of the 850,000 doctors now practicing in the United States.

Of particular concern are the 30 million people who live in areas designated by the federal government as medically underserved. In Alaska, which has a third fewer physicians than it currently needs, demand will nearly double during the next two decades, according to one study. “It takes about four months for a new patient to see me,” says internist Ross Tanner, president of the Alaska State Medical Association, who runs one of only four diabetes clinics in the state.
This wasn’t supposed to happen. A generation ago, the worry was that there would be too many doctors, not too few, and schools began limiting enrollment to reduce the glut. Yet now there are fewer physicians each year relative to the rising population, and a disproportionate number of doctors are nearing retirement, to be replaced by young physicians, who seem disinclined to work the slavish hours put in by old-timers.

To counter projected shortages, there’s a proposal to graduate a third more doctors in the coming decade, and a push to increase residency training slots. But these plans raise a host of issues. Upping medical school enrollment will take a while, and there’s no guarantee the additional physicians won’t gravitate to high-paying specialties and geographic regions that have plenty of doctors. Already, the lure of lucrative specialties has cut the number of graduates choosing family medicine by 50% since 1997. “We can create all the jobs we want, but the incentives aren’t there for young doctors to take them,” says Rick Kellerman, president of the American Academy of Family Physicians. Moreover, adding training slots in any specialty raises the question of where the money will come from at a time when Congress is bent on cutting the budget for Medicare, which funds most residency training. 

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Prescription for a Crisis

Although some areas have plenty of doctors, geographic distribution is far from even.

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1. “New Steam From an Old Cauldron—The Physician-Supply Debate,” by David Blumenthal, The New England Journal of Medicine, April 22, 2004. A comprehensive analysis of the revived debate about the physician workforce, analyzing methodology, ideological and social underpinnings and how policymakers may approach solutions.

2. “End-of-Life Care at Academic Medical Centers: Implications for Future Workforce Requirements,” by David Goodman et al., Health Affairs, March/April 2006. Groundbreaking study that challenges those who argue the physician workforce needs expanding and that contends states with the most medical specialists and general internists have lower quality of care than those with fewer.

3. Will the Last Physician in America Please Turn Off the Lights?: A Look at America’s Looming Doctor Shortage, by James Merritt et al. (MHA Group, 2004). Data, surveys and analysis provided by a leading physician-recruiting firm that support the growing doctor shortage based on such workforce measures as appointment waiting times, practice profiles and recruiting-package incentives.

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