While the nation debates the policy and payment issues in healthcare, a quiet crisis may be brewing behind the scenes.
Further reading: How federal policy has worsened the U.S. primary care shortage
“Access to care,” is the buzzword used by every administrator, policy maker and payer who wants to relay a convincing viewpoint. But, behind the vague phrases, there are real issues and real numbers when it comes to patients’ access to care.
The United States faces a physician shortage estimated to be between 40,800 and 104,900 physicians by the year 20301, according to the American Association of American Medical Colleges (AAMC)—that may translate into a situation in which patients cannot see a doctor when they need to.
Is there a looming physician shortage?
The recent data, which was requested by the AAMC and gathered by IHS Markit, a global information firm, does not differ from previous estimates gathered by other organizations. For example, in 2013, the Health Resources & Services Administration, which is part of the U.S. Department of Health and Human Services, projected a shortage of 20,400 primary care physicians by 2020.2
Despite these alarming results, the projections are somewhat controversial because the factors that are involved in calculating the need for physicians are quite complex and not necessarily clear-cut. While a simple calculation looking at the ratio of physicians to individuals in the population may seem that it should be straightforward and consistent, it is not.
As life expectancy increases, largely as a result of medical advances, individuals who live longer consume more medical care. Soft data suggests that physicians are retiring at a younger age due to regulatory burdens, and that more young physicians are opting for non-clinical careers.
On the flip side, many argue that medical care does not always need to be provided by physicians, and that physician extenders can provide some medical care to patients at a reduced cost. In fact, this solution was one of the proposals set forth by the AAMC. 3
The question is whether adjustments in patient care delivery coupled with modest increases in the available training spots for doctors will be enough close the gap between projected supply and demand for physicians.
The physician supply pipeline
The supply of physicians available to provide care to patients is not something that can be quickly or easily adjusted. Over the past 14 years, the number of medical students graduating from U.S. medical schools has increased 25% between 2002 and 2016. This increase in medical student positions is part of a long-term plan aimed at reducing the size of the physician shortage. Yet, graduating medical students are not trained or licensed to practice medicine, and need additional residency training before they can care for patients.
The number of physicians who are able to become qualified to practice medicine is largely controlled by the number of residency slots available to train physicians.