Physician Supply and Demand in the Next 10 Years
Dr. Shipman began by sharing some key physician shortage projections. By 2020, there is expected to be a shortage of 91,500 physicians — 45,400 primary care and 46,100 subspecialists — in the United States, assuming the Patient Protection Affordable Care Act stays intact, according to projections by the Lewin Group, prepared for the AAMC. However, Dr. Shipman cautioned these projections should be taken with a "grain of salt" since they are based on past utilization patterns, which could change with the expanded coverage the ACA will bring.
So what forces are influencing the future demand and supply of physicians?
- Increased access under ACA. Healthcare reform will provide insurance to roughly 32 million uninsured Americans, which is expected to increase the demand for healthcare services.
- Aging of current physician workforce. By 2019, the number of physicians reaching retirement age is expected to more than double, compared to 2009.
- Maldistribution of physicians. The number of physicians per 100,000 residents varies greatly by market, and it remains difficult to attract physicians to rural areas, exacerbating shortages in those areas.
- Medical school enrollment on the rise. Medical school enrollment is projected to increase 40 percent by 2015, compared to 2002, according to AAMC data. More medical schools are expected to open across the country, and growth in non-U.S. based medical schools enrolling U.S. students (such as Caribbean-based institutions) also influence this increase.
- Less interest by medical school graduates in primary care. Despite expected growth in medical school students, shortages in specific practice areas such as primary care are expected to continue unless major payment reforms to encourage more primary care residents are instituted. The percent of medical school (MD) graduates entering primary care has decreased 31 percent since 2000. When including osteopathic medical school (DO) graduates, the decrease lessens to 12 percent; however this is only because of the significant growth in DO graduates overall, not because they are favoring primary care over other specialties, according to Dr. Shipman.
- Residency slots may not keep up with growth in medical school graduates. Dr. Shipman said there is some concern there could be "insufficient" residency slots for U.S. medical school graduates. He noted current Medicare caps on graduate medical education dollars could drive such a situation, adding, "that's a concern the AAMC has been very vocal about." Additionally, although the number of residency and fellowship slots actually grew nearly 18 percent between 2000 and 2009, roughly 43 percent of that growth can be attributed to growth in subspecialty training.
- Desired work/life balance. Newer physicians value work/life balance and may work fewer hours as a result. Dr. Shipman shared the results of a survey that found 71 percent of physicians rated time for family and personal life as "very important" in work decisions.
What does this mean for the healthcare workforce?
According to Dr. Shipman, roles will change in ways that aren't completely clear yet, and the provision of care by non-physician clinicians, such as physician assistants and nurse practitioners, will become increasingly important.
Mr. Hooker believes the gap between the supply and demand for physician services will be partially filled by PAs and NPs and team-based care. According to Mr. Hooker, data suggests PAs can substitute for a physician in 83 percent of care provided in a primary-care setting. If used appropriately, mid-levels can free up physician time for higher-acuity cases and make physician practices more efficient overall.
The number of PAs reached 74,400 in 2010, compared to 45,865 in 2000. NPs numbered 105,000 in 2009, up from 67,880 in 2000. However, despite these increases, there are still fewer mid-level providers than there is a demand for, said Mr. Hooker. "While physicians are critical to the delivery of healthcare services there are many other players," he said.
Finally, Mr. Donino-Lenhoff addressed the role of allied health professionals in the future of healthcare delivery, saying they can also extend physician reach and efficiency. As the use of healthcare teams to deliver care evolves, he expects different types of teams to emerge for different types of conditions. He ended by stating, "Recruiting allied health professionals can help you retain physicians."
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