15 things to know about the physician shortage

According to projections by the Association of American Medical Colleges, the nation will be short more than 90,000 total physicians by 2020 and 130,000 physicians by 2025.

The physician shortage has the potential to affect our present and threaten our future; however, some argue that the impending physician shortage is overblown.

Here are 15 things to know about the physician shortage from both perspectives:

1. There are reports of a shrinking supply of physicians. One in three practicing physicians in the U.S. is over the age of 65 and close to retirement. Furthermore, six in 10 say it is likely many colleagues will retire in the next one to three years.

2. Physician shortages will impact primary care more than other specialties. In the wake of some specialties reporting more acute physician shortages, a report in Annals of Family Medicine projects that the United States will need 52,000 more primary care physicians by 2025.

3. A significant shortage of surgeons and oncologists is also anticipated. The country's demand for oncologists is slated to nearly double and lead to a shortage of nearly 1,500 cancer specialists by 2025. The number of new cancer cases in the United States is projected to increase by as much as 42 percent by 2025, but the number of oncologists will likely grow by only 28 percent. Oncologists are already in short supply in many rural communities, and more than 70 percent of U.S. counties have no medical oncologists at all. Furthermore, according to the AAMC, general surgery is predicted to be among the hardest hit, with a shortage of 21,400 surgeons by 2020. The number of practicing general surgeons is expected to fall to 30,800 by 2020 from 39,100 in 2000.

4. Population growth and the aging population drive the impending physician shortage. Approximately 33,000 additional physicians will be needed in the next 10 years due to population growth alone. Additionally, in the next ten years, 10,000 physicians will be needed to serve the aging population. By age 65, about two-thirds of senior citizens have at least one chronic disease. Currently 20 percent of Americans older than 65 see 14 or more physicians and average 40 physician visits each year.

5. Medical residencies are in short supply. Funding for the Teaching Health Center Graduate Medical Education Payment Program, which was created by the Patient Protection and Affordable Care Act, is set to expire at the end of federal fiscal year 2015. Through the program, the Health Resources and Services Administration awarded $83.4 million in funding to support primary care residency programs at 60 teaching health centers. These awards are helping support the training of more than 550 residents in family and internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and general and pediatric dentistry during the 2014-2015 academic year.

If not extended, the program's expiration is projected to cut the number of new residents being funded by 8,000 by the year 2025. Moreover, the number of Medicare-sponsored residency slots has been capped since 1997, making it financially challenging for health systems to expand residency capacity. Thus, medical school graduates will most likely exceed the number of residency positions by 2015, according to a report by the AAMC.

6. Legislation for increased residency availability is in the works. According to a New York Times article, bills currently in Congress could increase the number of residency slots for new physicians by 15,000 over a five year period. At this point it is difficult to say whether or not Congress will choose to pass those bills in addition to rehabilitating veterans' healthcare.

7. Telemedicine increases overall physician efficiency and specialist availability to rural areas. Telemedicine can help hospitals and health systems utilize the current supply of physicians more efficiently. Telemedicine can also help physicians make use of unused time by treating more patients, can connect specialists to rural hospitals and enables patient access to a wider pool of physicians.

8. Mid-levels may alleviate projected shortages. Mid-levels can enhance many aspects of primary care and can help lessen physician workloads. Depending on scope-of-practice laws, nurse practitioners and physician assistants are taking over some of the load of primary care demand. As a result, some analysts see the predicted physician shortages as exaggerated. The AAMC disputes that claim citing scope-of-practice and reimbursement issues as reasons why team-based care will not close the care gap. Only 18 states allow NPs to diagnose, treat and prescribe without some degree of supervision by a physician, which limits their impact as part of a care team.

9. Nurse practitioners have a positive effect on outpatient management of chronic conditions. A team approach that utilizes nurse-managed protocols can have positive effects on outpatient management of adults with chronic conditions such as diabetes, hypertension and hyperlipidemia. This approach can help lighten the load of some physicians and ensure quality care.

10. Currently, physician supply vs. demand is very dependent on geographic location. According to a Kaiser Health News report, the nation's primary care system is generally holding up fine (at least at present) with few shortages, even with the addition of patients who gained insurance for the first time under the PPACA. This is contrary to many other reports and to what many experts predicted would happen with the passage of the PPACA.

In a sampling of health centers and large physician groups in several states, including California, Colorado, Connecticut, Kentucky, New York, Florida, Texas and Pennsylvania, most providers said they were well-prepared for any large influx of patients, and few are reporting delays for patients wishing to receive care.

11. However, some Americans are living in areas already short of primary care physicians. While the PPACA may have increased insurance coverage for many, nearly 20 percent of Americans live in an area where there are too few primary care physicians to serve the community. Nearly half — 44 percent — of rural areas in the United States are experiencing a shortage of primary care practitioners. Federal guidelines recommend maximum population to physician ratios of 3,500 –to-one for primary care providers.

States with between 25 and 29 percent of their populations living in an area with a primary care shortage include: Arizona, Idaho, Illinois, Montana, North Dakota, South Carolina, South Dakota. In Alabama, Missouri and Wyoming, 30 or more percent of the population lives in an area of primary care shortage. New Mexico has more than 40 percent of its population with poor access to primary care, and more than 50 percent of people in both Louisiana and Mississippi don't have enough access to primary care physicians.

12. The new insurance exchange coupled with local physician shortages has presented a whole new set of challenges for hospitals. Local shortages of physicians make caring for the influx of newly insured patients very difficult. Furthermore, many providers are still anticipating a rush of new patients coming soon, as the newly insured become more familiar with benefits and what the system has to offer. Most executives feel they have not felt the full impact in the substantial increase in the volume of insured patients, according to a report in Kaiser Health News.

13. Medical school capacity is not improving. The average acceptance rate for medical students is at 44.5 percent with some schools accepting less than 10 percent amidst a rising need for physicians all over the country. Additionally, as previously mentioned, federal budget cuts have directly affected the number of residencies hospitals are able to offer for medical students, making it impossible for some students to finish their licensure. Although an increase in medical school acceptance rates may seem like a viable solution, the lack of residencies and therefore inability to continue their subsequent level of training complicates the ability to simply expand medical school enrollment. 

14. The AMA recognizes and is attempting to address the looming shortage by implementing new policies. The American Medical Association voted June 11 to support innovative education models to address physician shortages in specialties that are undersupplied and areas that are underserved. The new policy encourages federal and state governments and private payers to satisfactorily fund graduate medical education and increase the number of available GME slots. The policy also encourages the Accreditation Council on Graduate Medical Education and the American Osteopathic Association to develop methods to train and reward physicians who are part of patient-centered care teams.

15. Nearly a quarter of physicians regret their career choice and over a third are unlikely to encourage young people to enter the field. In addition to the 23 percent of physicians who would not choose to become a physician again if they could turn back time, 21 percent of physicians said that they would not choose a healthcare profession at all. The two greatest concerns of both physicians-in-training and practicing physicians are compensation and reimbursement and a lack of work/life balance. Additionally, only 35.4 percent of physicians reported "beyond satisfied" or "satisfied" with their income level and the amount of hours that they worked. Of physicians whose income decreased in the past year, 61 percent would not encourage a career in the medical field, and only 35 percent of physicians whose income increased say they are very likely to recommend a career in the field to a young person. These issues seem to be factors with regard to both the physician shortage and reports of physician burnout.

Veteran care is also threatened by the physician shortage amidst the ongoing Department of Veterans Affairs scandal. Military or government employment is listed as physicians' least favorite practice setting. The Department of Veteran Affairs is faced with only 2 percent of physicians being interested in military or government-employed practice. The VA is then forced to rely on temporary physician staffing creating more communication issues, a lack of continuity of care and discrepancies in accountability.

More Articles on the Physician Shortage:
VA Needs $17.6B to Resolve Treatment Delay Issues
Employers and Carriers Await Impact of Health Reform on Workers' Compensation
5 Suggestions to Offset the Physician Shortage: Minnesota Hospital Association

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