Is There a Doctor in the House?

Is there a doctor in the house?  What if the answer is no?
The U.S. has been facing a physician shortage, but why? It comes down to basic supply and demand. We can understand the demand side to the equation because more physicians are needed by the aging population that is growing at an astounding rate of 10,000 baby boomers turning 65 on a daily basis. But what about the supply side of the equation?

The answer: There are not enough residency positions to train physicians graduating from medical schools. Then why is there a shortage of residency positions to train doctors? In researching this column, I discovered that there has been a 17-year cap on our federal government’s support of physician training. (https://www.aamc.org/newsroom/newsreleases/374000/03212014.html). Due to the lack of support, many residency programs are unable to expand or may face closure. Even with a quick change in legislation (and we know that is unlikely given our experience with Congress), the process of “introducing” more physicians into practice is time-consuming. Why? Physician education and training is lengthy.
 
Here is a summary of a physician’s training:
Medical school is typically an eight-year program (4 years of undergraduate work and 4 years of medical school). Medical students are required to do residency programs (in teaching hospitals) to train as physicians.
Total: 8 years

• This residency process takes an additional three to eight years to complete, depending on the medical specialty. The following reflect typical residency time frames for various specialty areas:
  

          - Internal Medicine: 3 years, plus fellowship
          - Cardiology: 6 years (3 years of internal medicine and 3 years of cardiology fellowship)
          - Orthopedic Surgery: 5 years, plus fellowship
          - Neurosurgery: 6-8years, plus fellowship
Total: 3-8 years

• Following residency, some physicians take an additional one to three years for fellowship programs (http://work.chron.com/long-become-doctor-us-7921.html).

Total: 1-3 years
 
The major point here is that even if changes occurred in the process to expand residency programs, the physician shortage will not be resolved overnight. It takes a long time to prepare a physician for practice (11-19 years). We are long overdue to making changes in this country, since there has been a cap in place for 17 years restricting residency programs.
 
According to the AAMC (Association Of American Medical Colleges), our nation will be facing a physician shortage of 90,000 by the year 2020. The impact of this shortage affects 50% of our primary care services and 50% other medical and surgical specialties. We know how supply and demand economics works. With more demand and less supply, it means costs will go up and the availability will go down. The results of this scenario would typically translate to higher health care costs and longer wait times for services (or even inability of patients to be seen by certain physicians). We have long experienced our favored physicians not taking on new patients.
 
The solution for addressing the residency shortage is in the hands of Congress. Last year, the Resident Physician Shortage Reduction Act of 2017 was introduced to take measures toward alleviating the physician shortage by gradually providing 15,000 residency positions over a five-year period (https://news.aamc.org/for-the-media/article/gme-funding-doctor-shortage/). The AAMC  “urges Congress to act without delay to pass this legislation.”
 
Although no longer valid, some authorities previously disputed that the physician shortage projection was not real.

• They projected that it was actually a distribution issue (rural vs. urban location of physicians) and/or lack of appropriate use of other non-physician services. One solution to the distribution problem has been the promotion of “loan-forgiveness” programs, which is carried out when physicians work in underserved areas. This is a logical solution, but there is still a shortage issue.

 

• Another approach to addressing physician shortage has been the increase in funding programs that support the services of non-physician health professionals, such as nurse practitioners and physician assistants, meeting the demands of the healthcare workforce. The introduction of more non-physician health professionals adds great value to patient care, but physicians are still needed, and there is a shortage. As a result of this initiative, the team-based strategy has been found to be effective and efficient for patient care because members can carry out their areas of expertise (For example: pharmacists evaluate medication regiments and carry out medication education; nutritionists teach about diets; nurses instruct on wound care; etc.) 

 

• Still other solutions are looking at supplementary use of urgent care centers, retail clinics (located at CVS, Wal-Mart, etc.), and telemedicine, which uses remote monitoring via computers and smartphones (http://www.chicagotribune.com/lifestyles/health/sc-doctor-shortage-health-1111-20151105-story.html). However, the use of these supplementary services requires good judgment: For example, it’s appropriate to attend an urgent care facility for suturing a wound, to have a flu shot at a clinic, or utilize telemedicine for a consultation or patient monitoring. But a patient experiencing chest pain should not be relying on any of these supplementary services; the hospital emergency room is the safest choice.

It is valuable to look at these other additional measures for health care coverage; but the bottom line is, we still need doctors.
 
The more recent projections regarding physician shortage are emphasizing that the problem is real and measures still need to be addressed to increase the number of physicians into practice (https://www.marketwatch.com/story/americas-1-million-doctor-shortage-is-right-upon-us-2016-04-01 and https://www.aamc.org/). According to The Fiscal Times: “The (AAMC) report finds that demand for physicians will grow by 11 percent to 17 percent through 2025, while the number of doctors will increase only by 4 percent to 12 percent.”
 
To help alleviate the physician shortage, the AAMC has proposed a multipronged solution, which addresses the highlights in this article. “We believe this is a measured approach to deal with a problem that has the potential to affect every American.” Because of the expected retirement of one-third of the nation’s physicians, and the fact that it takes many years to train a doctor, our nation needs to act now.