Growing primary physician shortage complicates reform

President Barack Obama speaks about health care
during a town hall meeting at the Northern Virginia
Community College in Annandale, Va.,
Wednesday, July 1, 2009.
(AP Photo/Alex Brandon)

Personnel shortages exist throughout America’s healthcare delivery system, but most obvious is a lack of primary care doctors and general surgeons. The American Academy of Family Physicians estimates a shortfall of 40,000 general practice physicians by 2020.

A little math suggests that the situation may be much worse than admitted. According to the World Health Organization (WHO), there are 730,801 practicing physicians in the U.S. Of these, roughly 220,000 (30 percent) offer primary care services. Using census estimates and OECD averages for primary care physicians per thousand patients in developed countries, America will need 580,000 family doctors in 2020. The numbers predict there may be a shortfall of as many as 325,000 family docs in ten years. In out years the problem may worsen.

According to the American Association of Medical Colleges (AAMC), 250,000 physicians now practicing were at least 55 years old in 2005. Since America’s residency programs currently graduate only 22,000 new doctors each year, America will not quite replace those physicians likely to retire in all specialties by 2020.

Most of these new doctors graduate with $140,000 in training debt and opt to become specialists of some kind. A recent survey of medical school seniors said only two percent of graduating seniors plan primary care practices. And who can blame them? Primary care physicians average paychecks of around $175,000 yearly compared to cardiologists who earn over $400,000 on average and more than $300,000 right out of school.

It takes at least eleven years before a young doctor can hang out his or her shingle. Additional specializations may extend the training period to fifteen years or more. They tend to cluster in areas which offer the most desirable living environments. Again who can blame them? But none of this solves the shortage of family doctors overall and in rural and disadvantaged areas in particular.

Today and for the last two decades, around 16,500 new doctors earn their degrees each year. The 146 American medical schools have traditionally been funded at the state and local levels. The federal government has funded around 22,000 slots for new residents mainly through Medicare and Medicaid programs. This means we have imported about 25 percent of our residents from training programs outside the U.S.

Despite what is now 40,000 applications to medical school each year, the 16,500 openings have remained static. This is beginning to change. AAMC has pledged to increase enrollments by 30 percent in six years. If the targets are achieved, more than 21,000 students a year will enter medical school in 2015. About a dozen new schools are on the drawing boards in various stages of development. One has opened in central Florida. Another is planned for New Jersey. A third school will open in the fall of 2009 at Virginia Tech.

Promised progress and recognition of the problem is not enough. Government must drastically expand the number of residency openings especially in practice areas that need so many new doctors. America needs to put forth an effort equal to its push to land a man on the moon in the 1960’s. It has a similar ten year time frame to accomplish this goal.

U.S. citizens only get to see their doctors on average 3.9 times a year unlike their European cousins who visit with their physicians 6 times annually. Perhaps this begins to explain the difference in most metrics when comparing Europe and the U.S.

According to the Dean of the University Of California Medical School at San Francisco, best practices for each patient dictate that U.S. doctors spend 18 hours each day on patient care. According to the former Dean of the University Of Virginia Medical School, care of the 45 percent of patients with chronic problems should take 10.6 hours each day. Clearly with the current supply of doctors and training facilities, it ain’t gonna happen.

It is a conundrum. We must cut the cost of healthcare or be buried by it. We must explode the number of practitioners or go without at a time when millions of baby boomers are retiring and inflating need even further. And concurrently, we must find a way to pay for the training expenses of primary care physicians if they re-locate to the areas where they are needed.

Next: Shortages of nurses and other specialized professionals.

As America searches for solutions leading to a reformation of its own health care system, knowing the successes and shortcomings of health care regimes in other developed nations will be essential in negotiating the most palatable and efficient design for all concerned. This series attempts to connect the dots and explode the talking points in hopes that the folks who actually have a vote might come to a conclusion.

Al Portner is a former daily newspaper editor and publisher in seven states and author of the forthcoming “Mark Twain and the Tale of Grant’s Memoir.” He can be reached at alanportner@gmail.com

For more info: 
Shortage of primary care doctors a roadblock to reform
Ranking numbers of physicians by country (WHO)
Doctors currently in practice aging
Physician Shortages
Commonwealth Fund Multinational Comparisons