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Primary physician shortage spurs search for alternatives
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As an aide displays an archived newspaper story from 1955, Sen. Sheldon Whitehouse, D-R.I., right,
talks to reporters on Capitol Hill about the continuing challenges of passing a health care reform bill.
He is joined at left by Sen. Jay Rockefeller, D-W.Va. , center, and Sen. Sherrod Brown, D-Ohio, left.
(AP Photo/J. Scott Applewhite)
The costs of health care in the United States as compared to GDP were simlar to the rest of the developed world up until the early 1980s. Without adequate explanation, medical costs in America suddenly deviated from international standards and accelerated over the next 30 years until America’s costs today are double what is paid in similar countries.
Leading up to the cost explosion, U.S. medical schools typically graduated twice as many physicians as retired each year. Doctors feared a glut of competitors in the marketplace, and successfully fought to restrict the number of students in medical school at any one time. U.S. Medical schools abruptly stopped expanding after reaching a high water mark in 1985.
Doctors became worried about their future incomes. “The Journal of the A.M.A.” warned of a coming 165,000 physician surplus by the turn of the century. In 1997, Congress capped residencies 23,000 per class per year and that level has been held since the cap was imposed.
“[The glut of new physicians] never happened,” says Dr. David Blumenthal, now head of the H.H.S. Office of the National Coordinator for Health Technology. “Physicians aren’t driving taxis. We’re all gainfully employed, earning good incomes, and new physicians are getting [multiple] job offers.”
American medical schools don’t even graduate enough students to fill the existing residencies which explains why 6000 newly-educated foreign doctors (26 percent of the total) join the residency ranks each year.
Although schools have pledged to ramp up their programs by 30 percent, it will not be enough. One third of all doctors presently practicing will reach retirement age within ten years. Many of these older docs are primary care physicians and 98 percent of medical school graduates are choosing more highly paid specialties; not primary care. The pay difference between a Primary Care Doctor and a Cardiologist, for example, is 226 percent on average.
American physicians actually do very well. According to Dr. Tim Garson, Provost of the University of Virginia and an advisor to President George W. Bush on health policy, physicians take home salaries are two to three times what their colleagues in comparable countries earn. Professional fees account for around 21.1 percent of U.S. health care expense... second only to the 31.1 percent chunk consumed by hospital fees.
Further exacerbating the primary physician shortage are differences in working hours between today’s doctors and their predecessors. Experienced doctors tend to settle into a routine and work about 15 percent fewer hours than earlier generations. Gender differences among today’s physicians also contribute to a people-power shortage. Women have proven themselves very capable physicians and their numbers have grown to account for almost half of all medical school graduates, but studies show they work about 25 percent fewer hours than their male counterparts probably due to family obligations.
The 1980s fear of physician oversupply cannot be wholy blamed for the explosion in health care expense in the years that have followed, but they did contribute to the problem without much doubt. One of the inevitable effects of a market-driven economy is that prices increase as labor shortages surface.
The American Academy of Family Physicians now predicts that America will be 40,000 primary care doctors short by 2020. The Association of Medical Colleges says there could be a shortage of 125,000 in fifteen years if Congress mandates universal health care. Both estimates use current doctor/patient ratios in their calculations. But if America upgrades its ratios to the average of other comparable countries, she will need around 500,000 additional physicians by 2020. Further adding salt to an already oozing open sore is the fact that the first of the huge baby boom generation will achieve 70 years of age in 2016 and require much more care per capita.
The barriers to expansion of the workforce are vast. They include facilities shortages, clinical opportunities, and money, but most serious is a shortage of available teachers to pass on their experience.
Since it takes eleven to fifteen years to educate a fully qualified physician, the solution may lie in shorter, more intensive, educational subspecialties. Into this void created by shortages and increasing population may fit relatively new categories of providers with expanded training, but not quite to the level of an M.D. or D.O. These new primary clinical providers are the Physician Assistant and Nurse Practitioner. Both the P.A. and N.P. are educated to the Master’s degree level or higher. Their presence may ease the load on remaining primary doctors.
Next: What kinds of work can P.A.s and N.P.s lift from the shoulders of overburdened doctors? How will your health care access be affected?
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.” Portner is also the proprietor of The Assignment Desk, LLC and provides writers, editors, and photographers for numerous kinds of contract projects from proposals and speeches to public relations and journalism. Reach him at alanportner@gmail.com.
For more info: L
Distribution of health care expense
Shortage of primary care physicians a roadblock
Medical miscalculation creates shortage
Projected shortages and their effect on P.A.s.
Comparison Chart
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