The demand for physicians in the United States is growing faster than the supply. Within about a dozen years, there may be a lack of more than 120,000 physicians, according to a report published recently by the Association of American Medical Colleges (AAMC). Physicians are already stretched too thin, so what will an increasing shortage mean for them?
“The nation’s population is growing and aging, and as we continue to address population health goals like reducing obesity and tobacco use, more Americans will live longer lives. These factors and others mean we will need more doctors,” said Darrell G. Kirch, MD, president and CEO, AAMC. “Even with new ways of delivering care, America’s doctor shortage continues to remain real and significant.”
The AAMC commissioned the report, which was produced by IHS Markit, a global information company.
In the report, the projections for physician supply and demand vary, with estimates of a total shortfall ranging between 46,900 and 121,900 physicians by the year 2032. This includes estimated shortages of 21,100-55,200 primary care physicians and 24,800-65,800 specialists.
Among the specialists, researchers predicted an estimated shortage of 14,300-23,400 surgeons, 1,900-12,100 medical specialists, and 20,600-39,100 other specialists (such as pathologists, neurologists, radiologists, and psychiatrists).
The major factor driving the demand for physicians continues to be a population that is both growing and aging. The nation’s population is projected to increase about 10.3% by 2032, from about 326 million to 359 million, according to the US Census Bureau.
Here are some noteworthy highlights from the report:
• More older Americans, fewer younger ones. “The population under age 18 is projected to grow by 3.5%; the population aged 65 and older is projected to grow by 48.0%; and the population age 75 and older is projected to grow by 75.3%...Based on demographics alone, the percentage growth in demand for healthcare services used by seniors is projected to be much higher than the percentage growth in demand for pediatric services.”
• Physicians are aging, too. The nation’s aging population will also affect physician supply, since one-third of all working physicians will be older than 65 years of age in the next decade. The age at which these doctors decide to retire may have the greatest impact on physician supply.
• Surgeons will be in high demand but in short supply. “Based on current trends, the supply of surgeons is not projected to change substantially over the next 10-15 years, as future attrition offsets the number of newly trained surgeons. Demand continues to grow, with projected demand exceeding projected supply under all scenarios modeled…These projections represent an aggregation, and substantial variations in shortfall projections for individual surgical specialties would be expected.”
• Increase in hospitalists may outpace demand. “The number of physicians working as hospitalists over the past decade has grown rapidly—reflecting a shift in how care is provided rather than a growing demand for hospital inpatient services (which has declined over this same period)…It is unclear whether this growth surge in hospitalist employment will continue or the nation will reach a saturation point at which hospitalist demand will grow at roughly the same rate as demand for inpatient services. Likewise, if saturation is reached, it is unclear whether physicians who might otherwise choose to become hospitalists would choose other specialties.”
• Will physician assistants (PAs) and advanced practice registered nurses (APRNs) fill the primary care void? “The supply of PAs is projected to more than double by 2032 if current growth patterns in number of graduates continue…As with PAs, if current trends continue, the [nurse practitioner] workforce is projected to nearly double by 2032…Overall demand for healthcare services is projected to grow by about 16% between 2017 and 2032, so the supply of PAs and APRNs is growing at about six times the rate of growth of demand for healthcare services. This leads to questions of possible oversaturation in future years, though job growth remains strong in the short term.”
• Improving Americans’ health would increase physician demand. “If the population health goals of a modest reduction in excess body weight; improved control of blood pressure, cholesterol, and blood glucose levels; and reduced smoking prevalence were to be achieved, the demand for physicians would be 33,900 [full-time equivalent physicians] higher in 2032 than it would be if the goals were not met. This appears to be somewhat of a paradox—improving population health leads to greater demand for physicians. Our modeling efforts suggest that improved health will reduce mortality, and the resulting larger and older population will increase demand for physicians.”
What can be done?
Efforts designed to improve overall population health might be one way to mitigate physician demand—unfortunately, the report found that these efforts don’t make a significant effect. Such efforts include providing better care coordination across settings, reducing unnecessary hospitalizations and emergency visits, increasing use of advanced practice providers, reducing obesity and tobacco use, and applying managed care models and risk-sharing agreements such as accountable care organizations.
These measures only reduced the projected demand for physicians by 2032 by 1%, according to the report.
In an editorial on Doximity’s Op-Med, family physician Matthew Rehrl, MD, Marysville, WA, suggested individual physicians can take some steps of their own to avoid getting stuck in “high demand” (ie, overworked) jobs.
First, when considering a position, don’t become overly focused on the current and future financial compensation, Dr. Rehrl advised. You could be locking yourself into “golden handcuffs” that even Houdini couldn’t escape from.
Second, he recommended physicians take a critical look at their work environment, paying particular attention to whether their organization already has a shortage of physicians. “If it does, there will be significant pressure for them to maximize their ‘bang for the buck,’” Dr. Rehrl wrote.
Third, carefully consider the “macro environment,” such as the state where you’ll work. Take into account the secondary stressors, including the state medical board’s “punitive culture” and the state’s typical malpractice risk. Dr. Rehrl points to Wallet Hub’s “Best and Worst States for Doctors,” which ranks states by medical environment, including medical board and malpractice award factors.
Back on the national level, a bill to help address the physician shortage has been introduced in Congress: The Resident Physician Shortage Reduction Act of 2019 (S 348, HR 1763). If approved, the bill would provide increased Medicare support for an additional 15,000 new residency positions during the next 5 years.
“The AAMC supports legislation to increase federal support for graduate medical education as part of a multifaceted strategy to ensure that Americans have access to the care they need when they need it,” Dr. Kirch said. “Because it takes 7 to 15 years to train a doctor, we urge Congress to remove the freeze on federal funding for residency training that has been in place for over two decades without delay.”