Medicine in the United States faces a crisis: As the population ages, demand for doctors is outpacing the supply. Understanding the extent of the shortage has been a matter of conjecture and anecdotes shared in doctors' lounges. Now, a recent study from the Association of American Medical Colleges (AAMC) sheds light on the scope of the physician shortage—specifically, where the impact of the shortage will be most acute.
AAMC looked at 2017 census data to determine where physicians are most needed. The data show that rural areas of the US are the most underserved. The greatest demand for doctors is in the South, where the physician shortage stands at about 31,000 doctors. Doctors are next most scarce in the Midwest, where demand outstrips supply by nearly 13,000 doctors.
In the West, where rural areas are balanced by large population centers, the supply roughly meets demand, but with only about 100 more physicians available compared with current demand.
It’s a completely different story in the population-dense Northeast. There, the doctor supply outpaces demand by nearly 24,000 doctors.
Taking all of this into consideration, it seems that residents looking for work should head South or West. But, another recent survey shows that’s something they’re reluctant to do. In its annual survey of final-year residents, the physician staffing firm Merritt Hawkins said that only 1% of survey respondents would prefer to work in a community of 10,000 or fewer people. Only 2% said they were interested in practicing in a community of 25,000 people or fewer.
A nationwide problem
An aging US population is at the heart of the physician shortage. This applies to patients and doctors themselves.
The US Census Bureau’s 2017 population projections—the most recent available—reveal an increasingly gray America. File the year 2030 in your brain. That’s the year US baby boomers will exceed the age of 65. In 2030, 1 in 5 Americans will be of retirement age, the Census Bureau says, placing heightened demand on our strained healthcare system. This milestone means that older Americans will outnumber children for the first time in US history.
Compounding this problem is the fact that despite recent medical advances, American physicians are aging along with the lay population. AAMC projects that by the next decade, 2 out of 5 physicians will be 65 or older. After reviewing American Medical Association records, AAMC says that right now, doctors over the age of 65 account for 15% of the workforce.
But, AAMC points to one bright spot upon reviewing current physician demographic data. Medical school enrollment is on the upswing. The group says that medical school enrollment has increased by 30% since 2002. This has happened despite the level of federal medical school funding, which has been stagnant since 1997. AAMC says this amount should be raised to further increase the doctor supply.
How it affects specialists vs non-specialists
The shortage isn’t stage-IV-cancer bad, but it isn’t good either. The severity also varies between specialists and non-specialists. By 2032, AAMC says we can expect the physician shortage to stand at anywhere between 46,900 and 121,900 doctors.
Among primary care physicians, AAMC anticipates a shortage of 21,100-55,200 doctors by 2032. Increasing numbers of advanced practice registered nurses and physician assistants might drive the number of primary care doctors downward, AAMC says. While there might be fewer primary care doctors, AAMC says the increase in allied healthcare professionals could “strengthen the nation’s primary care foundation and improve access to preventative care.”
AAMC says we can expect to see a shortage of doctors in non-surgical specialties ranging from 24,800-65,800 physicians in 2032. Among surgeons, the group’s projection stands at 14,300-23,400 for the same time period.
AAMC points to “shifting workforce patterns” as one of the reasons behind the shortage of specialists. One of these patterns is the increasing number of physicians who aren’t working full time. AAMC notes that if the current trend of younger and older doctors working fewer hours continues, there will be 20,900 fewer full-time-equivalent (FTE) doctors than if work hours stayed the same. Other shifting workforce patterns cited by AAMC include economic pressure, healthcare delivery structure, burnout, and demographic patterns—all of which require further study.
Physician demand is also projected to fall along racial and ethnic lines in the US through 2032. White Americans will see the biggest increase in demand for doctors. AAMC places the number of FTE doctors needed to serve this portion of the population at 46,300.
However, reflecting the changing ethnic and racial makeup of America, people of Hispanic origin are a close second. The survey shows that the demand for doctors from this segment of the US population will be 41,500. Black Americans will need 21,200 doctors, and other non-Hispanic minorities will require 23,400 physicians.
Researchers say that these differences reflect “underlying differences in age distribution, disease prevalence, health-related behavior such as obesity and smoking, economic factors including medical insurance coverage and household income, possibly cultural differences in care utilization, and other access barriers.”