Physician shortage in the United States

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These measurements of healthcare service levels for specific areas of the U.S. came out in June 2020 through the Health Resources and Services Administration (HRSA), an agency of the Department of Health and Human Services (HHS) Health Professional Shortage Areas.jpg
These measurements of healthcare service levels for specific areas of the U.S. came out in June 2020 through the Health Resources and Services Administration (HRSA), an agency of the Department of Health and Human Services (HHS)

Concerns of both a current and future shortage of medical doctors due to the supply and demand for physicians in the United States have come from multiple entities including professional bodies such as the American Medical Association (AMA). [1] The subject has been analyzed as well by the American news media in publications such as Forbes , [2] The Nation , [3] and Newsweek . [4] In the 2010s, a study released by the Association of American Medical Colleges (AAMC) titled The Complexities of Physician Supply and Demand: Projections From 2019 to 2034 specifically projected a shortage of between 37,800 and 124,000 individuals within the following two decades, approximately. [1]

Contents

Healthcare in America itself may deteriorate for certain communities inside particular U.S. states due to such trends, particularly in terms of the lack of access to specialty services in rural locations. [1] For instance, a September 2022 report from the University of Hawaiʻi System found that the collection of islands faces "a severe physician shortage". [5] A piece published that same month by Spectrum News 1 - Ohio described the Midwestern state as featuring a shortage "that's expected to hit rural areas the hardest." [6] Mechanisms of structural inequality in the U.S. affect its national health due to past and current discrimination, particularly efforts to set people apart based on Americans' racial identities. [7]

In the broader context of evaluating peoples' health across the whole planet, worries over a doctor shortage have occurred in multiple countries besides the U.S. For instance, the World Health Organization (WHO) found in 2006 that "an estimated shortage of almost 4.3 million doctors, midwives, nurses and support workers [exists] worldwide". [8]

The Jackson Memorial Hospital (MJMH) complex in Miami, which serves as the primary teaching hospital for the Miller School of Medicine at the University of Miami Aerial-Picture-of-Jackson-e1445995779731.jpg
The Jackson Memorial Hospital (MJMH) complex in Miami, which serves as the primary teaching hospital for the Miller School of Medicine at the University of Miami

On September 30, 1980, the Graduate Medical Education National Advisory Committee (GMENAC) sent a statement titled "Summary Report of The Graduate Medical Education National Advisory Committee [9] " to the Secretary of the Department of Health and Human Services (Patricia Roberts Harris at the time), which "estimates a surplus of 70,000 physicians by 1990".

This led to an eventual nationwide voluntary medical school moratorium that would last from 1980 to 2005, intended to prevent a surplus of physicians in the U.S. The moratorium called for the halt of the creation of new medical schools and a reduction or freeze of medical school enrollment. The moratorium was successful, as the number of M.D. annual entrants never surpasses 16,660 (1981) nor did it fall below 15,800 (1989). Additionally, only three new M.D. schools were established during the moratorium. [10]

In February 2010, the news-magazine Newsweek published in a report that the "annual number of American medical students who go into primary care has dropped by more than half since 1997" to the point where it had gotten "hard to get an appointment with the doctors who remain". The journal also commented that "as many as half of primary-care providers have stopped taking new patients." [4] In addition, a 2010s study released by the Association of American Medical Colleges (AAMC) titled The Complexities of Physician Supply and Demand: Projections From 2019 to 2034 specifically projected a shortage of between 37,800 and 124,000 individuals within the following two decades, approximately. [1]

Known for serving as president of the American Academy of Family Physicians (AAFP), Sterling Ransone Jr., M.D., has commented that the demographics of medical professionals in the U.S. will generate noticeable effects as time passes. "By 2032, the U.S. population's going to grow by about 10%, but those of us who are age 65 or older, we’re going to grow by about 47%," he has remarked, adding that by "that same year... probably about one-third of active physicians are going to be over age 65, so our physicians— we’re aging as well". Dr. Ransone has highlighted his specific discipline of family medicine as already affected by these difficulties. [1]

The American Medical Association (AMA), a professional body in the U.S., has cited increasing costs of higher education in the country as a barrier to adequate growth in physician supply. In a 2022 article, the organization stated that "[m]edical school graduates typically finish school with about $200,000 in medical student-loan debt, which is often seen as an influential factor in specialty choice." The discussion of anticipated financial burdens from schooling itself can also result in a self-fulfilling prophecy. [1]

Healthcare in America itself may deteriorate for certain communities due to the shortage of medical professionals; the potential harm caused by the lack of access to specialty services in rural locations has garnered specific attention. The AMA has reported shortages already causing stress among U.S. patients. [1] In December 2021, an article from the financial publication Forbes argued that the "lack of funding for residency slots to expand the pool of physicians in the U.S. has been an issue for more than two decades." [2]

When evaluating specific states inside of the U.S., a September 2022 report from the University of Hawaiʻi System reported that the collection of islands "has a severe physician shortage" to the point that "statistics show the deficit is at least 750 full-time providers, with primary care specialties... [having] the greatest need." [5] A piece published that same month by Spectrum News 1 - Ohio relayed that the Midwestern state features a shortage "that's expected to hit rural areas the hardest." The article noted that the Northeast Ohio Medical University "estimates there are 11.7 physicians per a population of 10,000 in the Buckeye state compared to 38.9 physicians for that same population in a metropolitan area." [6]

Influence of history and effects from discrimination

Racial segregation in the U.S., expressed by activists such as those in Detroit, Michigan who erected signs such as these, has significantly affected the distribution of healthcare services for decades. We want white tenants.jpg
Racial segregation in the U.S., expressed by activists such as those in Detroit, Michigan who erected signs such as these, has significantly affected the distribution of healthcare services for decades.

Mechanisms of structural inequality in the U.S. affect its national health due to past and current discrimination, particularly efforts to set people apart based on Americans' racial identities. The academic journal Health Services Research published a 2012 study by Darrell J. Gaskin, Ph.D. and a team of other analysts that reported how "[r]acial and ethnic disparities in primary care are well documented" given that "[d]isparities in health care may be caused by higher proportions of minorities living in 'medical deserts,' that is, communities with limited health care resources." In short, their "findings indicate that residential segregation matters" as "African[-]American segregation was negatively associated with the availability of physician services." As the U.S. doctor shortage worsens the natures of these 'deserts', in their view, the analysts advised policymakers to focus on "[e]xpanding community health centers and [also] subsidies programs for physicians to serve in underserved areas". [7]

American scholars have theorized more broadly that, as detailed in the aforementioned Health Services Research report, aspects of cultural status such as "money, power, prestige, and social connectedness" influence medicine across the country. Thus, "those with the most access and control over resources are in a better position to avoid risks, diseases, and the consequences of disease." [7]

Issues and proposed actions

Socio-political news-magazine The Nation has argued in an article that a market-oriented system in the U.S., with its "fee-for-service framework", "remains embedded in American health care and endures as its dominant underlying driver" in a way that "places value on specialized services rather than on primary care". Thus, the whole framework serves as "a crucial factor behind the worsening shortage of primary-care doctors", according to the publication. Specifically, The Nation has asserted that the financial methodology "compensates doctors, clinics, and hospitals based upon number and type of visits involved in a patient's care, creating incentives for unnecessary procedures, excessive clinic appointments, and the mountains of paperwork that have become the bane of American doctors’ daily lives." [3]

Analyzing the possibility of expanded immigration to America to enhance the nation's workface, a piece from the general interest news-magazine Newsweek has reported,

"There's one more group of people, foreign medical graduates, who could theoretically fill in for the missing primary-care providers. The trouble is, they're already doing that. More than a quarter of primary-care doctors currently practicing in the United States have gotten their diplomas abroad. Increasing their numbers would be problematic for both the left (which might object to poaching doctors from developing countries that need them) and the right (which would surely object to recruiting non-Americans to do a job that reliably pulls in six figures, especially when unemployment is high)." [4]

A study by the Niskanen Center, a think tank based out of Washington, D.C., has found that the U.S. federal government's administrative processes within Medicare and other programs make the doctor shortage worse. "Medicare's residency funding was designed around the naïve assumption that private insurers would contribute their fair share to training" such that "funding is based solely on the number of Medicare patients a hospital sees", according to Niskanen analyst Robert Orr, with a structure coming about that "shortchanges geographic locations and facilities with fewer elderly patients". This still occurs, in Orr's analysis, "while separate programs exist to deliver funds to children's hospitals and rural clinics, [since] Medicare dwarfs them." [11]

Proposed efforts to change the viewpoints of medical students have received academic study. For example, an analysis explored in a Society of Teachers of Family Medicine (STFM) conference held in 2010 inside Jacksonville, Florida received wider distribution afterwards, with Dr. Julie Phillips of the Michigan State University College of Human Medicine (MSUCHM) and other scholars detailing what a 2006 to 2008 survey of approximately a thousand students at three different schools found. The experts observed broadly that "contemporary physicians struggle to meet the high expectations set by patients and their profession with limited time and resources." Specifically, results indicated that only 145 survey respondents (14.8%) leaned towards having a career in primary care. Furthermore, 11.2% of first-year students expressed interest in that medical focus in contrast to how 10.8% of second-year students showed interest. In addition, third-year and fourth-year students expressed more interest in having a career in primary care, at 18.3% and 21.0%, respectively. [12]

In the same study, those senior students rejected the widespread stereotypes about primary care. They did not believe that time constraints in medicine, such as short appointments, lead to poor doctor-patient relationships, which was most likely due to their increased first-hand experience with patients and doctors. Experts hypothesize that more student exposure to the life of physicians via shadowing may prevent prejudices and false assumptions about primary care. This study points out that junior and senior medical students are aware of the drawbacks associated with primary care, such as the relatively low salary, but what is more important to them is their interest in a particular specialty. [12] These students relied less on the known perception of primary care and more on their own personal value that they attached to it. The more exposure that medical students have to primary care, the more likely they are to become interested in it as an invaluable gateway to medical treatment. This data suggests that the combination of earlier introduction to primary care and an emphasis on its value would propel medical students to choose a career in preventative care. Such proposals, however, would require the participation of numerous stakeholders.

Increasing medical students’ experience in primary care relies on the participation of stakeholders, including medical schools. They can create initiatives that may include increasing the number of internships revolving around primary care. From a financial perspective, medical schools can alleviate their cost of schooling through scholarships, so that a medical student's selection of a specialty is not swayed by salary. [13] Offering opportunities to become involved in this specialty, while providing financial support, would address two problems of recruiting primary care physicians: it would provide students with more ways to experience what it is like to specialize in preventative care; and it would allow students to take advantage of the opportunities offered by the school, instead of focusing on the financial aspect of medical school.

See also

Related Research Articles

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<span class="mw-page-title-main">Emergency medicine</span> Medical specialty concerned with care for patients who require immediate medical attention

Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency medicine physicians specialize in providing care for unscheduled and undifferentiated patients of all ages. As first-line providers, in coordination with emergency medical services, they are primarily responsible for initiating resuscitation and stabilization and performing the initial investigations and interventions necessary to diagnose and treat illnesses or injuries in the acute phase. Emergency medical physicians generally practice in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units. Still, they may also work in primary care settings such as urgent care clinics.

<span class="mw-page-title-main">General practitioner</span> Generalist medical doctor working in primary care

A general practitioner (GP) or family physician is a doctor who is a consultant in general practice.

Osteopathic medicine is a branch of the medical profession in the United States that promotes the practice of science-based medicine, often referred to in this context as allopathic medicine, with a set of philosophy and principles set by its earlier form, osteopathy. Osteopathic physicians (DOs) are graduates of American osteopathic medical colleges and are licensed to practice the full scope of medicine and surgery in all 50 U.S. states. The field is distinct from osteopathic practices offered in nations outside of the U.S.—in which practitioners are generally considered neither parts of core medical staff nor of medicine itself; rather, they are considered alternative medicine practitioners. The other major branch of medicine in the United States is referred to by practitioners of osteopathic medicine as allopathic medicine.

<span class="mw-page-title-main">American Medical Association</span> Organization

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<span class="mw-page-title-main">Primary care</span> Day-to-day health care given by a health care provider

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<span class="mw-page-title-main">Family medicine</span> Medical specialty

Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is named a family physician. It is often referred to as general practice and a practitioner as a general practitioner. Historically, their role was once performed by any doctor with qualifications from a medical school and who works in the community. However, since the 1950s, family medicine / general practice has become a specialty in its own right, with specific training requirements tailored to each country. The names of the specialty emphasize its holistic nature and/or its roots in the family. It is based on knowledge of the patient in the context of the family and the community, focusing on disease prevention and health promotion. According to the World Organization of Family Doctors (WONCA), the aim of family medicine is "promoting personal, comprehensive and continuing care for the individual in the context of the family and the community". The issues of values underlying this practice are usually known as primary care ethics.

<span class="mw-page-title-main">Primary care physician</span> US term for medical professional providing first-line care

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Physician supply refers to the number of trained physicians working in a health care system or active in the labor market. The supply depends primarily on the number of graduates of medical schools in a country or jurisdiction but also on the number continuing to practice medicine as a career path and remaining in their country of origin. The number of physicians needed in a given context depends on several different factors, including the demographics and epidemiology of the local population, the numbers and types of other health care practitioners working in the system, and the policies and goals in place of the health care system. If more physicians are trained than needed, supply exceeds demand. If too few physicians are trained and retained, some people may have difficulty accessing health care services. A physician shortage is a situation in which there are not enough physicians to treat all patients in need of medical care. That can be observed at the level of a given health care facility, a province/state, a country, or worldwide.

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<span class="mw-page-title-main">Medical deserts in the United States</span> Areas with limited access to healthcare in the United States

The United States has many regions which have been described as medical deserts, with those locations featuring inadequate access to one or more kinds of medical services. An estimated thirty million Americans, many in rural regions of the country, live at least a sixty-minute drive from a hospital with trauma care services. Regions with higher rates of Medicaid and Medicare patients, as well those who lack any health insurance coverage, are less likely to live within an hour of a hospital emergency room. Although concentrated in rural regions, health care deserts also exist in urban and suburban areas, particularly in predominantly Black communities in Chicago, Los Angeles and New York City. Racial demographic disparities in healthcare access are also present in rural areas, particularly in Native American communities which experience worse health outcomes and barriers to accessing quality medical care. Limited access to emergency room services, as well as medical specialists, leads to increases in mortality rates and long-term health problems, such as heart disease and diabetes.

References

  1. 1 2 3 4 5 6 7 Robeznieks, Andis (June 1, 2022). "To overcome doctor shortage, get rid of obstacles to primary care". AMA-ASSN.org. American Medical Association . Retrieved October 7, 2022.
  2. 1 2 Japsen, Bruce (December 17, 2021). "To Address Doctor Shortage, U.S. To Pay For 1,000 New Residencies". Forbes . Retrieved October 7, 2022.
  3. 1 2 Reinhart, Eric (May 12, 2022). "The Blind Spot in Medicare for All". The Nation . Retrieved October 7, 2022.
  4. 1 2 3 Carmichael, Mary (February 25, 2010). "Primary-Care Doctor Shortage Hurts Our Health". Newsweek . Retrieved October 7, 2022.
  5. 1 2 "Summit examines ways to combat severe doctor shortage". Hawaii.edu. University of Hawaiʻi System. September 30, 2022. Retrieved October 16, 2022.
  6. 1 2 Marshall, Micaela (September 1, 2022). "Primary-Care Doctor Shortage Hurts Our Health". Spectrum News 1 - Ohio . Retrieved October 16, 2022.
  7. 1 2 3 Gaskin, Darrell J.; Dinwiddie, Gniesha Y.; Chan, Kitty S.; McCleary, Rachael R. (December 2012). "Residential Segregation and the Availability of Primary Care Physicians". Health Services Research . 47 (6): 2353–2376. doi:10.1111/j.1475-6773.2012.01417.x. PMC   3416972 . PMID   22524264.
  8. ↑ "The World Health Report 2006". WHO.int. World Health Organization. 2006. Archived from the original on 2006-12-02. Retrieved October 8, 2022.
  9. ↑ Tarlov, Alvin (September 30, 1980). "Summary Report Of The Graduate Medical Education National Advisory Committee" (PDF). Institute of Education Sciences. Retrieved June 9, 2023.
  10. ↑ Orr, Robert (2020-09-08). "The Planning of U.S. Physician Shortages". Niskanen Center. Retrieved 2023-06-10.
  11. ↑ "Op-Ed: America Can't Fix Its Doctor Shortage without Fixing Federal Financing". NiskanenCenter.org. Niskanen Center. October 26, 2021. Retrieved October 8, 2022.
  12. 1 2 Phillips, Dr. Julie; Weismantel, Dr. David; Gold, Dr. Katherine; Schwenk, Dr. Thomas (January 2012). "How Do Medical Students View the Work Life of Primary Care and Specialty Physicians?". Family Medicine. 44 (1): 7–13. PMC   4120645 . PMID   22241335.
  13. ↑ "Improving Access and Efficiency in Primary Care at York Hospital Community Health Center | IHI - Institute for Healthcare Improvement". www.ihi.org. Retrieved 2022-10-30.
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