Physician shortage in the United States

Last updated
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 due to such trends, particularly in terms of the lack of access to specialty services in rural locations. [1] In particular, 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 health across the globe, 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, Florida, which serves as the primary teaching hospital for the Leonard M. Miller School of Medicine ((UMMSM) within the University of Miami (UM), is pictured in July 2010. Aerial-Picture-of-Jackson-e1445995779731.jpg
The Jackson Memorial Hospital (MJMH) complex in Miami, Florida, which serves as the primary teaching hospital for the Leonard M. Miller School of Medicine ((UMMSM) within the University of Miami (UM), is pictured in July 2010.

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 general interest 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. "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 field of family medicine as already affected. [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

<span class="mw-page-title-main">Physician</span> Professional who practices medicine

A physician, medical practitioner, medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the study, diagnosis, prognosis and treatment of disease, injury, and other physical and mental impairments. Physicians may focus their practice on certain disease categories, types of patients, and methods of treatment—known as specialities—or they may assume responsibility for the provision of continuing and comprehensive medical care to individuals, families, and communities—known as general practice. Medical practice properly requires both a detailed knowledge of the academic disciplines, such as anatomy and physiology, underlying diseases and their treatment—the science of medicine—and also a decent competence in its applied practice—the art or craft of medicine.

<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 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.

In the medical profession, a general practitioner (GP) or family physician is a physician who treats acute and chronic illnesses and provides preventive care and health education to patients of all ages. GPs' duties are not confined to specific fields of medicine, and they have particular skills in treating people with multiple health issues. They are trained to treat patients to levels of complexity that vary between countries. The term "primary care physician" is more usually used in the US. In Asian countries like India, this term has been replaced mainly by Medical Officers, Registered Medical Practitioner etc.

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 US states. The field is distinct from osteopathic practices offered in nations outside of the U.S., whose practitioners are generally not considered part of core medical staff nor of medicine itself, but rather are 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> United States association of physicians and medical students

The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was 271,660 in 2022.

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

Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care that the patient may need. Patients commonly receive primary care from professionals such as a primary care physician, a physician assistant, a physical therapist, or a nurse practitioner. In some localities, such a professional may be a registered nurse, a pharmacist, a clinical officer, or an Ayurvedic or other traditional medicine professional. Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

<span class="mw-page-title-main">Residency (medicine)</span> Postgraduate medical training

Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, veterinarian, dentist, podiatrist (DPM) or pharmacist (PharmD) who practices medicine, veterinary medicine, dentistry, podiatry, or clinical pharmacy, respectively, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty such as an attending physician or consultant. In many jurisdictions, successful completion of such training is a requirement in order to obtain an unrestricted license to practice medicine, and in particular a license to practice a chosen specialty. In the meantime, they practice "on" the license of their supervising physician. An individual engaged in such training may be referred to as a resident, registrar or trainee depending on the jurisdiction. Residency training may be followed by fellowship or sub-specialty training.

<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

A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term is primarily used in the United States. In the past, the equivalent term was 'general practitioner' in the US; however in the United Kingdom and other countries the term general practitioner is still used. With the advent of nurses as PCPs, the term PCP has also been expanded to denote primary care providers.

A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children (paediatrics), cancer (oncology), laboratory medicine (pathology), or primary care. After completing medical school or other basic training, physicians or surgeons and other clinicians usually further their medical education in a specific specialty of medicine by completing a multiple-year residency to become a specialist.

<span class="mw-page-title-main">Medical education in Australia</span> Summary of education and training of medical practitioners (doctors) in Australia.

Medical education in Australia includes the educational activities involved in the initial and ongoing training of Medical Practitioners. In Australia, medical education begins in Medical School; upon graduation it is followed by a period of pre-vocational training including Internship and Residency; thereafter, enrolment into a specialist-vocational training program as a Registrar eventually leads to fellowship qualification and recognition as a fully qualified Specialist Medical Practitioner. Medical education in Australia is facilitated by Medical Schools and the Medical Specialty Colleges, and is regulated by the Australian Medical Council (AMC) and Australian Health Practitioner Regulation Agency (AHPRA) of which includes the Medical Board of Australia where medical practitioners are registered nationally.

Concierge medicine, also known as retainer medicine, is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. In exchange for the retainer, doctors agree to provide enhanced care, including commitments to ensure adequate time and availability for each patient.

Medical school in the United States is a graduate program with the purpose of educating physicians in the undifferentiated field of medicine. Such schools provide a major part of the medical education in the United States. Most medical schools in the US confer upon graduates a Doctor of Medicine (MD) degree, while some confer a Doctor of Osteopathic Medicine (DO) degree. Most schools follow a similar pattern of education, with two years of classroom and laboratory based education, followed by two years of clinical rotations in a teaching hospital where students see patients in a variety of specialties. After completion, graduates must complete a residency before becoming licensed to practice medicine.

<span class="mw-page-title-main">Physician supply</span>

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.

The Independent Payment Advisory Board (IPAB) was to be a fifteen-member United States government agency created in 2010 by sections 3403 and 10320 of the Patient Protection and Affordable Care Act which was to have the explicit task of achieving specified savings in Medicare without affecting coverage or quality. Under previous and current law, changes to Medicare payment rates and program rules are recommended by MedPAC but require an act of Congress to take effect. The system creating IPAB granted IPAB the authority to make changes to the Medicare program with the Congress being given the power to overrule the agency's decisions through supermajority vote. The Bipartisan Budget Act of 2018 repealed IPAB before it could take effect.

Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance.

<span class="mw-page-title-main">Physicians in the United States</span>

Physicians are an important part of health care in the United States. The vast majority of physicians in the US have a Doctor of Medicine (MD) degree, though some have a Doctor of Osteopathic Medicine (DO), or Bachelor of Medicine, Bachelor of Surgery (MBBS).

The Specialty Society Relative Value Scale Update Committee or Relative Value Update Committee is a volunteer group of 31 physicians who have made highly influential recommendations on how to value a physician's work when computing health care prices in the United States' public health insurance program Medicare.

<span class="mw-page-title-main">Choosing Wisely</span> U.S.-based educational campaign

Choosing Wisely is a United States-based health educational campaign, led by the ABIM Foundation, about unnecessary health care.

<span class="mw-page-title-main">Medical deserts in the United States</span>

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. 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. 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's drive of a hospital emergency room.

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 Sciencs. 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.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.