Doctor Shortage Could Cause Health Care Crash

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The United States will require at least 52,000 more family doctors in the year 2025 to keep up with the growing and increasingly older U.S. population, a new study found.

The predictions also reflect the passage of the Affordable Care Act -- a change that will expand health insurance coverage to an additional 38 million Americans.

"The health care consumer that values the relationship with a personal physician, particularly in areas already struggling with access to primary care physicians should be aware of potential access challenges that they may face in the future if the production of primary care physicians does not increase," said Dr. Andrew Bazemore, director of the Robert Graham Center for Policy Studies in Primary Care and co-author of the study published Monday in the Annals of Family Medicine.

Stephen Petterson, senior health policy researcher at the Robert Graham Center, said the government should take steps -- and quickly -- to address the problem before it gets out of hand.

"There needs to be more primary care incentive programs that give a bonus to physicians who treat Medicaid patients in effort to reduce the compensation gap between specialists and primary care physicians," said Petterson, who co-authored the study with Bazemore.

But such changes may be more easily said than done.

The problem does not appear to be one of too few doctors in general; in fact, in 2011 a total of 17,364 new doctors emerged from the country's medical schools, according to the Association of American Medical Colleges (AAMC). Too few of these doctors, however, choose primary care as a career -- an issue that may be worsening.

In a 2008 census by the AAMC and the American Medical Association, researchers found that the number of medical graduates choosing a career in family medicine dropped from 5,746 in 2002 to 4,210 in 2007 -- a drop of nearly 27 percent.

"It's pretty tough to convince medical students to go into primary care," said Dr. Lee Green, chair of Family Medicine at the University of Alberta, who was not involved with the study.

Green added that he believes this is because currently primary care specialties are not well paid, well treated or respected as compared to subspecialists.

"They have to think about their debt," he said. "There are also issues of how physicians are respected and how we portray primary care to medical students."

These problems loom even larger considering the aim of the Affordable Care Act to provide all Americans with health insurance -- and with it, more regular contact with a primary care doctor.

Perhaps the best known example of this approach has been Massachusetts, which since 2006 has mandated that every resident obtain health insurance and those that are below the federal poverty level gain free access to health care. But although the state has the second-highest ratio of primary care physicians to population of any state, they are struggling with access to primary care physicians.

Dr. Randy Wexler of The John Glenn Institute of Public Service and Policy said he has concerns that this trend could be reflected nationwide.

"Who is going to care for these people?" he said. "We are going to have problems just like Massachusetts. [They] are struggling with access problems; it takes one year to get into a primary care physician. Coverage does not equal access."

Some have already proposed solutions to this looming problem. One suggestion is that non-physician medical professionals, such as nurse practitioners and physician assistants, can pick up the slack. Doctors, however, said his may not be enough to fill the gap.

"It would take 10 nurse practitioners to equal one primary care graduate, based on volume," Wexler said.

Another potential solution is patient-centered homes, where everyone works on a team in effort to increase the number of patients per provider. Some patients can be served by a computer online portal or a phone encounter when feasible to decrease the number of physician visits.

Most experts encourage consumers to challenge the current system, hold political leaders accountable, insist that government officials demand change in health care system design, policy, and reimbursement, along with medical school admissions and residency position allocations.

But whatever the solution, Wexler said something should be done, and as soon as possible.

"Looking at shear reality, we can't turn on a spigot and drop out new doctors," he said. "Expect long waits if we cannot figure out how to resolve it, the only place left to go for primary care will be the emergency room."

Green's outlook was not as rosy.

"[Patients] won't be able to see a primary care physician hardly," he said. "Primary care will be past saturated with wait times longer and will not accept any new patients. There will be an increase in hospitalizations and increase in death rates for basic preventable things like hypertension that was not managed adequately."

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