October 16, 2019

Americans are aging.  The Baby Boomers are retiring.  That means that a massive segment of our national population will be requiring healthcare services at an increasing, and even alarming, rate.  The problem is that America is not currently supplying a sufficient number of physicians to take care of these millions of new uber-patients.  According to a recent study conducted by the American Association of Medical Colleges (AAMC), our country will face a projected shortfall of approximately 47,000 to 122,000 primary and specialty doctors by 2032.  That means in just over 12 short years, a health crisis of significant proportions will befall a significant number of our fellow citizens; and it is already beginning.

Places and Proportions

Arizona, which currently has the fourth-fastest population growth rate among the 50 states, is already experiencing doctor shortages in all of its counties.  The state ranks 44th in the proportional availability of primary caregivers, with about 78 per 100,000 citizens. The overall U.S. average is 91.7 primary doctors per 100,000.  From a regional perspective, the South has been hit hardest, facing a current shortage of 31,000 doctors, while the Midwest comes in second with an undersupply of 13,000 physicians.

These shortfalls will only get worse as America continues to age.  Dr. Atul Grover, the AAMC’s executive vice president, recently stated: “We know older patients use two-to-three times as many medical services as younger patients, and the number of people over age 65 will increase by almost 50 percent, just in the next 10 to 15 years alone.”  This means there is a time bomb waiting to explode onto the American healthcare system.

Oh, the Irony!

How ironic it is, then, to realize that a little over 2 decades ago, the American Medical Association (AMA) and other national healthcare representatives were warning that America was facing a glut of doctors and that steps needed to be taken to reduce the supply of residents coming out of medical schools.  In response, Congress reduced Medicare funding for resident programs at teaching hospitals under the 1997 Balanced Budget Act.  The law effectively capped the number of residents whose salaries would be supplemented by federal funding.  Those caps were only slightly lifted in 1999, when Congress allowed funding for additional residents at rural hospitals.

One is reminded of the decision by Decca Record executives in 1962 to reject signing the Beatles to a recording contract, asserting: “We don’t like their sound, and guitar music is on the way out.”  Sometimes the experts can simply get it wrong.  That seems to be the case with those who encouraged Congress to effectively reduce the availability of doctors in the latter half of the 1990s.  The resultant shortage of physicians today and in the foreseeable future may have severe implications for all Americans.

Just a Bad Dream?

Given the projected shortages of primary and specialty physicians in the next few years, we can only speculate as to what life will be like for the average patient.  One might conjecture the following possibilities:

• Americans will have to wait longer to receive an appointment or schedule a procedure.  This is already a reality for certain health systems around the world.  It is not sensational to assert that some will die as a result of delayed care.
• Doctors will be under even more stress as they struggle to keep up with an increasing workload, which will negatively affect their own physical and mental health.
• Hospitals will face greater financial pressures connected with the recruiting and retention of good physicians.  The decreasing supply of acceptable candidates will inevitably drive up the demand for higher wages.
• Healthcare will increasingly be in the hands of non-physician practitioners.  Laws may be enacted allowing for the increased autonomy and scope of service of nurse practitioners, physician assistants, nurse anesthetists and others.  With less doctors around, these non-physician clinicians will increasingly take up the slack in providing our care.
• Many Americans will turn to alternative medicine, where many of its practitioners do not have a medical doctorate.  In addition, they will make increasing use of self-diagnosis and treatment websites and phone apps, especially as they have less and less access to their doctor.

All of this suggests a frightful devolution of American healthcare in the years ahead—unless something is done now to reshape the future.

Solutions to the Shortage

I recently read one doctor’s proposed solution to the looming physician crisis.  He said:

Congress must, at the minimum, lift the graduate medical education funding caps implemented by Mr. Clinton’s 1997 law.  An even better response would be to increase Medicare funding to create more residency positions.

This physician also stressed that “time is of the essence,” noting that it takes four years to complete medical school and an additional three to seven years to complete a residency program, meaning we’re already pushing up against the 2032 threshold.  Accordingly, Congress should act as soon as possible to take some type of action.

Many will be relieved to know that our elected federal representatives are at least beginning to look seriously at this issue.  Bills to create more residency positions have been introduced in both the House and Senate in 2019.  In addition, the individual states have the ability to act, as well.  In Arizona, the legislature has made it easier for physicians to work in the Grand Canyon State by reducing certain licensing requirements for doctors coming from other states.  They are also trying to authorize the implementation of additional residency programs in the state, knowing that studies have indicated that a large percentage of doctors will end up practicing where they fulfilled their residency program.

We at MiraMed hope that this article will serve as a reminder to our clients that the projected physician shortage is likely to have a significant impact on their organizations.  Serious contingency planning is recommended in light of what may be coming down the road.  If we can assist you in this process, please do not hesitate to contact us.