AMA President Warns Physician Shortage Is 'Urgent Crisis'

Congress must take action as soon as possible, Jesse Ehrenfeld says.

A slew of factors is driving the country's physician shortage, including burnout, shrinking Medicare reimbursement, an aging workforce, administrative burdens, and efforts to criminalize care, American Medical Association President Jesse Ehrenfeld, MD, MPH, said yesterday in a National Press Club address.

The country is facing an estimated shortage of 37,800 to 124,000 physicians by 2034, according to the Association of American Medical Colleges. The projected shortage of primary care physicians ranges from 17,800 to 48,000. The projected shortage of specialists ranges from 21,000 to 77,100.

"The physician shortage that we have long feared—and warned was on the horizon—is already here. It's an urgent crisis hitting every corner of this country—urban and rural—with the most direct impact hitting families with high needs and limited means," Ehrenfeld said.

The physician shortage is leading to alarming gaps in access to care across the country, he said. "It's estimated that more than 83 million people in the U.S. currently live in areas without sufficient access to a primary care physician. In large parts of Idaho and Mississippi, pregnant women can't find OBGYNs to care for them. Ninety percent of counties in the U.S. are without a pediatric ophthalmologist and 80 percent are without an infectious disease specialist. More than one-third of Black Americans live in cardiology deserts."

While the physician shortage is already limiting access to care for millions of Americans, it is going to get worse, Ehrenfeld said.

He noted several disturbing statistics. About two-thirds of doctors reported experiencing burnout during the coronavirus pandemic. About 20% of physicians surveyed during the pandemic reported that they planned to leave medicine within two years. About half of practicing physicians are more than 55 years old. The average doctor leaves medical school saddled with more than $250,000 in debt, which drives them away from primary care to more lucrative specialties.

Ehrenfeld said declining Medicare reimbursement is driving many doctors out of business or forcing them to stop serving Medicare patients. "When you adjust for inflation, the payment rate to physicians who care for Medicare patients has dropped 26% since 2001, which was my first year of medical school, with additional cuts planned next year. I don't know many businesses in any industry that could withstand a 26% drop in revenue and still survive—much less an industry like ours which is so essential to the health and well-being of our nation. Meanwhile, we've seen high inflation, rising personnel costs, and increased practice costs that exacerbate these payment cuts."

Ehrenfeld listed five steps that could help address the physician shortage:

• Make significant Medicare payment reform
   
• Reduce administrative burdens such as limiting prior authorization
   
• Pass bipartisan legislation to expand residency training options, to provide greater student loan support, and to establish easier pathways for foreign-trained physicians to work in the United States
   
• Stop the criminalization of healthcare
   
• Ensure physicians are not punished for taking care of their mental health needs

The physician shortage and the factors contributing to it require immediate attention, he said. "We must take action to create a stronger and more resilient physician workforce to care for an ever-changing nation. We must ensure that you, me, and everyone else in America has a physician to care for them, or a parent, or a family member, in their time of need. Most of these solutions have bills pending in Congress with strong bipartisan support, and momentum growing in many states to put other safeguards in place."

Congress must take action as soon as possible, he said. "There isn't much that our two major political parties see eye to eye on right now, but on these issues they do. We just need the will—and the urgency—to get it done. We need leaders in Congress to step forward and make this happen. Sadly, every day we wait, the size of this public health crisis grows."

Photo credit: Chris Dorney

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