Physician Shortage to Quadruple Within Decade, AAMC Says

The numbers do not look promising.

According to an Association of American Colleges report, U.S. specialties will reach a shortage of 91,500 doctors by 2020. The AAMC predicts Americans will need an estimated 45,000 primary care physicians and 46,000 surgeons and medical specialists.

"It's certainly the worse [shortage] that we'll have seen in the last 30 years," says AAMC chief advocacy officer Atul Grover.

"For the first time since the 1930s, our number [of physicians] per capita will start to drop in the next couple of years. That's less doctors per person, but at the same time, since they are aging and have more chronic illnesses, each person is going to need more healthcare and not less healthcare. That's a pretty bad situation," he says.

There are currently 709,700 physicians (in all specialties) for a demand of 723,400 physicians, with an existing shortage of 13,700. By comparison, in 2020, there will be 759,800 physicians (in all specialties) for a demand of 851,300 physicians, essentially a shortage of 91,500 too few doctors, according to the report.

One third of all physicians will be turning in their white coat and stethoscope for retirement, states the report, but the supply of doctors will only increase by 7%, according to the U.S. Department of Health and Human Services.

With a tug and war between supply and demand, the predicted shortage of doctors will leave many Americans without any, or with insufficient, care. The most affected areas will likely to be rural regions and inner-city areas, according to the report. Because physicians are not evenly distributed across the country per capita, there are likely to be gaps in provider services in less-recruitable parts of the country, such as rural and inner-city areas.

Crunching the numbers
The shortage of 91,500 is a higher estimate than other studies have previously reported. The AAMC report is based on data from the Center for Workforce, which includes utilization of medical care, as well as census projections of the U.S. population. Researchers factored in physician retirement rates, increases in doctors from various specialties and regions, and healthcare insurance expansion.

With healthcare reform, 32 million more Americans will have access to medical insurance and 36 million to Medicare, the report says.

"As more people get insured, they are going to seek out the care they probably should have been getting all along but haven't been able to necessarily access. That's why those numbers look worse in the next 10 years than we previously had estimated," Grover says.

Perhaps more significantly, the demand is increasing because of the growing population of seniors, estimated to grow by 37%, according to the Census Bureau.

"The overall reason for the physician shortage has [less] to do with reform; it has more to do with the aging U.S. population," Grover says. "As we get this silver tsunami of baby boomers coming at us over the next 10 years or so, what you're going to see is their need for healthcare is going to be much higher on a per-capita basis than younger adults."

Older persons often require more specialty care, especially as the chances of cancer increases with age. In addition, there are more treatment options available to older Americans to prolong their lives, thus requiring more care.

Possible solutions
With this dark forecast of numbers of too few physicians to care for too many people, how should health leaders adapt? AAMC offers the following solutions:

1. Increased federal support of residency programs through Medicare, the primary source of graduate medical education funding. Since the Balanced Budget Act passed in 1997, teaching hospitals are restricted to a capped number of resident physicians they can claim under Medicare reimbursement. Teaching hospitals therefore accept more residents to accommodate community needs beyond that maximum limit, totaling 7,000 residents of which teaching hospitals pay for out of pocket, according to Grover.

2. Medicare support for 15% more residency training (about 15,000 residency slots). Seven thousand new medical school students are expected to graduate every year, states the report. Additional subsidized graduate medical education could add on 4,000 more physicians every year.

3. More effective use of healthcare providers to include advance practice nurses and physician assistants and team-based approaches, such as the medical home model.

"We're going to have to figure out how to be more efficient in the way we deliver care, how to use other healthcare professionals to the top of their licensed skill sets, and also figure out how to get more physicians out there into communities by training more," Grover says.

Even with 91,500 too few physicians in the forecast, there's still time to meet the growing need for medical care, according to Grover.

"You have to remember it takes about seven years to train a physician. What we're talking about is in the next year or two, we really need to start expanding those residency training programs to take in those larger medical school classes," Grover says. "It has to start in the next year or two."

See also:

Agencies warn of coming physician shortage

States take on strategies to address primary care physician shortage