Physician shortage projected to soar to more than 91,000 in a decade
■ Increases in residency positions are needed to counter rising demand for Medicare and expanded coverage for the uninsured under health reform, the AAMC says.
Nationwide physician shortages are expected to balloon to 62,900 doctors in five years and 91,500 by 2020, according to new Assn. of American Medical Colleges work force projections.
That's up more than 50% from previous estimates.
AAMC officials attribute the widening gap to increased demands from the aging baby boomer generation and expansion of coverage by 2019 to 32 million uninsured Americans under the health system reform law.
"As you get more people put in the ranks of the insured, that is going to make the shortage get worse a lot more quickly," said Atul Grover, MD, PhD, AAMC chief advocacy officer. "We have much less time to address these issues."
To counter shortages, the AAMC is urging federal officials to lift limits on Medicare funding for residency positions, which have been capped at 100,000 slots since 1997.
The Dept. of Health and Human Services estimates that the physician supply will increase by just 7% in the next decade and decrease in specialties such as urology and thoracic surgery. During the same period, one-third of practicing physicians are expected to retire and the number of Americans 65 and older is projected to grow 36%, according to figures released Sept. 30 by the AAMC Center for Workforce Studies.
"These are great challenges," said Patricia Hicks, MD, director of the pediatric residency program at The Children's Hospital of Philadelphia and professor of clinical pediatrics at the University of Pennsylvania School of Medicine. "It's critical to increase the number of residency training programs."
Supplying the work force
A 15% increase in residency positions would produce an additional 4,000 physicians annually, said Dr. Grover, assistant clinical professor of medicine at George Washington University School of Medicine and Health Sciences in Washington, D.C. "You can't just pull freeze-dried doctors off of shelves; it takes some time to train them," he said.
HHS announced Sept. 27 that it was releasing $167.3 million in grants to create an additional 889 primary care residency slots by 2015. Though the funding will help, it's only a fraction of the thousands of new positions needed to counter future shortages, Dr. Grover said.
During the past decade, new medical schools have opened and existing schools have expanded class sizes, but "there hasn't been a parallel increase in residency positions," said Thomas Ricketts, PhD, MPH, co-director of the American College of Surgeons Health Policy Research Institute and professor of health policy and management at the University of North Carolina at Chapel Hill School of Medicine.
In addition to training more doctors, there needs to be a focus on finding ways to use the existing physician work force more effectively by collaborating with other health care professionals. "We can do better with the physician supply we have to meet needs," Ricketts said.
Financial barriers to subspecialty fellowships also need to be removed, Dr. Hicks said. Many young physicians complete residency training with large amounts of debt that make it difficult for them to consider a fellowship.
Blaming future shortages on health system reform isn't really accurate, said George Rust, MD, MPH, professor of family medicine and director of the National Center for Primary Care at Morehouse School of Medicine in Atlanta.
"The uninsured have always had needs -- we just weren't meeting them. Now there will just be more paying patients," Dr. Rust said. "All of us are going to have to learn to work more effectively."