This fall, millions of uninsured Americans seeking health insurance, many for the first time, overwhelmed the unprepared federal website, still under repair, built to give it to them. Next year, the same people, all heading to hospitals and physicians' offices ready to make use of their new coverage, could crash something more tangible: the U.S. health care system itself.
America is running out of doctors, and next year's influx of patients will strain the current supply. The nation will be 91,500 physicians short by 2020, according to the Association of American Medical Colleges. By 2025, that number is expected to swell to more than 130,600.
Next year, the demand will be highest for primary-care physicians, such as general internists, family doctors, and pediatricians—the kinds of doctors many people go to first for nonemergency medical attention before seeing specialists. Last winter, an Annals of Family Medicine study predicted the country will need 52,000 more primary-care physicians by 2025.
The warnings aren't anything new. But they carry more weight now that the health care industry must soon meet the needs of millions of newly insured citizens. Not enough doctors could mean longer wait times in more-crowded rooms, and some practices may stop accepting new patients altogether. In July, half of primary-care practices remain closed to new patients in Massachusetts, seven years after the state enacted Obamacare-style health reform. For patients at practices growing their customer base, waiting times for appointments with primary-care physicians remain high. How would that look on a national scale?
A larger number of people seeking medical attention isn't the only burden for America's doctor shortage. Baby boomers are getting older and gaining new ailments, which translates into more doctor visits. Also aging are those practicing medicine themselves, who are nearing retirement age. Americans, insured and uninsured alike, are sicker than ever before. More than one in five middle-aged adults have more than one chronic health condition, such as hypertension and diabetes, worse than a decade ago.
So, what can we do? Mint new doctors, for one. That prospect, until recently, looked pretty bleak. But this fall, the U.S. saw a record number of students applying for and enrolling in the country's medical schools, according to the AAMC. The number of applicants grew by 6.1 percent, to 48,014, from the previous fall, breaking a previous high in 1996. The number of students who enrolled surpassed 20,000 for the first time, a 2.8 percent increase since 2012.
More med-school students doesn't necessarily mean more doctors, however. AAMC points out that the number of residences, crucial stages of medical training, remain unchanged, thanks to a government-imposed cap. The organization has pushed Congress to change the law, predicting that there won't be enough residencies for many hopeful doctors by 2015.
For others, however, making new doctors isn't the only answer. Another solution involves broadening the definition of primary care by allowing other health care professionals to do more for patients—and even replace doctors in some clinical settings.
Expanding medical homes and health centers where nurse practitioners and physician assistants are in charge could cut the primary-care physician shortage in half by 2025, according to a study by RAND Corporation, a nonpartisan policy research group, published Monday in the journal Health Affairs.
Nurse-managed care could be cheaper than physician-administered treatment, too, according to new research from the University of California (San Francisco). In states that require nurse practitioners to treat patients with the help or supervision of a physician, a visit to the clinic cost $543. In states that allow nurse practitioners to practice and prescribe on their own, the price tag is $484. Spreading the latter method to the rest of the country would save the country hundreds of millions of dollars in health care costs, the researchers say.
Widening the scope of practice for people working in the medical field, however, requires legislation. It would also take a cultural reevaluation of what health care professionals look like to the general public. But white coat or not, the country could use more of them in the coming years.