America Is Running Out of Doctors

Who will treat the millions of newly insured citizens next year?

National Journal
Marina Koren
Nov. 4, 2013, 11 a.m.

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.