A growing and aging population that will need more care, combined with an aging workforce of physicians nearing retirement, leaves the United States facing a severe shortage of doctors as it tries to address health system vulnerabilities that were exposed by COVID-19, warns a new report from the Association of American Medical Colleges (AAMC).
The country’s rapidly increasing demand for physicians over the next 15 years will outpace its supply, leading to a shortage of between 37,800 and 124,000 physicians by 2034, according to the report, The Complexities of Physician Supply and Demand: Projections from 2019-2034. That shortage includes shortfalls of 17,800 to 48,000 primary care physicians and 21,000 to 77,100 specialists. The report’s data was gathered before the COVID-19 pandemic, which exacerbated the challenges to the nation’s health care system, says AAMC President and CEO David J. Skorton, MD.
“The COVID-19 pandemic has highlighted many of the deepest disparities in health and access to health care services, and exposed vulnerabilities in the health care system,” Skorton says. “The pandemic also has underscored the vital role that physicians and other health care providers play in our nation’s health care infrastructure and the need to ensure we have enough physicians to meet America’s needs.”
The continued growth in the number of advanced practice registered nurses (APRNs) and physician assistants (PAs) could help to fill some of the gap, according to the report. “Without APRNs and PAs, the health workforce crisis the nation is facing would be much, much worse,” notes the AAMC’s director of workforce studies, Michael Dill.
The study, which is the AAMC’s seventh annual report on physician workforce projections, calculates ranges of physician supply and demand based on numerous possible scenarios, using data that came primarily from 2019. (“Physician” is defined as the equivalent of a full-time physician.) Below are some of the findings.
Growing and aging population drives demand
The country’s growing population, particularly of those age 65 and older, will demand more medical care. People in that age group now account for 34% of the demand for physicians; by 2034, they will account for 42% of the demand.
In raw numbers, that means that while people age 65 and up required 280,700 physicians to provide their care in 2019, they will need up to 407,300 physicians by 2034.
The nation’s aging population is expected to fuel a continuing growth in demand for physicians in surgical subspecialties. “An aging population requires more complex care and thus greater reliance on specialized care,” the report notes.
Older physicians: Will they stay or go?
A significant portion of the physician workforce is nearing traditional retirement age. How many of them take that step will affect the magnitude of the shortage.
More than 2 of every 5 active physicians in the United States will be 65 or older within the next decade, according to the report. On top of that, it shows that physicians already suffered high levels of job-related burnout and depression before COVID-19 arrived, and the exacerbation of those feelings caused by the pandemic could sway older doctors to curtail their hours or accelerate their plans to retire.
Nurses and PAs are crucial to shrink shortfalls
So many people are becoming APRNs and PAs that they will help to meet some of the rising demand for health care provided by physicians. If current growth rates of APRNs and PAs continue, the report notes, “the supply of these providers will more than double over the next 15 years.” There are currently about 290,000 APRNs and 139,700 PAs, according to the report.
That growth exceeds the projected growth in demand for their services, the report notes — creating more opportunities for APRNs and PAs to meet some of the growing demand for health care.
Shortfalls vary among specialties
Among specialists, the report points out a growing shortage of surgeons — projected at 15,800 to 30,200. While the demand for surgeons continues to increase, it notes that the supply of surgeons “is not projected to change substantially over the next 15 years.”
“The report has been projecting this shortage of surgeons for years,” Dill says. “We must find ways to address it, because the need is growing.”
The report also projects shortages of 3,800 to 13,400 physicians in medical specialties (i.e., subspecialties in internal medicine such as cardiology, infectious diseases, and allergy and immunology) and 10,300 to 35,600 physicians in “other specialties,” including anesthesiology, emergency medicine, and psychiatry.
Need for doctors vary by region
Almost all (98%) of the projected growth in demand for physicians will occur in metropolitan areas, with the largest growth expected to be in the regions of the country that are expected to gain the most population. According to the report, the additional physicians that will be required by region are as follows:
- South — 62,900.
- West — 54,600.
- Northeast — 12,600.
- Midwest — 8,800.
COVID-19 impacts are still to be determined
Because most of the data were collected before COVID-19, it may take several years to clearly understand the pandemic’s impact on the supply of and demand for physicians, according to the report. What is clear, it notes, is that the disruptions caused by COVID-19 “laid bare” challenges that the nation’s health care system must address as it recovers from the pandemic, including physician shortages, disparities in access to care, and a lack of pandemic planning. The AAMC says the analysis underscores the systematic differences in health care services among insured and uninsured people, individuals in urban and rural locations, and people of differing races and ethnicities.
Skorton praises Congress for recently adding 1,000 Medicare-supported graduate medical education (GME) positions — that is, medical residency training for new doctors — and notes that a current legislative proposal, the Resident Physician Shortage Reduction Act of 2021, would add another 2,000 GME federally supported medical residency positions annually for seven years.
“Addressing the physician shortage requires a multipronged solution that starts with educating and training enough physicians to meet America’s needs and includes improving access to care, diversifying the physician workforce, and ensuring our nation is prepared to address current and future public health crises,” Skorton says. “Now more than ever, the nation must make a long-term investment in the health care workforce.”