This month, the AAMC released our fourth annual study of physician supply and demand, modeling a wide range of health care and policy scenarios including payment and delivery reform, increased use of advanced practice nurses and physician assistants, and delays in physician retirements. The data are troubling. Under every likely scenario, this year’s workforce estimates project a shortage of between 42,600 and 121,300 physicians by 2030. The shortage results largely from demographic changes in the U.S. population, which is estimated to grow by nearly 11% by 2030. Most importantly, the population over age 65, who often require the most care, will increase by 50% by 2030. The physician workforce is aging, too—one-third of all currently active doctors will be older than 65 in the next decade, and the decisions that these physicians make about when to retire could have a great effect on physician supply.
When I think about the shortage, I often think about the patients I treated early in my psychiatry practice. I think about how much worse their outcomes may have been had they not had access to care in their community. And then I think about the effect that this shortage has on communities around the country, where people with mental illness and other disorders need to travel long distances for treatment and care. Nearly one in five people in the United States has a mental health condition, and our country faces a broad range of mental health issues from opioid addiction to increasing rates of depression and suicide. Meanwhile, psychiatry is one of the specialties most affected by the shortage, with 77% of U.S. counties having reported a severe deficit of psychiatrists.
Solving the shortage requires a multipronged approach, including buy-in from policymakers and the community of academic medicine. The AAMC supports bipartisan legislation currently before Congress that would increase federal funding for an additional 3,000 new residency positions each year for the next five years. In addition, the AAMC advocates for programs that encourage physicians to work in underserved areas and in specialties most affected by the shortage. These programs include the National Health Service Corps, Public Service Loan Forgiveness, and the Title VII and VIII diversity and workforce programs. Other essential programs, like the National Interest Waiver and the Conrad 30 J-1 Visa Waiver, help recruit physicians from abroad to practice in underserved communities in the United States to ease the physician shortage where doctors are needed most.
Supporting the next generation of physicians so that they thrive in medicine is essential to ensuring that our country has the supply of physicians that we need.
But legislation alone will not solve the physician shortage. At the same time as we advocate for increased GME slots, the AAMC is supporting our member medical schools and teaching hospitals as they address the shortage by making changes in how they admit and train future physicians. Since 2002, medical schools have increased class sizes by nearly 30% to address the impending shortage and are educating physicians for a future of team-based, interprofessional care. Teaching hospitals are testing new care delivery models and developing technology to drive efficiencies in care.
Our medical schools and teaching hospitals are also helping ensure that students have the information they need to choose career paths and specialties that are both the right fit for them and serve our needs as a nation. While specialty choice and training location are major decisions in an individual physician’s career, trends in these decisions also have implications for physician supply on a national level. By offering medical students clearer information about the culture and character of specific residency programs, we will better position them to choose the programs that will be the best fit for them. To this end, the AAMC Careers in Medicine® Residency and Fellowship Program Search has been expanded to include additional detail on thousands of residency programs, with each profile page now including a description of the program and characteristics of residents currently enrolled in the program as well as current data on graduate career plans—what trainees in that program do upon completion of their residency. I hope that medical students will use this information to assess their fit for individual programs, think about how to best achieve their career goals, and develop a targeted application strategy in partnership with their advisors.
This weekend, I will meet with those on the front lines of these challenges at the first ever AAMC Continuum Connections meeting which will bring together the next generation of physicians, who may practice during the worst of the doctor shortage, with the administrators and educators responsible for fostering their well-being and encouraging success. I am always energized to meet with students and residents as well as educators, and I cannot wait to discuss with them the many changes taking place in graduate medical education, challenges these changes pose, and current strategies to address those challenges. The meeting will focus on the issues that most affect these groups, including resilience and well-being, diversity and inclusion, and the transition to residency.
Supporting the next generation of physicians so that they thrive in medicine is essential to ensuring that our country has the supply of physicians that we need. Our demographic reality makes the physician shortage a certainty unless we make real changes today. As we advocate that Congress support a modest increase in GME slots, we must also do everything we can to support the next generation of physicians so that they thrive not only during residency, but throughout lifelong careers in medicine.