Even as the nation’s health care workforce combats the spread and lethality of COVID-19, a report from the Association of American Medical Colleges (AAMC) projects that the United States will face a shortage of between 54,100 and 139,000 physicians by 2033.
The pandemic, which struck after the projections were completed, magnifies the need to address shortfalls in both primary care doctors and specialists, the AAMC says.
“The physician workforce shortages that our nation is facing are being felt even more acutely as we mobilize on the front lines to combat the COVID-19 national emergency,” says AAMC President and CEO David J. Skorton, MD. “The increasing physician shortage over the last two decades, and now the COVID-19 pandemic, has demonstrated that we need to increase the number of physicians to ensure we can care for patients in the near-term and in the future.”
The overall projections in the sixth annual study, The Complexities of Physician Supply and Demand: Projections from 2018-2033, are up from last year’s report, which predicted a shortage of up to 121,900 physicians by 2032. The new study, which advances the calculations by one year, projects shortfalls in primary care of between 21,400 and 55,200 physicians, and in specialty care of between 33,700 and 86,700 physicians.
The study cites two demographic trends that particularly contribute to the shortage projections:
More people over age 65, who generally require more specialty care. While the national population is projected to grow by 10.4% during the 15 years covered by the study, the over-65 population is expected to grow by 45.1%, according to the report.
“Caring for an 85-year-old is, as a general rule, more complicated than caring for a 25-year-old” and more often requires specialty care, says Michael Dill, the AAMC’s director of workforce studies.
The study projects a shortage of between 9,300 and 17,800 medical specialists; 17,100 and 28,700 surgical specialists; and 17,100 and 41,900 other specialists, including pathologists, neurologists, radiologists, and psychiatrists.
More physicians reaching retirement age. The study found that more than 2 of 5 active physicians will be 65 or older within the next decade. Although each doctor’s retirement plans will be affected by numerous factors, the report observes, “Growing concerns about physician burnout … suggest physicians will be more likely to accelerate than delay retirement.”
“The physician workforce shortages that our nation is facing are being felt even more acutely as we mobilize on the front lines to combat the COVID-19 national emergency.”
David J. Skorton, MD
AAMC president and CEO
Other factors add to the gap
As dire as the numbers are, they don’t reflect the even higher demand for physician services that would exist if access to health care was more equitable across the country. The projections for the demand on physician services in the future are based on current levels of medical use by all population groups — including those with less access to care, such as some minorities and people living in rural areas.
“If underserved populations had health care use patterns like populations with fewer access barriers, demand could rise by an additional 74,100 to 145,500 physicians,” the report says.
In addition, although the study was conducted before COVID-19 appeared, the report says the pandemic “is likely to have short- and long-term consequences on the nation’s physician workforce.” The impacts could include medical education (such as interruption of classes and cancellation of clinical rotations), regulatory changes, changes in how medicine is practiced (such as more telehealth), and changes in interest in specific specialties.
“The intense focus on hospital-based care [for COVID-19 patients] has brought to light the fact that we need a lot of specialists,” Dill says.
In addition to training more physicians, Dill sees the need for a multipronged approach to address the shortage of physicians and the resulting gaps in care.
That approach includes better use of technology, including training doctors and staff on how to use it to improve care and reach underserved populations. Dill notes the rapid and substantial increase in telehealth practices brought on by COVID-19, and he hopes physicians will keep using telehealth more than they did before the pandemic to consistently reach those populations.
Also critical to addressing these issues, he says, is expanding the care that doctors and other health care professionals can provide. Dill notes that in response to COVID-19, some states expanded the roles of physician assistants and nurse practitioners and relaxed their license requirements in ways that allowed more doctors to practice across state lines.
“We need to make better use of the capabilities of all the members of the medical teams,” Dill says.
While the study focuses primarily on future physician shortages, Americans feel the shortfall now. According to public opinion research conducted in 2019 by Public Opinion Strategies for the AAMC, 35% of voters said they had trouble finding a doctor in the past two or three years. That’s 10 points higher than when the question was asked in 2015.
The new workforce study was conducted by the Life Science division of IHS Markit, a global information company. Each annual study covers a 15-year period, starting and ending a year later than the previous study did. This year’s study uses the latest data on levels of care in the United States, which is from 2018.