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  • Viewpoints

    We already needed more doctors. Then COVID-19 hit

    The pandemic took an incalculable toll on the nation’s physicians. We will be unraveling its impact for years to come.

    Masked doctors tend to patients in an emergency room

    We have known for many years that the United States faces growing physician shortages. The findings from this year’s AAMC workforce report, The Complexities of Physician Supply and Demand: Projections from 2019 to 2034, project a shortage of 17,800 to 48,000 primary care physicians and 21,000 to 77,100 specialty physicians. The fundamental drivers of these projected shortages? An aging physician workforce and a growing, aging population.

    The COVID-19 pandemic has only exacerbated our nation’s doctor shortages. Furthermore, it shined a spotlight on already profound inequities in health care access. Indeed, the AAMC report estimates that if all insurance-, place-, and race-based inequities in health care access were eliminated, then the country would need an additional 180,400 physicians — an estimate far exceeding even the high end of the range of shortages projected for 2034.

    While much remains unknown about the long-term impact of the pandemic on the physician workforce, we know that the extended and unrelenting pressures imposed by COVID-19 are disproportionately affecting women physicians and physicians of color. We also know that the financial challenges of delayed care have threatened smaller physician private practices and rural hospitals. Finally, we know that the pandemic has radically changed the delivery of care via the widespread adoption of telehealth.

    All of these changes are likely to impact the supply and demand for physicians. Here’s what we know — and don’t know — so far.

    An aging workforce

    According to data from Kaiser Health News and the Guardian, more than 3,500 health care workers have died during the pandemic. Nearly 17% of those deaths were physicians. That’s a tremendous loss for our nation. However, even more impactful in terms of the supply of physicians available to provide care is the possibility that many more physicians will retire in the coming years. Within the next decade, 2 out of every 5 physicians in the United States will be age 65 or older.

    Our projections have consistently emphasized the substantial role that physician retirements will play in the future supply of physicians, and COVID-19 may accelerate those changes. Burnout from the trauma of working through the pandemic could drive physicians to retire earlier than they might otherwise have done.

    The impact on Black and women physicians

    Black physicians are members of communities hit particularly hard by COVID-19, primarily due to persistent racial and social inequities. Additionally, in efforts to mitigate decades of racial discrimination in medical care, many Black physicians have felt compelled to assist in vaccine distribution to disproportionately affected Black communities. These pressures — combined with decades of systemic, institutionalized racism — may threaten the health and well-being of Black physicians or even compel them to leave the physician workforce.

    Research also shows the disproportionate impact of COVID-19 on women physicians — especially those with children. For example, a study of pediatric cardiologists published in the American Journal of Cardiology found that women were significantly more likely than men to report salary cuts and scaled back work during the pandemic due to parental and child care responsibilities. In addition, women physicians felt significant concern about the health of their families, and they were more likely than men physicians to report feeling drained. Thus, although the pandemic has been a source of stress for all physicians, the added burdens and excessive stress experienced by women physicians may impact their well-being and role in the workforce in the coming years. 

    Changes in health care delivery and use

    The economic fallout caused by COVID-19 will also shape future access to physicians, although it is too early to guess the magnitude. For instance, the pandemic proved a threat to many small private medical practices with revenue margins insufficient to sustain losses as businesses were forced to shut down and many patients delayed care. There was already a steady decline among physician-owned practices, and the pandemic will likely amplify this trend. Various programs, such as the Paycheck Protection Program and the Provider Relief Fund, have helped many small medical practices survive. However, it will take years before we can fully understand the impact of the pandemic on private practice.

    Furthermore, the financial battering that many hospitals and practices have taken during the COVID-19 pandemic raises concerns about the future workforce available in already disadvantaged rural and urban underserved areas.

    The growth and opportunity of telehealth

    Telehealth emerged as a critical strategy for providing continuity of care despite stay-at-home mandates. The expansion of telehealth services during the pandemic helped prevent an already grave health care crisis from getting considerably worse by keeping many Americans connected to the care they needed. Additionally, the shift demonstrated an untapped potential for telehealth capacity that is unlikely to fade completely with the pandemic.

    However, the rapid expansion of telehealth has also magnified existing disparities. For example, rural America’s disproportionately aging population and inadequate broadband pose significant barriers to telehealth. A study of individuals with diabetes found that older patients, those with limited English proficiency, and those with public insurance were less likely to use telehealth. Furthermore, experts are concerned that the population’s demand for telehealth may soon exceed the nation’s current telehealth capacity.

    Looking ahead

    Unfortunately, the physical, mental, and economic impact of COVID-19 has hit communities that are underserved hardest in terms of their need, their access, and the supply of physician services available to them. Although we’re not sure what health care utilization will look like as COVID-19 continues to recede, we know we need to monitor inequities in access and health and their long-term impacts on the need for physicians. We will also need to address the systemic and institutional racism that has negatively impacted patients’ access to such social determinants of health as healthy food and affordable housing, and which contributed to higher rates of COVID-19 morbidity and mortality among communities of color. Moreover, our nation’s mental health crisis has only deepened during the national trauma of COVID-19, and the long-term health needs resulting from people who postponed care due to COVID-19 — and those who contracted it — are likely to exceed current expectations.

    For the physician workforce itself, better and more equitable support systems are needed to help improve work-life balance and ensure a more diverse future workforce. We may also need to support physician services in underserved areas to avoid financial collapses when the next crisis comes. Medical doctors are crucial to meeting the nation’s growing health care needs — more doctors than we have or are currently on track to produce — and we need to be there for them as they have been there for us throughout this pandemic.